10 October 2015 – International Mental Health Day
THE RURAL MENTAL HEALTH CAMPAIGN CALLS UPON THE NATIONAL AND PROVINCIAL DEPARTMENTS OF HEALTH TO TURN THE TIDE ON THE CONTINUED NEGLECT OF RURAL MENTAL HEALTH PATIENTS
On Mental Health Day, the Rural Mental Health Campaign (RMHC) expresses its deep concern that once again we have a good plan, the National Mental Health Policy Framework and Strategic Plan (2013-2020), but which suffers from a total lack of implementation.
Today we release a report on the state of rural mental health care services from the testimonies of mental health care users in the Eastern Cape, KwaZulu-Natal, Limpopo and the North West. The findings reflect that rural mental health care services are still largely inadequate due to the lack of service availability and accessibility, budgetary constraints, drugs shortages, insufficient human resource capacity, a lack of integrated care, as well as stigma and discrimination. This picture emerges despite the fact that neuro-psychiatric disorders rank 3rd in their contribution to the national burden of disease in South Africa. A minority of South Africans living with mental disorders, one in four, have access to treatment[i]. An estimated one in six South Africans will have a mental disorder in a 12-month period and one in three will have a mental disorder at some point in their lifetime. [ii]
Campaign Chairperson Shannon Morgan from Rural Rehab South Africa comments that “the health of persons living with mental health-related challenges has long been neglected by the public health care system in South Africa”. Services offered have largely been modelled on institutional care and have lacked elements that promote social inclusion, empowerment, hope and independence. Services have been centralised in tertiary hospitals in the main cities of South Africa, while most people living with mental health-related issues in smaller towns and rural settings are confronted with unsupportive and inadequate mental health care services. The lack of mental health care services in rural settings is dehumanising. There is an urgent need for integration of services at a local level. This is well illustrated by Thembalihle who is HIV positive and a mental health patient:
“The challenge that I have is that mental health hospitals are very far from where I live. (…). I depend only on a disability grant which is too little to take care of all my needs e.g. visiting two different hospitals on different dates and sometimes my grant will be used by my family for other necessary needs, like food, electricity and many more so I become bankrupt. At least if the health services are integrated it will be better for poor people like us.” –Thembalihle.
Current predictions foresee depression as being the number one global burden of disease by 2030, surpassing heart disease and cancer[iii]. Research has further shown that people living with HIV and AIDS have an increased chance of enduring a mental disorder over the course of their lifetime[iv].
“One of the most important commitments in the National Mental Health Policy Framework is that provinces would be required to develop provincial strategic plans for mental health that contain specific strategies, activities, targets and budgets. The RMHC found that none of the provinces has met this commitment and there is no indication that any process is currently underway to do so”, says Daygan Eagar from the Rural Health Advocacy Project.
Through her article Charlene Sunkel from the South African Federation for Mental Health discusses mental health care users’ right to dignity and highlights how “Stigma and related discrimination have a huge impact on a person’s life, and cause severe disabling effects, even more so than the symptoms of their mental disorder. It creates barriers that prevent mental health care users from accessing and enjoying their constitutional rights.”
Mental health care services can no longer just be an added component of the services offered at Primary Health care level, but must be holistically integrated in all interactions with service users. If South Africa is to make a meaningful change then:
- Provinces must ensure that the National Mental Health Policy Framework is translated into the provincial strategic and operational plans.
- Provincial strategic and operational plans must explicitly demonstrate that the context of rural mental health care settings has been taken into account.
- Provinces’ plans must include targets, indicators, budgets and timelines that support the realisation of accessible and quality mental health care services for rural populations.
- Provinces must formalise human resources strategies that are favourable to rural mental health care settings and are in line with the commitments of the National Mental Health Policy Framework.
- Provincial health departments must monitor and evaluate the implementation of the National Mental Health Policy Framework and ensure the provision of a sustainable budget for mental health services to develop the capacity of mental health departments and supporting structures.
For further information and comment contact the members of the RMHC Task Team:
Shannon Morgan (Campaign Chairperson), Rural Rehab South Africa, 071 677 2576
Mafoko Phomane (Campaign Coordinator), Rural Health Advocacy Project, 073 068 1359
Meba Kanda, Rural Doctors Association of South Africa, 082 418 1414
Ingrid Daniels, Director Cape Mental Health, 021 447 9040
Charlene Mapukata, Professional Association of Clinical Associates in South Africa, 079 655 6025
Access a copy of the Rural Mental Health Factsheet here : www.rhap.org.za/rural-mental-health-factsheet
Follow the campaign and World Mental Health Month events on #DignityInMind and #WMHD2015
 The Rural Mental Health Campaign was started in 2014 by a group of organisations at the Rural Health Conference in Worcester, including the SA Mental Health Federation, RuRESA, RuDASA, RHAP, Cape Mental Health and many others, who were deeply concerned about the lack of progress made in the implementation of the National Mental Health Policy Framework. Through the discussions, a worrying picture was presented about the state of rural mental health care and it was decided that an organised response was needed to ensure that rural mental health is prioritised.
 A National Mental Health Summit was held on 12-13 April 2012 at St George Hotel in Gauteng Province, under the theme “Scaling up investment in mental health for a long and healthy life for all South Africans”. The Summit reviewed both the quality and quantity of mental health services that were being provided and found that some progress had been made in enacting mental health legislation and policy, but there were still many challenges especially with implementation. The new Mental Health Policy Framework and Strategic Plan was formally adopted for implementation by the National Health Council on 29 July 2013.
[i] Herman AA, Stein DJ, Seedat S, Heeringa SG, Moomal H, Williams DR. The South African Stress and Health (SASH) study: 12-month and lifetime prevalence of common mental disorders. South Afr Med J Suid-Afr Tydskr Vir Geneeskd. 2009 May; 99(5 Pt 2): 339–44.
[ii] Williams DR, Herman A, Kessler RC, Sonnega J, Seedat S, Stein DJ, et al. The South Africa Stress and Health Study: rationale and design. Metab Brain Dis. 2004 Jun; 19(1-2): 135–47.
[iii] WHO, Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level, December 2011
[iv] L Schlebusch MA(Clin Psych), MMedSc(Psychiat), PhD, C Psychol(UK), FRIPH(UK) (2005) Depression and suicidal behaviour, South African Family Practice, 47:5, 61–63, DOI: 10.1080/20786204.2005.10873234