Mental Health Care in South Africa, Research Paper Example

Inadequate Funding and Services for Mental Health Care in South Africa

According to a number of reports and studies conducted in recent years, the nation of South Africa faces a mental health crisis. The available statistics demonstrate that at least one in four, and maybe as many as one in three South Africans face some sort of mental health disorder. These numbers are nothing short of shocking, and it is clear that something needs to be done and that not enough is currently being done. Critics of the country’s mental health care infrastructure complain that mental health facilities such as hospitals and clinics are outdated and short-staffed, while public funding needed to provide appropriate levels of care is completely inadequate. With so many South Africans facing the challenges of mental health issues, this is not just a crisis for them, but for the entire country. The evidence is clear that South Africa needs to begin talking mental health issues seriously and must provide the necessary financial, political, and social support to help those citizens who are struggling with mental health disorders.

Mental Health Disorders in South Africa

A recent journalist investigative report on the problem of mental health issues in South Africa  presented some stark figures about the number of South Africans facing mental health issues: all told, one in three South Africans struggles with some form of mental health disorder (Tromp, 2014). Worse, asserts the author, the vast majority of those who suffer from mental health issues will get little or no help from either private or public health care services. There are a wide range of mental health disorders, and not every condition is as serious as all others, but even taking into consideration the fact that some mental health issues are less serious, it is still an indictment of the country’s health care system that only a small number of those with such issues will receive any treatment, counseling, or other help.

In the same article the author uncovers information about the specific conditions in some mental health facilities. According to the report, one hospital in Soweto has a mental health and psychiatric ward for female patients that has room for 55 women, and the ward is nearly always full (Tromp, 2014). The facility keeps these patients in large rooms with multiple bunk beds, meaning that patients with various disorders are housed together in close quarters. The author quotes one nurse in this hospital who states that there are only two nurses on each shift to care for all of the patients in that ward, which makes it virtually impossible to offer appropriate medical and psychological treatment to any of the patients. The crowded, noisy conditions are also not ideal for pate8nts suffering from depression, schizophrenia, and other mental health disorders. If anything, asserts the author, these conditions only seem to make matters worse for many patients (Tromp, 2014). The conditions in the hospital in Soweto are just one example of how facilities’ around the country are failing to meet the needs of patients.

There are a wide variety of mental health issues faced by South Africans. The most common mental health disorders are depression and anxiety, which affect many people. These mental health conditions are often seen in conjunction with other medical issues, such as in people who are infected with HIV or have progressed to full-blown AIDS In the cases of such individuals, depression and anxiety reportedly affect at least 40% of them, though the actual number may be much higher (SACAP, 2013). There are other circumstances and physical conditions that can trigger or worsen depression-related issues, and one study indicates that one in three low-income women in the areas outlying Cape Town are likely to suffer from post-natal depression (SACAP, 2014). In rural areas farther out from the major cities, this figure reaches to even higher numbers, and these statistical rates of post-natal depression in South Africa are significantly higher than in most developed countries (SACAP, 2014). These are just some of the figures related to depression, but they demonstrate how common and widespread these conditions are.

Another issue that can affect many South Africans is post-traumatic stress disorder (PTSD). There are a number of factors that can trigger PTSD, and Dr. Eugene Allers of the South African Society of Psychiatrists indicates that one common trigger for PTSD is involvement in a serious car accident (SACAP, 2014). Other factors are domestic violence, rape, and other violent or traumatic events. When combined together, Dr. Allers believes that as many as 6 million South Africans may suffer from PTSD, and that this condition may exist with or contribute to other conditions such as depression and anxiety (SACP, 2014). The evidence shows that it is common for individuals with mental health disorders to suffer from more than one condition simultaneously, which may make it more difficult to treat such individuals.

Substance abuse issues are also prevalent in South Africa, and these can lead to a range of more serious disorders. Individuals who drink or use drugs to excess may suffer from serious physical ailments, and are also more likely to suffer from depression and anxiety (WHO, 2012). The excessive regular use of drugs and alcohol can lead to more serious and long-term physical and mental health conditions, and this once again shows how mental and physical health can be intertwined. It also demonstrates that many individuals who suffer from mental health issues may have a number of such conditions that would all require different types of treatment or intervention, which compounds the problems associated with mental health care.

Besides disorders such as PTSD, depression and anxiety, there are other conditions that are sometimes more serious that affect many South Africans. Schizophrenia and bipolar disorder affect many people, and it can be difficult to accurately determine how many suffer from such disorders in South Africa since so many of them go untreated and unreported. While all mental health disorders call for some form of treatment, these serious conditions can be difficult to treat under the best of circumstances, and those who suffer from serious psychiatric conditions are likely to deteriorate if they do not receive some sort of intervention (Burns, 2011). The primary issue in trying to treat people with serious mental health disorders is the same issue that stands in the way of treating people with depression, anxiety, and other less-serious conditions: there simply are not enough adequate facilities or available funding to help everyone who needs help.

According to one study, there are “multiple barriers to the financing and development of mental health services” in South Africa (Burns, 2011). These barriers include the fact that the existing physical facilities, such as hospitals and clinics, are often outdated and in need of repair; that there are simply not enough mental health care workers (such as psychiatrists and psychologists) to meet the needs of the country’s mentally ill; that there are inadequate lower-level intervention programs, such as pre- and post-natal care for women, early-childhood development programs, nutrition aid and support, and other programs that can help people in danger of suffering from mental health disorders); inadequate substance abuse facilities and programs; and a general lack of funding for mental health services (Burns, 2011). The range fo issue that serve as impediments to getting mental health treatment mean that most South Africans simply will not receive the treatment they need.

