9 out of 10 with mental health issues lack access to treatment in SA – Sadag

July is Mental Health Awareness Month, and the statistics in South Africa are alarming.

According to the South African Depression and Anxiety Group (Sadag), one in three South Africans will experience a mental health issue at some point in their lifetime.

As of July 18, 2024, South Africa’s population is approximately 61,046,936, according to Worldometer’s elaboration of the latest United Nations data.

1 in 3 may have a mental health issue in their lifetime

However, the high number of people affected by mental health issues does not balance with the number of people who have access to treatment.

“Only one in 10 people with a mental illness have access to treatment or care which means nine out of 10 people with a mental health issue do not have access to treatment or care, which is very alarming,” Sadag operations director Cassey Chambers told The Citizen.

Chambers adds that SA’s statistics and prevalence rates are extremely high, highlighting lifetime prevalence.

“It’s almost at looking at every household, classroom and workplace. There [are] 1 in 3 people that may have a mental health issue at some point in their lifetime, which is a lot more than perhaps a lot of people think. When we put it into those facts and figures, it makes it more serious that people are dealing with this on a daily basis,” says Chambers.

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Additionally, mental health issues impact not only those dealing with it, but it also impacts the people around them.

When comparing the country’s statistics to global figures, South Africa is on the list of the top 10 countries with the worst mental health and high suicide rates.

“We normally make the kinds of lists that we don’t want to make, that don’t necessarily show that we have a good mental health system or the fact that the prevalence of mental health is a lot higher in South Africa,” Chambers added.

Depression and suicide

Depression is the most common form of diagnosis in the country, and undiagnosed depression is the leading factor in suicide. It is also the most prevalent diagnosed mental health disorder in the world.

“From Sadag’s perspective, we get about two and a half to three thousand calls every single day to Sadag. That’s a lot of people who are reaching out for help and they often are calling in because of depression, loss, trauma or relationship issues, and even furthermore, we see that the majority of our calls come from youth [people] and from females,” added Chambers.

Moreover, one in four calls received by Sadag is often suicide-related.

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According to statistics, it is estimated that there are approximately 23 completed suicides every 24 hours, said Chambers. For every single suicide, there are about 20 attempts.

This means that there are approximately 460 attempts of suicide every 24 hours.

Chambers said these statistics were especially alarming because they provide data showing only estimates.

“Suicide is very underreported. There’s a lot of shame and stigma, so we often don’t get people reporting especially when there is a lack of resources in rural areas… or whatever the case may be.

“Shame often prevents a lot of families from reporting suicide as a cause of death and that’s very concerning,” adds Chambers.

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Barriers to accessing healthcare

While this is not yet the case, Chambers said mental health services should be included as part of the primary health care clinics.

She says doctors and nurses should be trained to assess and diagnose mental health problems. She brings in the Mental Health Act which was amended last year.

This act outlines what kind of mental health services should be available to all populations, whether in urban or rural areas, or low-income communities. However, the practicality of this act and the reality of what happens in real life is very different.

People in rural and low-income areas often have to travel long distances for basic health care. Additionally, most healthcare facilities they have access to often lack adequate if any mental health services or psychiatrists.

With only one in 10 people having access to mental health facilities, Chambers highlighted the need for improved services.

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There are different types of services throughout the country, however, they are not accessible to everyone.

“Mental health care services on the ground definitely need to be increased and improved. We need more hospitals, hospital beds, community centres and programs and NGOs that can support patients living with mental health problems,” Chambers emphasised.

There are several barriers hindering access to mental health services. Sadag said it had received calls from people calling in saying they’ve been turned away from the clinic due to a lack of medication or the unavailability of doctors and information.

“Education or psychoeducation around mental health [is one of the barriers], people not understanding the signs and symptoms, where to go, what to do and who to speak to,” said Chambers.

