The state of mental health in South Africa: A focus on women
In a world plagued with a plethora of trials and tribulations, the need for self-care and mental health care has been put to the forefront. Mental health includes our emotional, psychological, and social well-being. Mental illness is a disease that causes mild to severe disturbances in thought and/or behaviour, resulting in an inability to cope with life’s ordinary demands and routines. In Africa, there is often a stigma around mental illness and its causes and treatments. Whilst safe care plays a critical role in ensuring a healthy state of mind, the government also has a role in mental health as it can become a public health crisis.
The state of the mental health in South Africa is very poor. Multiple factors contribute to the inadequacy of the system. These include the stigma that surrounds mental health and lack of awareness and commitment from government institutions to provide adequate support for South Africa’s mentally ill. Currently, mental health is regulated by the Mental Health Care Act whose objectives are not efficiently implemented nor adequately understood by practitioners. Although mental health challenges can be experienced across the board, they are felt in a unique way by women.
Women are among the marginalized and vulnerable groups in the country and therefore very susceptible to mental illness. Those who are already living with severe mental illness are not properly protected or cared for. Gender based violence is very prevalent in South Africa. Some men feel superior to women and therefore entitled to a woman’s body. This only adds to the already existing conditions and creates new levels of trauma. Women who are subjected to abuse, trauma, stigma and discrimination are more susceptible to challenges in mental health.
On 3 August, three days into woman’s month, a young woman by the name of Khensani Maseko, a Rhodes University student committed suicide after battling with depression following an alleged rape by her boyfriend earlier this year. What makes this matter astonishingly heart-breaking is the fact that when she reported the matter to the police, she was told that there is no evidence to support her allegation. It is this kind of behaviour that shames women and deters them from reporting rape cases. Had the police paid attention to Khensani’s cry for help, maybe she would not have resorted to suicide. Gender based violence survivors experience intense psychological effects. It is important that victims receive comprehensive care and support that addresses both short-term and long-term effects of rape as they become apparent.
As mentioned earlier, mental health problems may be related to excessive stress due to a particular unpleasant situation or series of events. Many women suffer injustices in the hands of their male counterparts at home, at work by their acquaintances, strangers and institutions. South Africa has one of the highest incidences of violence against women in the world. Every day, women are murdered, physically and sexually assaulted, threatened and humiliated by their partners in their homes or by unknown perpetrators. Organisations estimate that one out of every six women in South Africa is regularly assaulted. This situation is exacerbated when a woman is suffering from an intellectual disability. Sadly, a large number of these cases are not reported. Women are often forced to adopt coping strategies such as bottling up their emotions and substance abuse. This leads to excessive stress which often leads to some sort of mental illness and if left untreated, may eventually lead to suicide.
Most families do not know how to cope with learning that their loved one has a mental illness and cannot manage taking care of the latter. It can be physically and emotionally trying, and can make them feel vulnerable to the opinions and judgments of others. This is where community health care workers come in. Mental health care workers are specially trained to care for people with mental health conditions. They work with psychiatrists and other healthcare professionals to treat people with mental health issues, providing information, support and care in a community based care unit.
The government has introduced policies to regulate and support people with mental health illnesses. These include; The National Mental Health Policy Framework and Strategic Plan; The Mental Health Care Act; and White Paper on the rights of people with disabilities. Be that as it may, mental health care takes the backseat when it comes to the allocation of resources. Mental health should be given the same priority as any other infectious and non-communicable diseases. Policies alone are not good enough, especially if they are not accompanied by an empowering budget, lack enforcement mechanisms and there is no accountability.
In April, SAHA made a PAIA request to the Department of Health on behalf of an organization called the Mental Health Law Project (MHLP), an organisation which aims to promote a vision of a health system which protects and promotes the rights of mental health care users and people with intellectual disabilities in South Africa. The request sought information related to the recruitment and retention of community mental health care workers, broken down by province. In response the Department of Health stated that the department did not keep such records and that it would be best for the request to be transferred to the different provinces. This response meant that we now had to pursue nine separate requests for the same information from the various provincial departments of health.
Feedback from the provinces has been disappointing thus far. Some provinces have not given us any response and getting hold of some over the phone has proved impossible. Other provinces do not have accurate addresses; some deny receipt of our requests. There also seems to be a great deal of confusion as to what exactly SAHA is asking for. We had an extended correspondence with one province where we had to repeatedly inform them of their obligations and what information we were asking for. After notifying another province of the fact that we could launch an internal appeal, we received a reply from their information officer asking for clarity on what exactly we meant by “community health care workers”. We are currently finalizing our internal appeals to those bodies who have not responded to us.
The above discussion indicates a pattern of ignorance of mental health care, poor record keeping and unaccountability from our various provincial departments.Currently, there is an insufficient number of trained mental health care professionals. There is a heavy reliance on psychiatric hospitals to care for and manage mentally ill patients. Public sector mental health care services are not accessible to the country’s most vulnerable populations, which are the poor and women. The hospitals also do not have enough trained mental health care professionals. This means there is a large treatment gap. About 75% of people with mental health illness do not have access to mental health care.
Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.Mental health care management and services need to be made a priority. Mental health care must be de-institutionalized so that community-based care can be set up in a systematic way. This would entail first strengthening and then expanding community-based care. This is in line with ancient African traditions of caring for our own and ensuring no one is left behind.