Mental health is a state of mental well-being that enables people to cope with the stresses of life, realise their abilities, learn and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in. Mental health is a human right. And it is crucial to personal, community and socioeconomic development.

The executive director of the public interest law centre SECTION27, Sasha Stevenson, says many people in South Africa are not sufficiently aware of their right to access mental health care. She encouraged people to find information on mental health and their rights through organisations such as SECTION27 and the South African Depression and Anxiety Group (Sadag). 

“The Life Esidimeni disaster was a real illustration of the inadequacies of the mental health care system and also a failure of the key roleplayers, people who are responsible for ensuring access to mental health care services, a failure by them to do the right thing, take decisions and implement projects in the way that they should be.

“It was arguably one of the most dramatic and significant human rights violations of our democratic era. It has highlighted the vulnerability of mental health care users, but it also shows the importance of collaboration for organisations, activists, and families who are doing similar work,” Stevenson said.

In the Life Esidimeni tragedy, 1,700 vulnerable and mentally ill people in Gauteng were moved from specialised care facilities to unlicensed organisations in a bid to save money, resulting in the deaths of 144 people from causes including starvation and neglect. 

Depression the driver

Mental illness is a general term for a group of illnesses that may affect a person’s thoughts, perceptions, feelings and behaviours. Mental health issues and illnesses can affect working and personal relationships. According to Sadag, counselling, medication, or both can help treat mental illness.

The South African Stress and Health study shows that the most prevalent classes of mental disorders in South Africa are anxiety disorders, followed by substance use disorders and mood disorders.

Cassey Chambers, the operations director at Sadag, explained: “Depression is the primary driver of mental illness, and young adults, adolescents and children are particularly vulnerable. 

“It is most often diagnosed in women because they are more likely to screen and reach out for help. Undiagnosed and untreated, depression is the leading cause of suicide in South Africa and globally. In fact, in South Africa, men are four times more likely to die because of suicide than women.”

Young people and depression

Many mental health challenges stem from childhood and teen experiences, and mental health practitioners say they see a pattern of depression among young people. According to the SA Society of Psychiatrists, almost one in 10 teenage deaths in South Africa every year is the result of suicide. Up to 20% of high school learners have tried to take their own lives.

The SOS Children’s Villages South Africa highlighted that the right to health is a fundamental human right, also recognised by the UN Convention on the Rights of the Child. As health cannot exist without mental health, this year’s theme for World Mental Health Day was “Mental health is a universal human right”.

“Ignoring this component has tremendous consequences on individuals and the society. For children, mental well-being plays a key role in their child’s development and learning abilities. Strong mental health positively affects a child’s quality of life in the long term, strengthens resilience and has overall positive impacts on communities,” the SOS Children’s Villages said.

Adverse experiences leading to mental health issues have a major impact on a child’s development if not addressed. Similarly, the mental well-being of parents and caregivers is crucial for children. 

“Children who have lost or who risk losing parental care are more vulnerable to mental health and psychosocial difficulties than their peers. Caregivers and other professionals who work directly with children, adolescents and families at risk may experience their own mental health pressures, also due to working conditions / being overworked and insufficient resources,” the SOS Children’s Village said.

In a webinar held by Sadag, Stevenson was joined by psychiatrists and Sadag board members Laila Paruk and Mashadi Motlana. They reiterated the importance of access to mental health care for people from all walks of life. Motlana acknowledged that people miss treatment opportunities because of socioeconomic issues such as not having transport money to get to a clinic or hospital.

Experts in Sandton, Johannesburg, speak about whether mental illness is the next global pandemic. From right: Cassey Chambers, operations director at the South African Depression and Anxiety Group, Dr Noluthando Nematswerani, chief clinical officer at Discovery Health, Dr Mosima Mabunda, head of Vitality Wellness and Dr Maritha van der Walt, chief medical officer at Discovery Life. (Photo: Naledi Sikhakhane)

Increasing depression reports

In recognition of World Mental Health Day, Discovery convened a panel discussion with four expert panellists reflecting on the prevalence of mental illnesses locally and globally. 

Bongani Bingwa, a journalist and host of the Breakfast show on 702, facilitated the discussion, which focused on depression.  

Dr Maritha van der Walt, the chief medical officer at Discovery Life, said that in 2020 alone — the first year of the Covid-19 pandemic — Discovery Life experienced a 25% spike in mental health-related claims.

She said: “While the pandemic is behind us, people continue to feel the effects of the loss of loved ones, jobs, income, and for a while to come there will continue to be mental health claims.”

Discovery Life data also showed that in 2022 the scheme experienced suicide claims that were 13% higher than in the 2019-2021 period and 24% higher than in the 2016-2018 period.

Comparing 2022 to 2019 and 2021, Discovery Life data also show a 149% increase in suicides in people under 30 years of age. Women are 1.8 times more likely than men to claim through the Income Continuation Benefit for mental health-related reasons. However, life cover claims related to suicide are 2.2 times more likely to be for men than women.

Dr Noluthando Nematswerani, the chief clinical officer at Discovery Health, said that depression is the condition affecting the majority — 60% — of members diagnosed with a mental health condition (mostly young adult female members). She said the prevalence of depression had increased from 6.3% in 2018 to 8.1% in 2022 and had also steadily increased over the years preceding this period.

Digital therapeutics 

Nematswerani was excited about the new tool they will be introducing to help people help themselves.

“At the end of September, we made South Africa’s first funded digital therapeutic — or ‘DTx’ as they are called — available to [Discovery Health Medical Scheme] members aged 18 years or older, who have a diagnosis or symptoms of depression. 

“This tool represents Discovery Health’s partnership with SilverCloud by Amwell — a globally leading digital behavioural health and well-being platform,” Nematswerani said.

Prescribed by a GP, psychologist or psychiatrist, the new digital mental health benefit gives members access to internet-based Cognitive Behavioural Therapy (iCBT), funded from the scheme’s risk pool. 

Evidence shows that to treat depression and anxiety, iCBT is as effective as CBT delivered face-to-face. Discovery said the benefits of providing Discovery members access to this tool include allowing patients to access care 24-7, no matter where they are located. Care and treatment can also be personalised to increase treatment effectiveness and outcomes. 

Experts say the shame and stigma around mental health disorders present the biggest fight that mental health practitioners face. Regardless of economic standing, communities use language such as “crazy” and “schizo” that shames mental illness.

This makes it harder for people to admit they are having mental health struggles, let alone reach out for help. There are tools such as toll-free calls, pop-up mental health counselling containers and even apps. If you need help, take the first step and research the one that best suits you. DM