Mental healthcare is a sector that has long been neglected in the South African context. Some experts say that it has even been treated as an insignificant part of the health sector. This has all been to the detriment of the people living with mental illnesses, however, in recent years there has been an improvement both in the legislation surrounding mental healthcare and the mental healthcare services that are being provided. 

Mental health takes a backseat

According to the South African College of Applied Psychology (2018), one in six South Africans suffer from anxiety, depression or a substance use disorder and about 60% are struggling with post-traumatic stress disorder from car accidents or crime-related incidents. A clear demonstration that the mental healthcare sector has not been receiving adequate focus is that only 27% of South Africans with severe mental illness are being treated, which leaves 73% of South Africans with severe mental illness untreated. 

Based on recent data that has been published, the government is spending about 5% of South Africa’s entire health budget on mental health, the bulk of which goes towards psychiatric care in hospitals. While places like schools and rural areas have little or no mental health services. There are only about 600 psychiatrists in the country, according to Dr Mvuyiso Talatala, board member of the SA Society of Psychiatrists. Many psychiatrists have emigrated, and we have also lost some to Covid-19 since the start of the pandemic, Talatala went on to say. With millions of HIV/AIDS and gender-based violence sufferers in our country, we are sorely lacking in support for this and many other issues, in the mental health department. 

Rural Health Advocacy Project officer Lungile Gamede has highlighted another major flaw in the system, where some patients who are suffering from mental health issues are being cared for by nurses without any psychiatric training. According to Gamede, “If nothing is done, this will pose a significant threat to the successful integration of mental health in primary healthcare in the future, where communities living in rural areas will bear the brunt. It is also vital that nursing education plays a role in closing the mental health treatment gap through social accountability in nursing education and producing nurses whose competencies align with disease burdens as healthcare workers who are mostly the first point of contact for patients at primary healthcare centres,”. 

The impact of Covid-19 

Not only has South Africa seen major physical illness and financial woes from the Covid-19 pandemic, but it has also had a significant impact on the state of our people’s mental health. From healthcare workers having to deal with the trauma of seeing many cases first-hand, to the average citizen, Covid-19 has seen a rise in post-traumatic stress disorder, mood disorders, anxiety disorders, phobias, and obsessive-compulsive disorders. During the first lockdown in South Africa, 33% of South Africans suffered from depression, 45% felt fearful and 29% experienced loneliness, according to the Human Sciences Research Council (2020). This was further exacerbated by the fact that many people couldn’t receive treatment, with in-person contact being limited and the shortage of mental health practitioners in the country. This has served to further strain SA’s already struggling mental healthcare sector. 

The way forward 

The stigma around mental health in South Africa has unfortunately resulted in many people avoiding seeking help. Quito Esteves, joint CEO of Livewell Estates says, “The stigma attached to mental health, and the lack of awareness needs to be addressed so that we can move the country towards a higher level of understanding and better treatment of mental illnesses. Here at Livewell Estates, we are striving to create a place where people can receive specialised care along with the understanding that is needed to create a comfortable environment for those with degenerative mental diseases.”

Malose Langa, associate professor in psychology at University of Witwatersrand expresses his concerns about the state of mental health in SA saying, “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.” Langa goes on to suggest a solution that involves educating people, starting with children at a school level and working up into workplaces and the community level, he thinks that this will rectify a lot of the stigma around mental illness. He also believes that making treatment more accessible in the local communities will help the situation. 

Some facilities are working hard at creating a comfortable place for people with mental illnesses, like Livewell. “Creating a peaceful and welcoming environment for everyone is crucial to the treatment and wellbeing of all those who stay in our estates. It’s vital that everyone feels comfortable and looked after, and this comes with having a staff that is compassionate and well-informed on the degenerative mental diseases that we care for,” says Sandro Nassi, joint CEO of Livewell estates. He goes on to say, “Encouraging a life of meaning and purpose is one of the best ways to assist those living with Dementia and Alzheimer’s and we aim to bridge the gap that has been left in SA in the mental healthcare sector, within our facilities.” 

The future of mental healthcare in SA is now about making mental health a topic that has no stigma around it, one that we can talk about in the workplace, at home and in our communities to raise awareness and make others feel comfortable enough to seek help if they need it. It’s imperative that those who have mental illnesses and those supporting them, have access to the correct mental healthcare. The future of mental health in SA, therefore, relies on everyone, to be open and transparent with each other and work towards a more informed and understanding society.