Better off than most of the province in terms of mental health services, the Port Elizabeth area is home to three public sector in-patient mental health treatment facilities – the Dora Nginza, Elizabeth Donkin Psychiatric and Life Care Managed hospitals.

As part of an almost three-year, multi-pronged study into the barriers to mental health treatment in the area, researchers from Nelson Mandela Metropolitan University (NMMU) interviewed about 25 health workers including senior managers, nurses and psychologists from these hospitals as well as clinics and other mental health out-patient facilities.

According to recently presented preliminary results, a lack of basic resources and facilities, including those to treat children and substance abusers were some of the most commonly cited barriers to care.

“There are so many people that there aren’t enough beds,” said one health care worker interviewed as part of the project, which was carried out in conjunction with Sweden’s University of Gothenburg. “People are literally sleeping on top of each other.”

Health care workers also reported that facilities in the area battled shortages of psychiatric drugs and sometimes struggled to provide patients with clothes.

“I think we have to ask ourselves what kind of disservice do we do mental healthcare users when we can’t even provide them with the most basic support,” said NMMU researcher Keegan Topper, who presented preliminary results at a recent colloquium.

Multiple health workers surveyed also complained about facility conditions, including peeling paint, crumbling infrastructure and office space shortages that force as many as three health care workers to share an office, compromising patient confidentiality.

“We don’t have proper facilities,” added one health worker. “Our buildings are not geared towards dealing with the mentally ill.”

A double diagnosis

More broadly, the province also continues to lack widespread access to special facilities for children under the age of 14 years as well as those with what NMMU Director of the School of Clinical Care Sciences Dalena van Rooyen called the double diagnosis of mental illness and substance abuse.

According to one health worker interviewed, the entire province lacks any public sector speciality facilities for children: “There isn’t an area in the Eastern Cape where you can admit a child.”

Despite health workers’ efforts, children like these often fall through the cracks.

“Health care practioners often have to get quite creative in how they treat such (children),” Topper said. “The majority of the time, they actually can’t because there are no play groups or facilities to accommodate them.”

As part of the research, the universities also conducted a household survey of about 1000 people living in the area and found high rates of substance abuse. Preliminary results show that about half of all men surveyed had drinking problems.

Health care workers describe seeing what they called a “revolving door” of patients who were not only mentally ill but also substance abusers and who returned again and again to clinics and hospitals.

However the area lacks a government subsidised rehabilitation centre, according to respondents

“The services for substance abuse are dismal,” Van Rooyen told Health-e. “Patients go to the clinic and the clinic sister will say, ‘sorry, you’re problem is drugs and we don’t treat that here.’”

Show me the money

To increase access to mental health services, government has said it will introduce district mental health teams in all 11 National Health Insurance pilot districts but health workers are saying more needs to be done to put more money behind mental health.

According to recent parliament presentations, the country spends about R472 million on mental health annually but those in the sector argue programmes have been chronically underfunded.

Dr Zukiswa Zingela is the clinical head of Dora Nginza Hospital’s psychiatry department. She said that with the introduction of government’s new mental health framework and strategy, things may change but that health workers must hold policy makers to their promises.

“The biggest challenge that we have had to so far is that fact that the mental health has never been properly resourced or funded,” she said. “For the first time in a long time, we are starting to hear a political frame work not only acknowledging this but clearly stating that this has to be reversed.”

“We need have a joint voice to make our displeasure known should we see that what has been written in policy not happening on the ground,” Zingela told Health-e. “The people that we serve don’t often get a voice so we actually need to be the advocates.”