MHM Magazine

2 | MENTAL HEALTH MATTERS | 2023 | Issue 3 MHM case shows that the economic value of restored productivity over a 15 year scale up (from 2020 to 2035) amounts to R117.7 billion when quantifying the social value of the investment. In other words, it makes good economic sense to invest in mental healthcare and prevention. The new mental health policy document also sets out a new vision: “Comprehensive, high quality, integrated mental health promotion, prevention, care, treatment and rehabilitation for all in South Africa by 2030.” The mission of the policy states: “From infancy to old age, the mental health and well-being of all South Africans will be enabled through the provision of evidence- based affordable and effective promotion, prevention, treatment and rehabilitation interventions. In partnerships between providers, people with lived experience, carers and communities, the human rights of people with mental health conditions will be upheld; they will be provided with care and support and they will be integrated into normal community life.” The new policy document also sets out “Areas for Action”, including organisation of services, financing, promotion and prevention, intersectoral collaboration, advocacy, human rights, special populations, quality improvement, monitoring and evaluation, human resources and training, psychotropic medication, and research and evaluation of policy and services. The final section of the policy document is a strategic plan which includes 8 specific objectives, with related key activities, targets, dates and indicators. The objectives are: 1. To strengthen district and primary healthcare based mental healthcare services including the establishment of one District Mental Health Team in each district in the country. The role of District Mental Health Teams is to adopt a public health approach to the mental health of their district: conducting a situation analysis, coordinating mental health stakeholders and developing and implementing a district mental health plan – a crucial and proven means of coordinating and delivering services at local level. 2. To build institutional capacity for mental health at national, provincial and district levels, including the establishment of Provincial Mental Health Directorates in each province and ensuring the availability and functionality of the Mental Health Review Boards in keeping with the Mental Health Care Act of 2002. 3. To conduct mental health surveillance and research and to strengthen innovation, including establishing a national mental health research agenda in partnership with all relevant research stakeholders. 4. To develop and improve infrastructure and capacity of mental health facilities, including mental health inpatient units in designated district and regional hospitals and revitalising dilapidated mental health facilities in all provinces. 5. To monitor and improve the availability of mental health technology, equipment and medicines. 6. To strengthen intersectoral collaboration at national, provincial, and local levels. 7. To increase and strengthen human resources for mental health including training of primary healthcare staff in basic mental health care to improve detection, care, and referral of people with mental health needs. 8. And finally to strengthen mental health promotion, prevention and advocacy; including establishing a national education programme for mental health to improve knowledge about mental health and reduce stigma and discrimination against people living with mental health conditions. This includes a strong emphasis on the prevention of suicide including through the establishment of a suicide helpline. The new Mental Health Policy Framework and Strategic Plan (2023-2030) was presented to the public for the first time at the National Mental Health Conference attended by approximately 700 delegates in Johannesburg on 24 to 25 April 2023. Although the policy was generally welcomed, those attending the conference expressed frustration with the poor implementation of the previous policy. Many also spoke about the urgency of implementing the new policy, given the daily reality faced by thousands of people living with mental health conditions: inadequate services, a treatment gap exceeding 90%, and widespread stigma, depriving people of their right to care and dignity. This is the challenge that now faces all of us: how do we translate a mental health policy with its lofty ideals into reality in our communities? In short, how do we ensure that it makes a real difference in people’s lives? A key barrier in implementing the previous policy was the failure of some provincial Departments of Health to allocate budgets to implement the policy. Indeed, some provinces actually cut mental health spending, with the Life Esidimeni tragedy in Gauteng being a case in point. It is therefore vital that we hold provincial governments to account to deliver on the policy, particularly for vulnerable groups such as children and adolescents, people living in poverty and older adults. Now more than ever before we know what needs to be done to provide effective and humane care and to prevent mental health conditions across the life course. With a new policy providing direction to government and civil society, we have an opportunity to unite behind the policy from diverse sectors of society and implement it. Mental health is everybody’s business. The time to act is now. References available on request.