SOUTH AFRICA AS A CASE STUDY
The important role that Support Groups play in mental health is magnified in the third world setting. Sufferers in third world countries are subjected to inadequate or limited health services and, as a result, they are often deprived of education, proper medication and health care. In South Africa, for example, there are only 250 qualified psychiatrists to service the entire population of +/- 42 million. In these environments the power of an advocacy organisation, such as a Support Group, can be harnessed in a vital way to compensate for the lack of mental health resources.
Over the last two decades, the mental health sectors have witnessed an emergence of support groups in almost every sphere of mental illness. In 1980, experts suggested that these kind of helping groups were destined to become the foremost method of mental health care in the near future (Tyler, 1980 in Dies, 1992). Recent statistics show that support groups now exist for almost every problem listed by the World Health Organisation (Nash & Kramer, 1993).
A number of theories have been postulated as to why this self-help trend has escalated over the past two decades. The most widely supported theory stems from the functionalist framework in which new institutions are thought to arise in society when there are recognised needs among members that are not being met by existing institutions. According to this theory, we can conclude that one of the most important factors that has lead to the creation of support groups organisations world-wide is the relative unavailability and inadequacy of health services for the individual (Tracy and Gussow, 1976 & Lieberman and Borman, 1976).
The third world setting creates unique opportunities for support groups to infiltrate communities and compensate for the overwhelming lack of health services. The South African context can be used as a case in point to illustrate this argument. Prof. Mkhize, Head of Department of Psychiatry at the University of the Transkei, further explains the important role support groups play in the South African context: “We need support groups because most of our population does not have access to mental health resources. In Mpumalanga, for example, there is only one psychiatrist to service 1.3 million people. Support groups empower sufferers to recognise their illness and seek effective treatment.”
Bernstein (1989) found that support groups in South Africa have developed out of a strong historical and cultural tradition. In 1995, Makhale conducted a countrywide mailing survey and could only locate 14 functioning support groups in South Africa. His study concluded that support groups in South Africa are still far too scarce and not widely distributed to effectively penetrate the community. As well as this, the support groups he examined were racially disproportionate – the majority of them were serving white, middle – upper class communities.
A support group established over five years ago in South Africa, The Depression and Anxiety Support Group, is the first support group to take the initiative and infiltrate disadvantaged and rural communities through education and support programmes. The group is the largest private initiative in South Africa with over 150 active regional support groups countrywide – 50 of which have been specifically created for previously disadvantaged communities. The group interfaces with a wide network of professionals and its members have easy access to an extensive referral system of supportive health professionals. In recognition of its groundbreaking work, the SA Federation of Mental Health and W.H.O. honoured the group with an award for “reaching service users of previously disadvantaged groups” and “creating several support groups in hitherto unserved areas.”
Therry Nhlapo, the Outreach Projects Co-ordinator for the Support Group, has been committed to implementing outreach programmes in areas where resources are scarce and there is a lack of education and funds for the community. In these areas, Therry embarks on a campaign to educate local doctors, primary health care workers and the general community about the symptomology and treatment of the various depressive and anxiety disorders. Dr. Seape, psychiatrist at Baragwanath Hospital (the largest hospital in the southern hemisphere) and member of the Group’s Advisory Board, sees these programmes as making help accessible to all people in South Africa. “The Group emphasises that there are many things patients can do on their own to improve their conditions, even without psychiatric help,” she says.
Therry has also been instrumental in the creation of 40 outreach support groups, which are run mainly by ex-sufferers and pursue effective self-help programmes. These support groups are found countrywide stretching from Tembisa to Kimberley, Mmabatho, Klerksdorp, Umtata and Qwa-Qwa. The settings vary from townships, e.g. Alexandra, Soweto to cities, e.g. Pretoria, Potchefstroom to rural villages, e.g. Thlabane. The Support Group has also made a significant impact in the correctional services. Two well co-ordinated support groups are flourishing in Mogwase Prison and Leeuwkop, and there are plans for more such interventions in the near future. These outreach support groups empower sufferers in three important ways. Firstly, they help to ease the stigma of depression and anxiety disorders as the sufferers learn more about their disorders and identify with each other. Secondly, they help to ease the burden placed on the sufferers’ families as the sufferers find invaluable support and understanding in these groups. Finally, they give the sufferers a collective “voice” so that they are able to campaign for their rights.
Therry has further forged vital links between the Support Group and the Sangoma Association of South Africa. The Support Group has become increasingly aware of the significant role that traditional healers play in the mental health of many black South Africans. A number of workshops and meetings arranged between the Support Group and Sangoma Association have resulted in closer co-operation between the two groups in the interests of mental health.
The successful work of an advocacy organisation such as the Depression and Anxiety Support Group in a third world setting, sorely deprived of essential mental health resources, such as South Africa, illustrates the tangible difference advocacy organisations can make in third world settings. The Support Group continues to help depression and anxiety sufferers across the racial and socio-economic spectrum of South Africa. The 40 regional support groups that have been established countrywide empower disadvantaged sufferers. In the words of Ernest Magopodi, an inmate at Mogwase Prison and member of the successful Mogwase Prison Depression and Anxiety Support Group, “I was a victim – I am now a survivor!”
Bernstein. A.J. (9189). Self-help groups in the South African context – a developmental perspective. University of Natal: Department of Social Work.
Dies, R.R. (1992). The future of group therapy. Psychotherapy, 29(1) 58-62.
Lieberman, M.A and Borman, L.D. (1976) Self-help groups. Journal of Applied Behavioural Science (special issue) 12, 261-263
Makhale, M.E. (1995) An analysis of Support Groups of Mentally Ill People as a Psychiatric Intervention Strategy in the communities of South Africa. University of Natal: Department of Psychiatric Nursing
Nash, K.B. & Kramer, K.D. (1993) Self-help for sickle cell disease in African communities. Journal of Applied Behavioural Science, 29, 202-215
Tracey, G.S. & Gussow, Z (1976) Self-help groups: A grass roots response to a need for services. Journal of Applied Behavioural Science, 12(3), 381-396