Nkateko Ndala-Magoro, counselling psychologist and lecturer in the Department of Psychology at UP, details the barriers that exist to accessing mental health treatment.

World Mental Health Day is commemorated annually on 10 October. On this day, mental health practitioners, organisations and advocacy groups attempt to demystify notions around mental health and build trust in seeking mental health intervention.

Another aim of World Mental Health Day is to create general awareness of mental health issues. This day is meant to mobilise support and funding from governments around the world towards mental health interventions.  

In their Global Burden of Disease study in 2017, the Institute for Health Metrics and Evaluation reported that about 10.7% people worldwide lived with a mental health disorder.

On average, the burden of disease caused by mental illness accounts for 12% of total disability-adjusted life years (DALYs) and 35% of total years lived with disability (YLDs). However, these figures could be underestimated due to under-reporting, especially in middle- to low-income countries where there is limited access to mental healthcare facilities and services. This points to a clear imbalance between the burden of disease and health expenditures, with most countries reportedly spending as little as 2% of their GDPs on mental healthcare.

Accordingly, there are several barriers to accessing mental healthcare.

The first barrier results from inadequate government funding. The Mental Health Care Act 2002 was implemented in South Africa in 2004 and, like the Constitution, it was acclaimed as one of the most progressive pieces of mental health legislation in the world. An entire chapter was devoted to human rights for those living with mental disabilities. In addition, the act contained literature that spoke to mandatory admission, protection of patients’ property, rights to appeal, the reporting of abuses and the formation of independent review boards with full ombud functions. The act also emphasised the importance of treatment as well as rehabilitation, and the reintegration and decentralisation of mental healthcare from tertiary institutions, such as psychiatric hospitals, to primary health facilities such as clinics and community-based health services.

Unfortunately the act’s intentions were inadequately funded, which meant that training and facilities were not provided; no government budget was allocated for the implementation of this legislation. The results of this oversight can be seen in incidents like the Life Esidimeni tragedy in 2016. Despite several organisations and lobby groups trying to intervene, patients were removed from Life Esidimeni as a “cost-saving” measure. 

Consequently, 144 mental healthcare patients died, while 1 418 other patients were exposed to ill-treatment, trauma and poor healthcare management. The legacy of not funding mental health interventions is evident in the number of countless challenges encountered throughout the health services nationwide in relation to the care, treatment and rehabilitation of those with mental health illnesses.

The second barrier to mental healthcare services stems from the fact that, generally, psychology and mental healthcare is associated with Western cultures because of its roots and emphasis on Western science. South Africa still lacks mental healthcare practices that are Afro-centric and collectivistic in their approach, and that are more appropriate to the South African context. Some individuals might therefore be hesitant to access mental healthcare, because they do not relate to professionals or could be worried that they (and their concerns) will not be fully understood.

The COVID-19 pandemic has highlighted the fact that nations cannot ignore the impact of mental illness on society and individuals. Indeed, mental illness has been described as the “second wave of COVID-19”, in that as much as the pandemic has impacted us economically, the lasting impact might be on mental health. How various governments deal with the recovery of their citizen’s mental health challenges as a result of the pandemic has a direct effect on the economic recovery of these nations.

We still have a long road to go towards addressing these mental health challenges. Only through actively promoting and supporting access for all can this be achieved.