MHM Magazine

20 | MENTAL HEALTH MATTERS | Issue 1 | 2022 MHM Prof Rita Thom’s survey found that in 2017 the average length of stay: • District Hospitals: 8.6 days • Regional Hospital: 28.6 days • Tertiary Hospital: 54.8 days • Specialised Psychiatric Hospital: 151.1 days THE ECONOMIC BURDEN ON HOUSEHOLDS Even in the private sector, insured mental health patients have no financial protection and face many out-of-pocket expenses. As part of the International Emerald Household Survey it was found that in the uninsured public sector there is high level of economic instability in families with a mental health diagnosis. The cost of mental health care is high and is compounded by the loss of earning potential when someone is ill. These families open more shop accounts, take on extra work, and ask for more loans. To ‘save money’, these households: • Reduce quantity and quality of food • Reduce healthcare in general • Withdraw children from schools MENTAL HEALTH CARE SPENDING Despite good policies, mental health care remains marginalised. South Africa’s 2016/2017 health expenditure was within the WHO’s recommended constraints but disproportionately spent. Over 80% of healthcare spending is on in-patient care. “A big concern going forward is that we cannot de-institutionalise care if there is no funding for anything outside of a hospital,” says Dr Docrat. Mental health services remain separate and unintegrated. One example of this is ante-natal screening. Every ante-natal patient should be screened for depression. Despite nurses being trained to do this, it is not happening. The cost of inaction is far more severe than the cost of mental health care action. According to the WHO, $1 spent is a $4 return on investment. THE NHI SERVICE BENEFIT FRAMEWORK The NHI Service Benefit Framework has the potential to provide universal health care but in its current form it doesn’t meet even basic needs and it totally ignores mental health. Currently, proposed guidelines make zero provision for specialist care and is reinforcing institutionalised care. Mental health is included as one of the Sustainable Development Goals, yet there are no explicit targets for sectors to deliver services. In addition, South Africa has signed the UN Convention on the Rights of People with Disabilities but our systems and policies don’ reflect it. WHERE TO NOW? Across districts, we need to map out all services that are available – PHC, private health care, mental health, counselling, support groups and to make them accessible to all citizens. It is crucial to understand the link between physical and mental health. Psychoeducation, early screening and identification needs to be done across all sectors – from teachers to community organizations, police, banks, families and individuals. “We need a paradigm shift from institutionalised and hospital care to community health, inclusion and rehabilitation,” says Prof Moosa. Communities need to be empowered across the country – trained, supported and licensed. PHC services as well as existing mental health care services are lacking. Secondary level psychiatric care as it does exist must continue as it is the only option available. South Africa’s health care system certainly operates too much in silos and there is too much focus on specialist care. Realistically, there won’t be a sudden increase in the number of psychiatrists or psychiatric beds for in-patient care. We are trying to do a lot with very little financial or human resource support. South Africa must shift the approach to mental wellness and mental health care.