Is mental health in South Africa moving forward?

In April 2023, the first national collaborative South African Mental Health Conference (SAMHC) took place. The conference, themed “Join the Movement”, emphasised a ‘whole of society’ approach. It urged various sectors to work together to address the country’s mental health burden.

Challenges in South Africa

South Africa faces significant mental health challenges. Common mental illnesses have increased three- to seven-fold since the onset of the COVID-19 pandemic.

Factors contributing to the causation and exacerbation of mental illness in the country include poverty, unemployment, inequality, violence, gender-based violence, and political upheaval.

Dr Olive Shisana highlighted in her opening presentation at the SAMHC that access to mental health services occurs at both a systemic and individual level.

She suggested possible solutions, such as stratifying plans and policies, determining implementation costs, and setting up monitoring teams.

The Current Health System and Mental Health

South Africa currently employs a two-tier health system. 84% of the population use the government-funded public sector, while 16% access private care.

The recently passed National Health Insurance (NHI) Bill was put forward during the conference as a possible solution to inadequate access to healthcare services.

However, the South African Medical Association (SAMA) has expressed major concerns regarding NHI. Issues such as contracting units for primary healthcare, benefit packages, and reimbursement models have not been finalised.

The Importance of Community Engagement

The conference emphasised the importance of community-based services led by people with lived experience. Community engagement can potentially contribute to more culturally competent services and personal empowerment of recipients of care.

To improve access to mental healthcare and recovery for people with mental health conditions, community-based interventions with community engagement need strengthening.

South African culture, including Ubuntu (humanity), traditional African healing, and ancestral callings, intersects with psychiatry and should be considered in mental health interventions.

Human Resources and Mental Health Service Delivery

Mental health service delivery in South Africa faces severe human resource challenges. There is an average of 0.31 psychiatrists per 100,000 population in the South African state sector, with an unequal distribution between rural and urban areas.

Dr Antoinette Miric, co-founder of the Healthcare Workers Care Network (HWCN), highlighted at the conference that healthcare workers are particularly vulnerable to workplace stress, which came to light during the recent COVID-19 pandemic.

Future recommendations include improvement in the working environment, proactive leadership, and easy access to confidential counsellors and employee assistance programmes.

Moving Forward in South Africa

The National Mental Health Policy Framework and Strategic Plan 2023–2030 has an ambitious vision to achieve comprehensive, high-quality, integrated mental health promotion, prevention, care, treatment, and rehabilitation for all in South Africa by 2030.

However, poor implementation of the previous policy was evident in the conference sessions, particularly with respect to youth. The question of how to provide accessible, quality care to children and adolescents was pervasive.

As stated by the World Health Organization, “Change is not happening fast enough. And the story of mental health is one of need and neglect.” South Africa has now had its first mental health conference, raising a broad range of issues and placing many potential options for change on the table.

Advancing information systems, transparent management, and monitoring of indicators are imperative in moving in South Africa.

Article based off research paper