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Untreated mental illnesses impact SA's economy, social and family stability

- William Gumede

The shame which many South Africans, particularly black communities, place on people who live with mental illnesses are preventing sufferers from seeking help.

The shame which many South Africans, particularly black communities, place on people who live with mental illnesses are preventing sufferers from seeking help.

Growing up a child in the townships and informal settlements, families often hid relations with mental illnesses away, because of the fear of the prejudice, discrimination and isolation those with mental illnesses were subjected to.

Psychiatric hospitals such as the Weskoppies psychiatric hospital in Pretoria or the Valkenberg psychiatric hospital in Cape Town were prejudicially referred to as places for “lunatics” – where people are beyond redemption go to. So those with mental illnesses – and their family members were often bullied, ridiculed and cut off.  

Astonishingly, leaders such as former President Jacob Zuma have irresponsibly and wrongly headedly claimed that stress was a “white man’s disease”. Reinventing African “culture”, Zuma in 2017 claimed that the isiZulu community did not suffer from stress or mental distress as it was a foreign concept to them.

Sadly, such views that mental illness does not exist among black people and the stigma attached to mental illnesses appear to remain widespread in present-day South Africa. The stigma attached to mental health means that family, friends and co-workers are often not supportive of those who are unwell.

The multiple crises caused by Covid-19 - health, financial and social – have caused an epidemic of mental illnesses. Mental illnesses are likely to increase because of financial stress, anxiety and self-isolation.

The phenomenon of “Cabin Fever”, the symptoms of depression, hopelessness and irritability, associated with being confined in isolation for long periods as experienced during the hard lockdowns, are increasing South Africa’s mental illness caseload.

The collapse of businesses, loss of jobs, “Cabin Fever”, and other negative effects of Covid-19 is likely to lead to many broken marriages – which will increase mental strain. The reality of possible illness or death surrounding us – and the possibility of becoming a victim can cause profound anxiety, depression and unease.

Women bear the brunt of the fallout of South Africa’s social, political and financial crises. They are expected to be the refuge for families deeply stressed. Cape Mental Health said: “There needs to be additional mental health support for women who bear the brunt of this pandemic, either because they have lost a loved one, their income or home, or that they have been subjected to increased domestic violence in the home”.

Children are particularly vulnerable to lockdown-induced mental illnesses – the isolation, loneliness and restriction of movement. Adults suffering from Covid-19 related stresses also impact their children. Young people are also suffering. A UNICEF, the United Nations’ children’s agency, survey in nine developing countries in 2020 of youth between 13 and 29, found that 27% felt anxiety and 15% was depressive about the future.

But healthcare workers are also suffering from mental strain, depression and anxiety because of the emotional trauma from treating Covid-19 patients and seeing those infected dying in such high numbers.  

Even before Covid-19 South Africa had high levels of mental illnesses, a silent epidemic, which were often not regarded as such, because of the high levels of stigma attached to mental illnesses.

The last World Health Organisation mental health survey of South Africa, before Covid-19 hit, estimated that 30% of South Africans will suffer from a mental disorder over the course of their lifetime. Covid-19 is likely to substantially increase this figure.

Before the Covid-19 pandemic, only 15% of South Africans with mental health receive treatment. This is due largely to the fact that many do not seek help because of the public stigma attached to mental illnesses and because in many cases mental health support is just not available in public medical facilities.

South Africa only spends 5% of its total health budget on mental health – putting South Africa at the bottom of international benchmarks of country public spending on mental health. This translates into less than 1 person per 10 receiving mental health care. Poor South Africans are worse off when it comes to access to mental care – because of the lack of capacity, accessibility and resources in the public health sector for mental health care.

A 2019 survey by the Faculty of Health Sciences at the University of Cape Town showed that so severe are the shortages of mental health specialists, that only three provinces had child psychiatrists. The survey revealed that drugs for chronic mental illnesses such as depression, bipolar disorder and anxiety were routinely unavailable.

It is not only the public sector, which lacks a supportive environment for mental illnesses, the private sector is also found wanting. Many medical aids are not enthusiastic about providing financial resources to members suffering from mental illnesses. Medical aid options often do not adequately cover mental illness treatment. This need to change.

Currently, mental health support does not feature significantly in government’s Covid-19 recovery plans. There has to be a more dedicated effort from government to improve access to mental health facilities, resources and staff. Government and the private sector must make available Covid-19 funds to organisations involved in treating mental illnesses, including community-based organisations, who are at the coalface of treating the vulnerable.

There has to be an all-of-society effort to tackle the stigma, especially in black communities around mental illnesses – from civil society groups, religious bodies and traditional leaders; and schools, higher education institutions and workplaces.

Companies must become more supportive of employees facing mental strain, introducing support programmes for those suffering from mental illnesses and educate employees about mental illness – to tackle the stigma associated with it. Untreated mental illnesses undermine the productivity of businesses as much as physical health problems. It undermines South Africa’s economy, social and family stability – it must therefore be tackled with greater urgency, and with more resources and greater all of society collaboration, than currently the case.

William Gumede is Associate Professor, School of Governance, University of the Witwatersrand. This article has been done in support of Cape Mental Health, to mark October Mental Health Awareness Month in South Africa. It was first published on News24.