October is Mental Health Awareness Month.

Now, as we are still in the grip of a global pandemic, there has been an unprecedented strain on collective and individual psyches from adapting to lockdown to the grief over the loss of loved ones during the Covid-19 pandemic.

So, it is especially fitting that we put the spotlight on mental health this month.

Special series on mental health

Spotlight will publish a mental health special series in the coming weeks. The articles in the special series will unpack the statistics around mental health in South Africa, the latest policy developments, assess the gains and where the challenges are in mental health services, and get some expert input and community insights on how to get where we need to be in providing quality mental healthcare for all who live and work in South Africa.

Where we are

Once hailed as a landmark piece of legislation, the country’s Mental Health Policy Framework has lapsed, so it is fair to say that we are finding our way through profound psychological global distress essentially in a policy vacuum. The South African Mental Health Federation’s director Bharti Patel says of the now lapsed framework, “The framework’s emphasis on generating scientific evidence and best practice underscored by a deep commitment to human rights and serving vulnerable populations was seen as being highly commendable. However, there is still a long way to go to improve access to quality mental healthcare to meet the needs of people throughout South Africa.”

In her upcoming article, Tiyese Jeranji will unpack what this lapsed policy framework means for South Africa and try to get answers from the authorities.

To kick off the special series, Professor Lesley Robertson, who leads the Sedibeng District Specialist Mental Health Team in Gauteng, looks at our medical model of disability and mental health legislation and unpacks the change needed at the societal and health system level. Robertson penned her article, “Mental health: We need shifts in mindset and structure at the micro, meso and macro levels” in her personal capacity. 

Life Esidimeni

With the Life Esidimeni Inquest now in full swing, SECTION27’s communications officer Julia Chaskalson will recap the progress so far and what to expect in the coming weeks/months. The Joint Judicial Inquest into the deaths that occurred in the Life Esidimeni tragedy of 2016, began on 19 July 2021 and so far, four witnesses have testified and a fifth has now begun their testimony. Chaskalson writes, “The road ahead towards criminal accountability looks to be a long one.” 

Provinces

In the Eastern Cape, Luvuyo Mehlwana investigates what has changed for mental health services users in the province following a few reports on the state of mental healthcare. In 2018, the Health Ombud released its report with findings on mental health services at Tower Hospital following allegations of human rights violations at the hospital. The Health Ombud could not find any “prima facie evidence of institutionalised, systematic or deliberate violations of human rights by staff at Tower Psychiatric Hospital and Psychosocial Rehabilitation Centre but, also importantly recommended that the provincial health department appoints a mental health administrator to look after all mental health services in the province.

A year later, at a different facility, the Public Service Commission after a visit to the Cecilia Makiwane Hospital’s mental health unit, called it a “disaster”. Following this, the provincial health department announced that over R236-million had been allocated towards improving mental health facilities across the province for the next three years. This amount would cover 15 infrastructure projects, including 13 psychiatric facilities, and two projects that will include district hospitals and psychiatric facilities.

Last year, in a report on the conditions at some Eastern Cape hospitals such as Livingstone Hospital, the Deputy Public Protector in her report recommended that the health department must ensure that an integrated mental health strategy for public hospitals be developed for the Nelson Mandela Bay Metropolitan area, “within 90 days from the date of this report”. The report was released in August 2020.

In the Free State, Refilwe Mochoari tries to find out what happens when people present at primary healthcare facilities (often the first port of call to access health services in the public sector) with mental health concerns. One patient told her that when she shared her mental health experiences with a nurse at one of the rural clinics in the province, she was “sent home only with Panado”. There are many challenges to accessing mental health services in South Africa’s public health sector, but in rural areas, these challenges can be more pronounced. 

Elri Voigt will then zoom in on how conditions like major depression and bipolar disorder are treated in our public healthcare sector. She will unpack how depression and bipolar disorder are typically diagnosed in the public sector, if there are treatment guidelines for these conditions and once diagnosed, if there is any kind of psychotherapy available, what medication or support, and how the referral system works. 

In Gauteng, Thabo Molelekwa is visiting some organisations driving interesting projects in communities to complement mental health care, which includes projects adding great value to early childhood development and maternal mental wellbeing as well as projects roping in men to better manage their mental health.

In the Northern Cape, we follow up on the multi-million rand Kimberly Mental Hospital and ask whether this hospital, dubbed by some an expensive white elephant, is now being put to good use. 

We will also look ahead at South Africa’s proposed National Health Insurance (NHI) system and the implications it may have for mental health services. How will mental health services and access improve under NHI? SECTION27 legal researcher Mbali Baduza will also unpack the links between climate change and how this can impact mental health.

Where we should be

As the series will show, access to mental health services is crucial not just for the fulfilment of rights but also for strengthening our social fabric. There are many challenges underlying this, but they are not insurmountable. We are nowhere near where we should be in providing quality mental healthcare in South Africa — not with the budgets and resources we make available or with how we understand and view mental health as a society. 

Maybe this is the gift of this pandemic — that we now have this pause, this ‘unfortunate’ breathing space, if you will, to re-assess and to rethink the health system we want and how we can get there. DM/MC

Alicestine October is deputy editor of Spotlight.