MHM Magazine

38 | MENTAL HEALTH MATTERS | Issue 1 | 2022 MHM Mental ill-health and awareness of it has become more prevalent globally as there is greater understanding as to what it entails and of the effects it has on individuals and societies at large. Research suggests that 80% of people in under-developed and developing countries are known to suffer with depression but are not formally diagnosed or treated. This compares to 50% of people in developed countries who live with depression and are mostly correctly diagnosed. South Africa is classified as a middle-income country. This means that, as a society, South Africa has pockets of communities that have high-income country health services and for these communities, diagnosis with mental ill-health and access to treatment is better than in the low-income communities. Although South Africa has a growing middle-class population, the burden of unemployment and underemployment is felt and absorbed by this middle- class. People who occupy the middle- class may or may not have access to comprehensive medical aid to afford regular heath care. An unmet health care need is mostly observed amongst people of African descent who require mental health services. The South African working class wholly relies on the public healthcare services. Needless to say, even before the Covid-19 pandemic, the South African public health system had challenges meeting the health needs of its users. This unmet need continues against the backdrop of a common practice of medical pluralism (the use of both African and Western allopathic systems). Although medical pluralism exists in South Africa, not enough support is provided to the African healing modalities. Even with calls from institutions of higher learning and research councils to decolonise knowledge systems and promote indigenous knowledge systems, this is not matched with adequate resource allocation. Nduna , Mzikazi Faculty of Health Sciences, University of Fort Hare; Packery , Jogini; Sefanyatso , Kamogelo, Department of Psychology, University of the Witwatersrand Nkomo , Thobeka; Department of Social Work, University of the Witwatersrand Mdanda , Sanele; Department of Geography, Archaeology and Environmental Studies, University of the Witwatersrand Kheswa , Jabulani, Department of Psychology, University of Fort Hare Nkala , Bongani Alphouse, Department of Applied Science, Pearson Institute of Higher Education, and African Traditional Research Institute. INTEGRATE TOWARDS DUAL THERAPY INTERVENTIONS FOR MENTAL HEALTH SERVICES IN SOUTH AFRICA THE SOUTH AFRICAN MENTAL HEALTH CHALLENGE The call for decolonial education and the promotion of indigenous knowledge systems recognises that the understandings and conceptualisation of mental health and ill-health in science and medical practice are deeply situated in Western culture. The ability of the Global North to inform how mental health and ill-health is understood and perceived in the Global South is a remnant of the power relations from colonial times whereby Western biomedicine is prioritised. Owing to colonial education and science, indigenous methods of healing and intervention are not developed, although they may be the most accessible to most people in Global South settings. Within the Global South, social and cultural aspects are just as important as medical aspects in the understandings and treatment of mental ill-health. With that being said, the World Health Organisation (WHO) states that mental health is ‘not merely the absence of mental disorder or disability but a state of well-being’. This state of well- being comprises of a realisation of one’s abilities and ability to cope with typical stresses, working productively, and contributing to one’s community. Mental ill-health doesn’t only impact the individual but communities and societies too.  Notably, the intersectionality of race, culture, religion, gender, class, and disability in the Global South is ignored. Obliviousness to the intersectionality of these identities and experiences has dire effects on many individuals and families in South Africa, due to their exposure to systemic violence. This lack of analysis of intersectionality reproduces knowledge that inadequately addresses the mental health needs of many people who are viewed narrowly by the health care providers and policymakers. Even where there is evidence that indigenous ways of addressing mental health are comprehensive and accommodating of the reality of the embodiment of multiple identities, they are neglected and side-lined from the mainstream. As a result, people may sit at home with unmet mental health needs which the allopathic services cannot meet due to both the lack of capacity and lack of insight into the effects of intersectionality. Whilst many South Africans continue to be treated by traditional health practitioners, these practitioners are not adequately supported by the South African government. ONE PERSON IN MANY Many persons in one – calling for an intersectional perspective on mental health policy and practice