Violence, alcohol abuse and mental disorders are “inextricably linked and pose a major public health challenge”.

Yet there is a lack of recognition of the links between the three, and few properly trained healthworkers to recognise and address patients’ substance abuse.

This is according to Jo-Anne Corrigall from the University of Cape Town’s School of Public Health and Family Medicine and the Medical Research Council’s Richard Matzopoulus writing in the SA Health Review.

South Africa is one of the most violent countries in the world. South Africans are 30 percent more likely to die violently than those in other sub-Saharan countries, according to the World Health Organisation.

Interpersonal violence was the second highest causes of death and disability in 2000. Our homicide rates are eight times the global norm, while the rate of women murdered by their intimate partners is one of the highest in the world.

Many South African children have been frequently exposed to violence and display symptoms of post-traumatic stress. Some 70% of primary school children in Lavender Hill and Steenberg (Cape Flats) had witnessed violence, while half of children in a Gauteng survey had either been victims or perpetrators of violence. A Khayelitsha study found 45% of children had witnessed at least one murder.

“Mental disorders are associated with substance abuse, smoking and unsafe sex and, as such, mental illness results in a higher risk for injuries, cardiovascular disorders and HIV,” according to Corrigall and Matzopoulus.

South African drinkers are in the top five “riskiest drinkers in the world”, and alcohol “is the most widespread drug of abuse in SA”.

When measuring the harm caused by alcohol, a quarter of harm was “intentional injury”.

Alcohol is associated with “all forms of inter-personal violence as well as suicide, and a 2006 study estimates that between 27-47% of “intentional injuries” relate directly to alcohol use. More than half the victims of violence lying in urban mortuaries in 2005 tested positive for alcohol.

Exposure to violence is linked to disorders that include “depression, suicidal tendencies, substance abuse, post-traumatic stress disorder and other anxiety disorders”, according to the authors.

Mothers living in unsafe neighbourhoods were more likely to be depressed, while “maternal distress was associated with family violence and community danger”.

“Given the strong interdependence of mental illness, alcohol abuse and violence, provision of mental health services for children and adults is a critical part of primary, secondary and tertiary prevention of both alcohol misuse and violence.”

Yet access to mental health services is difficult, while “rates of detention of mental health disorders is poor”. In addition, the demand for substance abuse treatment outstrips supply.

The Department of Health’s strategies to deal with violence and mental illness, including alcohol, “appear vague, and integration between alcohol abuse, trauma and mental health services is not apparent”.

In addition, government tends to work in “silos” with the Department of Trade and Industry responsible for regulating alcohol trade, and the Department of Justice responsible for violence when an integrated, intersectoral response would be more effective. – Health-e News Service.