If you’re living with a serious mental illness in this country, you probably won’t get treatment and care. Only 27 percent of South Africans with acute mental health disorders get the help they need. What’s more, the national health department spends less than R100 per person, per year on mental health services. Statistics show there’s one suicide reported every hour in South Africa (#DStv403: 2019).

Mental Health – A neglected component

Bannis (2020) stated that mental health is an underserved cause in international aid for the same reasons it is still a taboo topic in most countries. In the same vein, Bannis continued and that it is as a result of the stigma attached to it and when a person suffers from a mental condition, the common perception is that there is something wrong with the person. Moreover, in the case of international aid, mental health struggles to attract donations also due to a marketing issue. The outcome of this combination of problems is that mental health is one of the most neglected health problems in developing countries. In the meantime, the socio-economic repercussions of untreated mental illnesses are devastating. Depression is the single most prevalent mental illness, affecting women at twice the rate of men. In Africa, depression affects 1 in 4 women and, of these women, the overwhelming majority – 85 percent – have no access to treatment Bannis (2020)

Mental health has pre-eminently been overlooked in Africa’s health and development policy agenda. Confronted with many problems, including intractable poverty, infectious diseases, maternal and child mortality, as well as conflict, African political leaders and international development agencies frequently overlook the importance of mental health (Lund: 2018). This tendency is often aggravated by three factors: ignorance about the extent of mental health problems, stigma against those living with mental illness and mistaken beliefs that mental illnesses cannot be treated. The treatment gap – the proportion of people with mental health problems, who do not get treatment – ranges from 75% in South Africa to more than 90% in Ethiopia and Nigeria (Lund: 2018). In 2003 the WHO launched an Investigation in Mental Health, in which magnitude and burdens of the problem were identified and in the executive summary of the above document below, as listed below:

The magnitude and burdens of the problem

• As many as 450 million people suffer from a mental or behavioural disorder.
• Nearly 1 million people commit suicide every year.
• Four of the six leading causes of years lived with disability are due to neuropsychiatric disorders (depression, alcohol-use disorders, schizophrenia, and bipolar disorder).
• One in four families has at least one member with a mental disorder. Family members are often the primary caregivers of people with mental disorders. The extent of the burden of mental disorders on family members is difficult to assess and quantify and is consequently often ignored. However, it does have a significant impact on the family’s quality of life.
• In addition to the health and social costs, those suffering from mental illnesses are also victims of human rights violations, stigma, and discrimination, both inside and outside psychiatric institutions

The provision of long-term mental health care for people with severe mental disorders has been, and still is, one of the major challenges for mental health systems reform in the last decades, for various reasons. Despite these disorders having a low prevalence, the impact they have on individuals, families and societies is enormous. Schizophrenic disorders are the most important of the severe mental disorders since they are associated with the greatest impact on functioning, with an estimated point prevalence of 0.4% and a lifetime risk of 1% i.e. one in a hundred people will suffer from schizophrenia during their lifetime (Goldner et al., 2002). It is the 7th most important disease in terms of years lived with disability, accounting for 2.8% of disability caused by all disease. For people aged 15 to 44 years, it is the 3rd most important disease, accounting for 4.9% of disability caused by all diseases (WHO, 2008). Second, the experience in most countries is that the development of community services is a complex process that faces several important barriers.  Mental illnesses are health conditions involving changes in emotion, thinking or behaviour (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.

Mental health and the way forward for South Africa

The South African Foundation for Mental Health (SAFMH) launched the country profile that has been developed, which concludes with the following four recommendations for mental health campaigning in South Africa (SAFMH. News Room: 2020).

1. The first recommendation is to improve representation of mental health care users at policy level which implies pressing with force for the re-appointment of a ministerial task team and advisory panel to monitor progress on mental health indicators by the 2013-2020 Policy Framework for Mental Health. Unfortunately, this advisory body lacks the representation of mental health care users (MHCUs). User-led advocacy groups need to be consulted in the evaluation of the existing guidelines as well as in the upcoming revisions and changes required in the upcoming framework.
2. Calling for stronger implementation of constitutional rights for mental health care users in South Africa

• MHCUs do not have the right to participate in elections within South Africa, which goes against their constitutional rights as South African citizens and the Mental Health Care Act 17 of 2002. The state has a responsibility to review and align this position as outlined in the country’s own human rights framework and in global recommendations made by the UN Convention on the Rights of Persons with Disabilities to respect the individual autonomy of MHCUs, including the right to make political decisions.
• Advocate and disseminate a key finding of the South African Human Rights Commission – “Broader conversations about law reform of instruments such as the Mental Health Care Act and the Electoral Act are required. Particularly in light of their potential contravention of the UNCRPD and in light of ongoing debates regarding matters such as legal capacity”.
• Focus on inclusion and the importance of highlighting Southern-African-led advocacy in the region by empowering MHCUs to share their stories.

3. Strengthening South Africa’s mental health review boards

• Local investigations have found that Mental Health Review Boards have not been as involved in psychiatric units within general hospitals (where a large proportion of involuntary detentions take place), and report a lack of appeals from many units. This suggests that these governing bodies, which have been put into place to protect patients from inappropriate detention, are not being upheld according to the recommendations made by the Mental Health Care Act of 2002.
• As a formal structure, its terms of reference must be clearly defined and strengthened in line with the National Health Act and the Mental Health Care Act 2002, and its independence and authority re-established.

4. Increased investment in mental health care systems

• Irregular and ineffective monitoring systems for mental health are one of the contributors to resource misallocation in South Africa. National and provincial governments need to invest in the development of information systems with patient registers and a database by which to make evidence-based decisions, monitor and evaluate health care delivery.

It is clear that all four of the above recommendation were not appropriately implemented either as a result of ignorance or no interest. We unconditionally support the call from the WFMH: “Our call is a simple one – let us hold hands and unify our voices in moving the mental health investment agenda for increased focus and access to mental health and thereby making mental health a reality for all – everyone, everywhere”. But while it is a simple call, in that what is being asked for is clear and easy to grasp, achieving it might not be that simple as it requires concerted efforts from the South African government to start placing more emphasis on mental health – in 2020 and beyond SAFMH. News Room: 2020).