The health authorities of South Africa’s richest province, Gauteng, have opened an investigation into 37 deaths attributed to chronic mental illness that occurred over four months. These patients were among 1300 people who had been relocated last December from a mental facility. Janine Bezuidenhoudt discusses why mental health in developing countries is still neglected. South Africa is no exception.

Mental health has become a priority in the world. Has this resulted in a change in the way mental health is managed, especially in developing countries?

The challenges facing developing countries are unique and can either worsen or cause mental disorders. People who have experienced trauma, violence, or injury, as well as those with infectious diseases and harsh economic conditions, are all included.

Depression is the most common mental disorder in the world. According to the World Health Organisation, more than 350 million people worldwide suffer.

Mental health is not given priority when it comes to allocating resources. The burden of infectious diseases and non-communicable illnesses is given priority.

Mental health is a priority in developing countries. Mental health disorders and nervous system disorders, which include neuropsychiatric disorders, are the third largest contributor to the disease burden after HIV/AIDS.

A second problem is that, despite the fact that policies for mental health have been developed, their implementation continues to be a challenge. The management of mental healthcare in developing countries is not different.

How is South Africa treating its mentally ill?

South Africa is known for its unkindness to its most vulnerable citizens. This includes people with mental disorders. The last decade has seen a significant improvement in terms of policy. Several programs are in place to help people with mental health issues. These include:

These policies are designed to ensure that citizens with disabilities have the same rights and responsibilities as other citizens.

Policies alone will not suffice, particularly if they are not enforced or if there is no accountability.

Several examples show that the policies don’t have the desired impact. The recent death of 37 people over four months was perhaps the most shocking.

A total of 1300 patients with mental illnesses were transferred to non-governmental organizations from the Life Esidimeni Health Care Centre. The South African Depression and Anxiety Group, Psychological Society of SA and Section 27, a human rights group, and the South African Federation for Mental Health all warned against this move.

The government transferred the patients to organizations that lacked the necessary resources to care for and manage them. The deaths were shocking. There are still questions about the living conditions and quality of care for the other patients.

What are the challenges facing South Africa?

Mental health is not adequately funded and resourced.

Mental health professionals are insufficiently trained. In 2010, South Africa only had 1,58 psychosocial providers per 100,000 people. Argentina had 13,19 psychosocial providers per 100,000 people during the same period. World Health Organisation has recommended that South Africa increase its number of psychosocial professionals by 29,37.

Mentally ill patients are heavily reliant on psychiatric hospital care and management. The most vulnerable people in the country cannot access mental health services provided by the public sector. Mental health professionals are also not enough in the hospitals.

There is a significant treatment gap. Around 75% of those with mental illness don’t receive mental health care.

Western psychological models are also used. They are not representative of the South African population. South Africa’s high HIV/AIDS and TB prevalence means that mental health screening tools, treatment care models, and other measures are needed. The country doesn’t use indigenous knowledge systems, like traditional healers, for primary prevention.

Mental health management and treatment are not generally integrated into other healthcare programs.

Discrimination and stigmatization are common for people with mental illnesses. They don’t get the care they need. They often don’t receive the care they need.

What is needed?

Priority should be given to the management and delivery of mental health services. Mental health care needs to be de-institutionalized in order for community-based care to be implemented on a systematic basis. It would be necessary first to strengthen and then expand community-based care.

Mental health screening should be part of primary care, especially for those with TB, HIV, AIDS, or recently given birth.

The country should develop indicators to monitor and evaluate mental health services. These indicators need to be assessed and monitored.

The human resources need to be addressed as well. It is important to do this at different levels. All healthcare professionals should receive training on how to deal with mental disorders. Mental health care, treatment, and management must be taught to managers at the management level to ensure that mental health is treated as a vital part of health care. It should be incorporated into routine healthcare delivery. Cognitive health management should not be considered a specialty. The curriculum should include cognitive health management as part of the broader curriculum.