Call for mental health service rethink
13 April 2012
Describing South Africa's mental health services as fragmented, unfairly distributed and inadequately resourced, Health Minister Aaron Motsoaledi has called for greater awareness, better planning - and a move away from a "hospi-centric" approach to the treatment of mental illnesses.
Speaking at a two-day National Mental Health Summit in Pretoria on Thursday, Motsoaledi said a 2008 survey by the College of Medicine found that, out of a total of 302 public sector psychiatrists countrywide, there was one in Mpumalanga province compared to 111 in Gauteng.
"We know that there continues to be over-reliance on psychiatric hospitals as the mode to care, treatment and rehabilitation," Motsoaledi said, adding that South Africa had continued to follow the colonial, "hospi-centric" approach, in doing so neglecting critical aspects of primary health care.
People with mental illnesses 'voiceless'
He said it was an offence against human rights and the country's Constitution to neglect the worst-off in society.
Mental illnesses are medical conditions that disrupt a person's thinking, feeling, mood and ability to relate with others, resulting in a diminished capacity for coping with the ordinary demands of life.
High levels of mental illness have been found to co-occur with infectious diseases such as HIV and tuberculosis, as well as non-communicable diseases such as cancers, cardiovascular disease and diabetes mellitus.
"Because of their condition, mental health care users are often 'voiceless', and it is critical that we both give this group the space to voice their needs and then respond appropriately through including mental health in all health plans and programmes," Motsoaledi said.
According to the South African Stress and Health study, the first nationally representative epidemiological survey of common mental disorders in the country, published in the SA Medical Journal in 2009, only one in four South Africans with a mental disorder has obtained some form of treatment.
This is in line with the World Health Organization (WHO) surveys that show that between 76 percent and 85 percent of people with severe mental disorders in low- and middle-income countries receive no treatment.
'Not the sole domain of expert practitioners'
Motsoaledi stressed that resource, infrastructure and social mobilisation plans and employment targets had to take mental health issues into consideration.
He challenged the summit to propose clear targets on the different categories of mental health human resources to be produced by 2016/17, which should include bringing back a post-basic psychiatric course, which had been done away with.
"To meet the need, we must increase the production and employment of other mental health professional categories too," he said.
"At the same time, we must ensure that mental health does not become the sole domain of dedicated mental health practitioners, but that mental health becomes integral to the training of all health professionals, especially those that work in primary health care services.
"We need to scale up investment in our community-based mental health services and reverse the trend of institutionalised care. We must examine how mental health can be integrated into general health care and particularly into primary health care."
'We also have potential and talents'
Also addressing the conference on Thursday, Dick Shingange, who suffers from psychosocial disability, said that people with mental illness were always considered as "useless".
However, times had changed, thanks in part to new technology, and people with mental illnesses should no longer be bystanders to their personal journeys or allow other people to speak on their behalf.
"Work beside us and respect our voices as we also have potential and talents," Shingange said.
"We have potential and can make a great contribution to the world. We believe in an Africa where all people are treated with dignity. We want to be listened to and fully participate in decisions concerning our lives ... No one can speak for us."