MHM Magazine

A few years ago, when my colleagues and I organised the first mental health advocacy walk in Durban, the public spirit was infused with excitement and possibility from get-go. We started with a few dozen people at our first walk in 2016 and this grew to over 1000 by 2019. There was a genuine desire from citizens to show up and speak up. I was not surprised by the positive uptake. Results from the Global Burden of Disease Study (1990-2017) show that mental disorders are in the top 5 leading causes of disability in sub-Saharan Africa and that depression was on its way to become the leading cause of disability by 2030. Yet, the treatment gap in South Africa is over 90% with appallingly low public spending on community mental health. In fact, I was shocked that the hundreds of patients languishing on long waiting lists at most hospitals were not already taking to the streets to demand that government employ more healthcare workers. However, despite the obvious need for radical activism, the transformation of this need into a citizen-led movement has been slow. As professionals, we used our convening power to create the advocacy walk, but hoped that patients, or service-users/ people in recovery, their families, communities, allies and fellow activists would leverage the initial successes and take ownership of its future direction. A thousand people pitching up once a year to destigmatise mental illness is amazing; but how do we keep mental health activism on the agenda for the other 364 days of the year? In light of the emotional earthquake caused by Covid-19, isn’t it obvious – yet! – that mental health really does matter? For complex reasons, it’s difficult for ordinary citizens to drive advocacy. Foremost, the healthcare system is not enabling of, and receptive to, the voices of the people it’s meant to serve. There are structural barriers preventing people’s voice taking center stage. Speaking up is one thing; being heard is another. Redefining ‘experts’ There are few, if any, embedded spaces in the healthcare system that actively solicit and implement the advice of people living with mental illness. For example, how does it feel to undergo a 72-hour observation, as per the Mental Health Care Act? Do people with suicidal thoughts know where to access help? When people are put on waiting lists to see a psychologist or psychiatrist, what do they do in the meantime? Why is adherence to psychotropic medication so difficult for some people? Do people feel empowered to tell their GPs about mental distress? Do GPs routinely screen for depression, self-harm, substance abuse, or neuropsychological decline, given that GPs are the first point of contact? WE NEED A MENTAL HEALTH MOVEMENT LED BY PEOPLE WITH LIVED EXPERIENCES EDITORIAL Suntosh R. Pillay Clinical Psychologist Durban suntoshpillay@gmail.com Issue 61 | 2022 | MENTAL HEALTH MATTERS | 1 MHM