Thursday, 20 May 2021, marks the first International Mental Health Action Day. This day is dedicated to drive people to take Mental Health Action for themselves and others. The South African Depression and Anxiety Group (Sadag), alongside 1,000+ organisations around the world, has partnered to change awareness into action.

South Africa already had a mental health crisis before Covid-19. Now, the pandemic has created new issues for millions and has exacerbated challenges for millions more. Sadag has seen the devastating impact the pandemic has had on mental health, especially among those who already had a mental health issue before lockdown. 

Covid-19 and the effects thereof have caused much mental health strain for many who didn’t have mental health issues before the pandemic. With over 1,500 calls per day, Sadag call volumes have doubled since lockdown and they continue to rise. 

Key groups such as healthcare workers and NPOs have been hit particularly hard – emotionally and mentally – as they work longer and harder, with fewer resources than most. 

Experts around the world have dubbed the mental health crisis as the “second pandemic”, and still our country doesn’t have a plan or strategy to help mitigate the mental health impact going forward.

The state of mental health in South Africa is in crisis – we were in crisis long before Covid-19 appeared and we still haven’t seen the kind of changes necessary to combat the “second pandemic”.

The Life Esidimeni horror – first reported in 2015 – is evidence of this. This tragedy saw 144 people die in the care of the public health system, with hundreds of survivors having to live with the trauma and emotional impact of what happened. As we delved deeper, we heard harrowing accounts of neglect, starvation, abuse and death among the most vulnerable individuals. These injustices shook us to our core to such an extent that, six years later, it still sends chills down our spines.

And yet we have seen no accountability. 

We haven’t seen any improvements in mental health services or an improved allocation of resources. We still don’t have enough psychiatric beds, especially for adolescents and children. This is particularly concerning since adolescents are one of the most at-risk age groups for mental illness and suicide. 

We still get reports of medication stock-outs and lack of available medication for patients living with chronic mental illnesses such as schizophrenia and bipolar disorder.

Life Esidimeni highlighted the massive flaws in the mental health system. 

Fortunately, because of the advocacy and awareness at a national level, there have been investigations into the tragedy, namely the Health Ombud’s report, the Life Esidimeni Arbitration Hearing Award and the South African Human Rights Commission’s Report into the State of Mental Health.

Investigations and reports such as these provide recommendations for national and provincial governments, advocacy groups, residential facilities and mental healthcare workers to deliver better quality of care when it comes to mental health – but unfortunately not much has changed since these reports have been released.

Accountability in particular appears to be virtually non-existent.

How much worse must the system get before we see mental health being prioritised?

Six years later, I am sure many people wonder why we still talk about Life Esidimeni; people must be getting bored of us saying the same thing over and over again. A psychologist recently said, “You talk, talk and talk until someone listens”, and this is what we need to do to resolve these issues in South Africa. 

We have to remember the lives lost. We have to remember the stories of these people who could have been our loved ones, our mothers, brothers, sisters and uncles. 

We have to share the journeys of these families to try to navigate the mental health system. We have to continue talking about the failed mental health system and how it continues to fail people in our communities every single day. 

We have to talk about it and continue talking about it until someone listens. 

We can never forget; it can never happen again. 

If we remember Life Esidimeni every day, then surely we won’t allow it to happen again. We can all be part of the solution to fix the mental health system so that such a tragedy never happens again.

What now?

So, why is improving the mental health system now more important than ever? Why is it important to turn mental health awareness into action? 

The national health budget was recently cut, which would mean even less money allocated to mental health. The SA Human Rights Commission report to Parliament in December 2020 highlights significant issues within mental health facilities in each province. It also raises serious human rights issues and gives very clear recommendations which need to be taken seriously and acted on by national and provincial governments.

The National Mental Health Policy Framework and Strategic Plan expired in 2020. It needs to be updated, and updated quickly. Most importantly, it also needs to be budgeted for so it can be implemented on the ground. 

What we want to avoid is sitting with a nice policy on paper, but one that leaves the people on the ground unable to benefit from the policy.

For the Life Esidimeni family members, an inquest is scheduled to be held in the Pretoria High Court in July. This is an important step towards accountability and getting answers from those who were responsible for the 144 lives lost. 

Additionally, the launch of the Life Esidimeni online memorial and advocacy project today ensures that we don’t forget the people who died. Through the website, we are able to provide anyone needing access to treatment or care, or needing to report issues at hospitals or clinics, a pathway to better care. 

We can give those who are unable to cope with poor mental health a clear pathway to report issues in care and get help – before it is too late. We must ensure that Life Esidimeni never happens again.

As we head towards what might well be the emergence of Covid-19’s third wave, we urgently need a strategy to mitigate the impact on mental health. We know from global research that a third of patients with, or who have had, Covid-19 will develop mental illness or psychological distress. We do not currently have a system that can deal with this influx of people needing access to mental healthcare or treatment – we are barely managing the demand as it stands.

Next steps

An important step is to make the shift from awareness to mental health action. We need to encourage and empower people to take action, for themselves, for their loved ones, to ensure systemic changes to improve our social and mental wellbeing.

It’s time to change how we treat mental health in our culture, in our communities, in our politics and in our policies – and quickly.

No longer can we wait for government to fix the mental health system… We have been waiting for six years and there hasn’t been much change.

Change starts from the ground up. It starts with you and me.

We owe it to the 144 people who died and those who survived. We owe it to everyone accessing mental health services every single day, and for the many more who are too afraid to speak up or don’t even know where to begin to get help. 

An estimated one in three South Africans are suffering, or will suffer from a mental illness at some stage in their lives, we need to make drastic changes to mental healthcare in South Africa. These people are us – they are our loved ones, our neighbours, our colleagues, our partners and our children.

It starts with empowering people to be able to access treatment and directing them to the right resources, and helping them when they hit the inevitable roadblocks. 

It starts with educating teachers and parents on mental health in adolescents so they can help identify the warning signs and know how to get help. 

It starts with giving people a platform to report mental health issues or complaints via helplines, email, online platforms or SMS. 

It starts by encouraging more people to share their mental health stories so that we can break the stigma and shame associated with poor mental health, and in doing this, normalise poor mental health. 

It starts by empowering everyone to be advocates for mental health and be part of the change so that we can push for better policies, bigger budgets and clearer strategies that are patient-centred – for the people, by the people.

There is no health without mental health.

We will never forget – and we will not allow others to forget either. DM/MC

Cassey Chambers is Executive Director of the South African Depression and Anxiety Group.