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“We also know stigma [is a barrier and] people are too afraid to seek help, to go to the clinic, or take medication. They worry what their families will say if they find out that they have a mental health issue, they are worried if they are going to lose their job if their boss finds out that they have a mental health issue. That stigma is very real,” Chambers said.

The cost of mental health treatment is expensive, poor families would opt to cut these expenses first if they had to choose between feeding their family or paying for medical and mental needs.

Lack of adequate resources

There are only just over 450 psychiatrists in the country, with Chambers saying that there are also some provinces with just one psychiatrist.

“We have in Gauteng like one psychiatrist who will cater for a whole district. We just don’t have enough professionals and human resources to help with mental health concerns,” she added.

Moreover, she highlighted the severe lack of child psychiatrists in the country. She said with Sadag being often the first choice for people to receive help, the lack of resources made it especially difficult to find adequate support and medication for people, often being pulled from pillar to post.

The main barriers to seeking mental health help in South Africa include stigma, cost, and lack of awareness.

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‘Depression does not discriminate’

Chambers said anyone would be likely to be affected by mental illness.

“Depression does not discriminate, it can affect anyone, anyway, anyhow,” Chambers said.

There are children who are diagnosed or dealing with mental health issues as well as the elderly. The youth are majority of the callers coming through to Sadag, and reaching out through awareness campaigns.

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“There are various populations groups that are more vulnerable, including LGBTQI+, people dealing with chronic conditions such as cancer, diabetes, heart disease. These people are higher rate or risk for depression or anxiety. Young people [especially teens] are the most at-risk age group for suicide. However, in all age groups, no one is immune from dealing with mental health issues,” said Chambers.

Furthermore, she highlighted that South Africa has various “contributing factors that could cause, trigger or exacerbate someone’s mental health issues”. These include unemployment, loss, relationships, family matters, finances, the workplace environment, substance abuse and addiction, and trauma.

Implementation and funding of mental health policies

While SA has good policies and strategies for addressing mental health, the problem lies with the implementation of these interventions.

The Mental Health Care Act was launched in 2002, and last year an updated mental health strategy and policy framework and strategic plan was launched at the Mental Health Care Summit.

“While government supports Sadag’s initiatives, we ourselves don’t get any funding from the Department of Health for our mental health services. A perfect example of what is happening on the ground and how mental health needs to be better prioritized, supported and financed, you can look at the Life Esidimeni tragedy— you can see directly what happens when you try to cut mental health budgets and disinvest in its services. It can have fatal consequences,” Chambers said.

Covid-19 impact on mental health

One of the big red flags that came out of the Covid-19 pandemic was the mental health impact according to Chambers.

“Whether you were employed, unemployed, or ill, everyone’s mental health was impacted in some way post covid.”

She said the country should be working on the improvement of mental health services to deal with the increasing demand.

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This can be seen in the increase of the calls Sadag was receiving pre covid, which are about 600 calls daily, however, this has increased to 2500 to 3000 calls per day, excluding hundreds of emails, WhatsApp texts and social media messages.

Chambers says the demand for mental health services has grown exponentially and has not been met equally by increasing services thereof.

Community Outreach

Sadag has implemented the counselling container of hope in order to help communities who don’t have access to psychiatrists or other forms of therapy or treatment.

Chambers encouraged people to educate themselves about mental health and stray from making it a taboo topic.

“Normalise more conversations about mental health, whether it be around the dinner table, on the way to school, around the water cooler at work, around the business meeting table, or at a braai with family and friends.

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She added that normalising healthy conversations around mental health helps break the stigma and paves the way for people to access and accept help. Additionally, advocating for mental health through supporting civil society efforts, and organisations, and joining the call for action can result in more people reaching out for help.

“Choosing carefully about who we are voting for, who we are incorporating as policy and decision-makers, making sure that mental health is on their agenda and then holding them accountable.

“We as a community can come together because everyone is impacted in some way by mental health and i think together we can do so much and it starts by [simply] talking about it. “