Lerato Mthunzi, Health and Allied Workers Indaba Trade Union (HAITU) General Secretary

October is mental health awareness month and as it draws to an end, a few key issues must be highlighted to make this month less of a ritualistic procession filled with lofty rhetoric, yet minimal action. 

South Africa is a nation affected by high levels of mental illness. It is important to deal meaningfully with the serious issue of mental illness. 

In 2022, the MRC/Wits Developmental Pathways for Health Research Unit (DPHRU) released a paper titled, “The prevalence of probable depression and probable anxiety, and the associations with adverse childhood experiences and socio-demographics: A National Survey in South Africa”. The report found that more than a quarter of South Africans suffer from “probable depression”. 

These alarming statistics are of grave concern, and it should force us to recognise that this is a crisis which deserves our attention all year long – not just in the month of October. 

Fertile grounds for mental illness

These findings should not surprise us at all. South Africa is the most unequal country in the world. And we are infamous for having extremely high levels of poverty and unemployment. 

Expanded unemployment, which is unemployment among people who’ve given up looking for work, is over 40%. One of the most distressing statistics is that at least 61% of jobless people are young people. These numbers are higher than in the Ukraine, and they are a country at war.  

It is difficult to be hopeful about the future when you are poor and unable to feed yourself or your family. 

These problems are far greater than the failure of the state to create jobs and stimulate growth in the economy. These conditions are caused by failed neo-liberal capitalist policies which promote austerity and cut backs on state spending. 

Dr Ashleigh Craig a researcher at DPHRU says: 

“Our study shows that 25.7% of South Africans are probably depressed, with more than a quarter of respondents reporting moderate to severe symptoms of depression….Mental illness significantly impairs overall health. And, of course, Covid-19 worsened depression and anxiety, with fear, uncertainty and social and economic disruptions arising during the pandemic. Although mental health care was considered an essential service during the lockdown period in South Africa, restrictions on physical contact, in-person consultations, transport, and financial restrictions made access to facilities difficult. Thus, those seeking treatment could not access comprehensive care.”

The lockdown definitely worsened conditions for the poor. The stress caused by massive job losses, coupled by high numbers of deaths caused by the virus, and in particular, the fact that the public was discouraged from mourning in the way they are used to, in order to prevent the virus from spreading, contributed negatively to mental illness. The South African Depression and Anxiety Group (SADAG) confirmed that its call volumes went from 600 per day to 1200 per day from the first day of lockdown. 

Mental illness usually results in distress, it can impair functioning, and increase the risk of suicide. This, in addition to high levels of crime and an anaemic economy where poverty and food insecurity are at alarming levels, has the potential to tip South Africa over the edge. 

All talk, no action

So far, the government has, as is the norm, only paid lip service to this critical issue. Instead, it is rushing headlong into austerity, thereby ensuring that any mental health services that had been provided by the state will inevitably face cuts. These job cuts have a direct impact on the level of care given to patients. 

In September a young pregnant woman died unnecessarily through suicide, at Kopanong Hospital in Vereeniging. Kopanong is a provincial hospital and the largest hospital in that region. But despite its size, it was unable to suitably care for this patient who was suffering from mental illness. This death could have been prevented if the hospital had enough staff, and also enough facilities for mentally ill patients. 

Further cutbacks are expected from the National Treasury when the Medium Term Budget Policy Statement is delivered. Austerity is a life and death issue. If there is less money, it means fewer resources, and that people are more likely to die. 

As the Health and Allied Workers Indaba Trade Union (HAITU), we have consistently demanded that the government engage all stakeholders, including workers, who are at the coal face of providing these services to vulnerable communities, in order to create a viable strategy to deal effectively with mental illness. This strategy will have to be centred on treatment and prevention.    

The World Health Organisation states that governments should promote community-based mental healthcare. It is more accessible and acceptable than institutional care, helps prevent human rights violations and delivers better recovery outcomes for people with mental health conditions. HAITU has been fighting for community-based healthcare workers to be made permanent because of the crucial role they play in providing essential support in HIV. 

In addition to this community based approach, the government should also do the following:

1. Increase funding and access to mental health services. Many people who need mental healthcare do not receive it due to lack of resources, stigma, or discrimination. The government should allocate more funds to provide affordable and quality mental health services for everyone who needs them. They should also train more mental health professionals and reduce barriers to access, such as long waiting times, geographical distance, or cultural differences. 

2. Promote mental health awareness and education. Many people are not aware of the signs and symptoms of mental health illness, or how to seek help when they need it. Governments and other stakeholders should do more to launch campaigns and programmes to raise awareness and educate the public about mental health challenges, their causes, and their treatments. They should also encourage people to talk openly about their mental health and seek support from others.

3. Implement policies and laws that protect the rights and dignity of people with mental illness. People with mental illness often face discrimination, harassment, or abuse in various settings, such as workplaces, schools, or communities. We must enact and enforce laws that prohibit such practices and ensure that people with mental health problems have equal opportunities and access to services. They should also monitor and hold accountable those who violate their rights.

4. Support research and innovation in mental health care. Mental health is a complex and evolving field that requires constant research and innovation to find new and better ways to prevent, diagnose, and treat it. We must invest in research and development of new technologies, therapies, and interventions that can improve the outcomes and quality of life of people with mental health problems. It should also facilitate the dissemination and implementation of evidence-based practices in mental healthcare.

5. Foster a supportive and inclusive environment for all. People with mental health challenges need social support and acceptance from their families, friends, colleagues, and communities. The government and other stakeholders should create and maintain a positive and inclusive environment where they can feel safe, respected, and valued. They should also promote social participation and integration of all people including people dealing with mental health challenges in various aspects of society.

The mental health and well-being of South Africans is crucial towards achieving a vibrant and prosperous nation. Immediate action is required from the state to engage willing partners to develop a viable strategy to ensure that the mental health of all South Africans is improved. –Health-e News