Mental health in general is not fully recognised in SA healthcare, experts say

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  • Mental health is not fully recognised in South Africa's healthcare system and this can be seen in services in general, according to experts.
  • They say stigma is one of the reasons why mental health challenges are taken lightly.
  • Experts are of the view mental health resources need to be focused on in the local community instead of only primary health facilities.

Mental health, in general, is not fully recognised in South Africa's healthcare system, an associate professor in psychology at the University of Witwatersrand, Malose Langa, says.

"I think; generally, mental health difficulty is not fully recognised as compared to physical elements; you see this even when it comes to services in general.

"Generally, not being specific on the conditions, mental health issues are generally not taken into account," he added.

A senior lecturer in the Faculty of Health Sciences, Dr Nompumelelo Ntshingila, said mental health challenges such as depression and anxiety were taken lightly due to many reasons, including stigma.

Ntshingila said:

The stigma attached to mental illnesses and the lack of awareness about the mental illness give reasons for mental illness not to be taken seriously.

Stigma creates a position of social distance or rejection, and that is why people sometimes choose not to say that they have mental health challenges," Ntshingila added.

Langa and Ntshingila were speaking to News24 on Tuesday regarding the mental health landscape in South Africa.

Langa said as a result of the healthcare system in general, access to services was a major problem.

"Let us say you are depressed and you have to go to the clinic, and you are staying in Soweto; you cannot go straight to Bara; they will refer you to the clinic.

"But you know, at a clinic often there are no mental health practitioners, no psychologists, not even social workers and it is very difficult for a person to go straight to the primary hospital."

He added even in primary healthcare facilities, the resources were not easily accessible and focused on admitted patients and could not accommodate outpatients.

News24 reported in October last year six patients living with an eating disorder had been on the waiting list at the specialised psychiatric Tara Hospital in Johannesburg for 214 days.

According to Cassey Chambers, the operations director at the SA Depression and Anxiety Group, there were often waiting lists at clinics, hospitals, and even facilities like Tara.

"This is not unique - waiting lists occur at facilities all around the country. I also think with lockdown, when many facilities were not taking on new referrals, this would have contributed to the backlog," Chambers said.

READ | Tara psychiatric hospital: 6 patients with eating disorders on waiting list for 214 days

When probed on why facilities do not see a patient with mental health with the same urgency as someone who may arrive at a facility with a "physical" injury/condition, Langa said "mental health difficulties: many of them are invisible, the person is not bleeding…"

He pointed out a prime example that demonstrated their view about mental health in South Africa was Life Esidimeni.

The tragedy saw 144 psychiatric patients die, many of them from starvation and neglect after they were transferred from the Gauteng health facility due to the provincial health department cancelling its contract to save money, News24 reported.

This tragedy sparked calls for a further investigation, not only into the circumstances of these events but also concerning the broader mental health care system in this country.

A report by Chapter 9 institution, the SA Human Rights Commission (SAHRC), found, among other things, there was a considerable under-investment in mental health by the government.

In addition, the SAHRC found the healthcare system was plagued by stock-outs of medicines in most provinces, and the largest proportion of mental health budgets and mental health professionals continued to be in psychiatric facilities.

It also found the numerous human rights concerns that have been highlighted in its investigation could be said to arise out of a prolonged and systemic neglect of mental health at the level of policy and resource allocation.

"Throughout the investigation, lack of resourcing, lack of technical capacity, and possibly even lack of concern for the welfare of people with intellectual and psychosocial disabilities have arisen as root causes for system-wide failures to protect and promote the rights of this group," the report read.

How do we address the treatment gap and lack of recognition of mental health?

For Langa, this can be achieved by placing mental health practitioners in the local community such as schools, churches, and municipalities so that access to treatment was more accessible.

Ntshingila echoed similar sentiments, stating the gap could be bridged through information campaigns at schools, communities and workplaces.

"This is creating an environment where it is acceptable for people to have mental health challenges and people are not discriminated upon," he said.

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