Mental Health Facilities and Programs in South Africa

According to a report from the World Health Organization (WHO) there are inadequate mental health facilities in South Africa. The WHO report states that there are only 80 day treatment facilities in the entire country, and that none of these facilities offer treatment or services to children or adolescents. With so few day treatment facilities in South Africa, only 3.4 out of every 100,000 people in the general population can receive treatment at one of these facilities’ (WHO, 2007).  If one in three members of the general population has some sort of mental disorder, this means that for every person who can receive treatment at a day treatment center there are approximately ten thousand who cannot.

The figures are similar for outpatient facilities. While there are many more such facilities than there are day treatment facilities, there were still only 3,460 outpatient treatment centers in the entire country as of 2007(WHO, 2007). Less than 2% of these outpatient facilities offer treatment to children and adolescents (WHO, 2007). Out of every 100,000 people in the general population, only 1660 can receive care at an outpatient treatment center, leaving tens of thousands who need mental health  care to seek some other outlet for treatment or to go without treatment altogether.

There are some treatment centers for inpatient care, but like the example of the hospital in Soweto shows, many psychiatric treatment facilities are inadequate. Inpatient care for acute patients is either found in psychiatric wards of larger hospitals or in centers and hospitals that treat mental health issues specifically. All together there are 41 facilities that treat mental health issues on an inpatient basis (WHO, 2007). One of the significant problems with this is that such facilities often serve as little more than jails or holding cells for patients, as there are often few caregivers to provide mental health services. Patients who are experiencing psychotic episode or other serious ailments may be taken to a mental health facility for inpatient treatment, but many will simply end up locked up or restrained in such facilities on a short-term or long-term basis (Burns, 2011). Such patients may receive little or no actual care including medication, counseling, or other treatment.

Perhaps the greatest concern for critics of South Africa’s mental health care system is the overall lack of community-based programs intended to help citizens avoid developing more chronic conditions or otherwise deal with issues that can lead to mental health issues. In the earlier example of postnatal depression among lower-income women, such conditions could potentially be addressed through community-based counseling and support systems. Such programs could, at least in some cases, help women deal with postnatal depression before it advances to the stage where more serious and costly interventions would be needed. Similar community-based programs could potentially address issues related to other conditions, from substance-abuse issues to illness-related depression and anxiety. In virtually all levels of the South African health care system, mental health issues do not receive the attention or funding needed to begin addressing the needs of the overwhelming number of people with mental health disorders.

Mental Health Disorders as a Human Rights Issue

The chronic lack of appropriate mental health services in South Africa is, according to critics, a human rights issue (Burns, 2011; WHO, 2007). The United Nations Convention on the Rights of Persons with Disabilities was ratified by South Africa in 2007, a move which indicated that the South African government was publicly expressing its committement to serving the needs of citizens with physical and mental disabilities and disorders (Burns, 2011). Because mental health conditions are considered to be disabilities within the framework of the United Nations Convention, it is the responsibility of the South African government to live up to the rule and guidelines related to persons with disabilities. Critics of the South African government claim that it is failing to meet its obligations under the Convention, and is failing to inform disabled South African citizens of their rights (Burns, 2010). Moreover, the decision to sign on to the United Nations Convention was the second step taken by the government related to mental health, as it also signed the Mental Health Care Act (MHCA) in 2002. Like the United Nations framework, the MHCA was intended to establish a set of guidelines for how persons with mental health issues were to be treated and the rights they were to be given. The failure of the South African government to live up to the guidelines of either the MHCA or the United Nations Convention on the Rights of Persons with Disabilities  is nothing less than a violation of the human rights of those with mental health issues.

Conclusion

Despite the significant and serious issues South Africa faces related to mental health disorders, critics of the current system do have some room for hope. In April 2012 a national summit on mental health care was held in South Africa, and was attended by many top national and international experts (Lund et al, 2012). Among the main areas of concern for the summit delegates was the need for developing a plan to overhaul the country’s broken mental health care system, and several key ideas were developed at the meetings. The most important first step suggested by the members of the summit was the need to develop community-based mental health care programs to reach the nation’s poorest citizens. In order to do this, a framework was developed that is intended to increase networking and communication among the nation’s health care services and those provided by non-governmental organizations (nimh.nih.gov, 2014). The suggestions and proposals are only a first step towards improving the county’s failing mental health care systems, but they at least represent an acknowledgment that something must be done. It is imperative that the government of South Africa work with national, regional, and local agencies and programs to provide the health care services that are so desperately needed by so many millions of people. With one in three South Africans suffering from some form of mental health disorder, the safety, security, and well-being of the entire nation is at stake.

Works Cited

Burns, Jonathan Kenneth. ‘The Mental Health Gap In South Africa-A Human Rights Issue’. The Equal Rights Review 2011; 6: 99 113 (2011): n. pag. Print.

Burns, Jonathan K. ‘Mental Health Services Funding And Development In Kwazulu-Natal: A Tale Of Inequity And Neglect’. SAMJ: South African Medical Journal 100.10 (2010): 662–666. Print.

Lund, C et al. ‘Mental Health Services In South Africa: Taking Stock’. African Journal of Psychiatry 15.6 (2012): n. pag. Web. 19 Oct. 2014.

Nimh.nih.gov,. ‘NIMH · Africa Focus On Intervention Research For Mental Health — AFFIRM’. N.p., 2014. Web. 19 Oct. 2014.

Sacap.edu.za,. ‘Mental Health In South Africa: Whose Problem Is It?’. N.p., 2014. Web. 19 Oct. 2014.

Tromp, Beauregard. ‘One In Three South Africans Suffer From Mental Illness – Most Won’t Get Any Help’.Times LIVE. N.p., 2014. Web. 19 Oct. 2014.

World Health Organization,. ‘Who-aims report on mental health system in south Africa’. N.p., 2007. Web. 19 Oct. 2014.