Psychiatrists call for government to invest more in mental healthcare

The South African Society of Psychiatrists (Sasop) has called for the government to invest more in mental healthcare at community level.  

Responding to finance minister Enoch Godongwana’s 2023 budget tabled on Wednesday, the society said it was concerning that mental healthcare continued to be underfunded while common mental health conditions including anxiety and depression were on the rise. 

“Mental healthcare continues to be allocated only 5% of the national public health budget and, since the health budget itself is declining in real terms, the mental health portion is actually declining in monetary terms,” said Sasop public sector national convener Dr Kagisho Maaroganye. 

The statistics revealed that one in three South Africans suffers from mental illness, with 75% unable to access treatment. 

Maaroganye said mental healthcare professionals had seen a significant increase in common mental health problems “after Covid-19 ran through the country and caused both documented and untold misery for all citizens”. 

 “Common and treatable mental health disorders have overtaken physical illnesses and injuries as the leading cause of medical disability claims in South Africa.

“The combined effects of the Covid-19 pandemic – social isolation, job losses, illness and threats to people’s physical health, deaths of family members – have caused widespread emotional distress and mental illness,” he said.  

However, according Maaroganye, the focus of the mental healthcare system is skewed towards more severe mental health conditions that affect less than 1% of the population. 

“Treatment rates fell due to lack of access to mental healthcare facilities during lockdowns and patients may have had relapses, while those who did not previously experience mental health problems now find themselves with anxiety, depression and sleep disorders,” he said. 

Underfunding of mental healthcare hampered prevention and diagnosis of mental illness and limited access to treatment. 

“Shortages of mental health clinicians, a lack of experienced practitioners, insufficient resources to follow up and ensure compliance with treatment, all contribute to a persistent treatment gap,” said Maaroganye.

“In addition to the factors that put the general population at risk of mental illness, there are specific populations that are particularly vulnerable to mental illness, specifically the maternal population and children and adolescents.”

He said South Africa’s mental healthcare budget, as a percentage of the overall health budget, was at the lower end of international recommendations for mental health spendingand was also misdirected.  

“Budget allocations are hospital-centric and reactive, with 86% of the budget allocated to inpatient care and almost half that on specialised psychiatric hospitals. 

“The focus is on treating the most severe conditions, which have a prevalence of less than 1%, rather than preventing or providing early intervention and treatment for widespread and common mental health conditions of anxiety and depression before they escalate into more serious mental illness. 

“Almost 20% of the mental healthcare budget is spent on hospital readmissions. This ‘revolving door syndrome’ is a costly reflection of a highly inefficient system with an inability to optimise care at primary and community level,” he said. 

Maaroganye said community psychiatry offers the best prospects of optimal care for a stabilised mental healthcare patient in the community and preventing the costly “revolving door”. 

“While specialised psychiatric hospitals and psychiatric wards in general hospitals do serve a purpose, the success of a healthcare system ultimately depends on the extent to which we can prevent illness and on treating illness effectively to prevent relapse. The aim is to improve quality of life by enabling persons with mental illness to maintain their dignity, obtain or re-obtain independence and return to being productive members of society,” he said.

Within the budget limitations for mental healthcare, Sasop has called on the government to focus investment in mental health care at the community psychiatry level. 

The organisation proposes the following as more appropriate investments in mental healthcare:

• Develop IT systems that hold and distribute psychiatric information between community-based psychiatric facilities and psychiatric units and hospitals to facilitate continuity of care, better understanding of care outcomes and inform service planning;.
• Strengthen child and adolescent mental healthcare through the establishment of more community-based mental health facilities and provision of treatment and rehabilitation for children and adolescents.
• Expand the substance abuse helpline set up in Gauteng that gives help-seekers access to human and physical resources to manage their substance use disorders.
• Improve mental healthcare for expectant and new mothers by investing in the mental health care education of all primary care nurses and healthcare workers, not only antenatal care nurses and midwives, to bolster early detection and treatment of depression and other psychiatric conditions that have a high prevalence during pregnancy and after childbirth.
• Increase government expenditure on community psychiatry by hiring psychiatrists, psychiatric medical officers, mental health nurses and allied professionals with interest and expertise in mental health, and renovate or expand primary healthcare clinics to accommodate mental health clinics.
• Facilitate the training of generalist clinical staff to manage patients’ mental illness independently or with support from psychiatric clinicians.

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