Speech by the Minister of Health: Dr MJ Phaahla, MP, at the World Mental Health Day commemorative event; Madadeni Hospital, Kwazulu-Natal Province. Tuesday, 10 October 2023
Programme Director, Dr Sandile Shabalala;
Deputy Minister of Health: Dr Sibongiseni Dhlomo;
MEC for Health; Ms Nomagugu Simelane;
World Health Organisation Country Representative, Dr Owen Kaluwa;
Director-General of the Department of Health, Dr Sandile Buthelezi;
Chairperson of the SA Human Rights Commission, Adv Bongani Majola;
Registrar of the Health Professions Council of SA, Dr Magome Masike;
Vice Chairperson and Members of the Ministerial Advisory Committee on Mental Health;
Members of Mental Health Review Boards;
Officials of the Department of Health and other government departments;
Our Healthcare Workers
Distinguished guests
Today we have gathered here joining the rest of the global community to observe one of the most important days on the international health awareness calendar, World Mental Health Day to educate the general public and raise awareness on mental health and mental illness issues like signs and symptoms, access to treatment, importance of support structures at family and community level to enable those experiencing mental health problems speak out and seek help on time.
We are commemorating this day to mobilise stakeholders, communities, employers and families and the general public to play a role in promoting and respecting the rights of mental health care users, dispel any myths and misinformation about mental health.
Programme Director - I am saying this because social stigma and discrimination against people with mental health are rife and serve as barriers for some people to avoid getting the help they need because of the fear of being stigmatised, and this makes their problems worse, making it harder to recover. That is why as the department we are going to intensify mental health awareness campaign to empower the citizens reduce stigma associated with mental illness, promote help seeking behaviours and emotional well-being practices, and also prevent avoidable suicide.
At least less than 30% of people who suffer from mental health illness receive treatment in South Africa, and the rest do not, and this should concern all of us because this means we are living with family members, relatives, colleagues who remain undiagnosed and at risk which can cause danger to others. The question is, where the rest of 70% are, what do they do with their problems. Imagine a bus or truck driver with unresolved or unattended mental problems transporting people on the road on a daily basis.
Mental health is an important topic which should be discussed more frequently in communities, schools, employment settings. This year’s World Mental Health Day theme is “Mental Health is a Universal Human Right”.
The theme is reminding all of us as government, civil society, communities, and stakeholders about the importance of mental health and the need to further strengthen access to quality mental health services for all and ensure that human rights and well-being of people with experiences of mental disorders are protected, promoted, and respected.
We have convened the first South African Mental Health Conference this year in April which served as an important and much-needed platform for dialogue and the policy framework and strategy to guide our implementation efforts.
The conference enabled mental health experts, policy maker, mental health providers, and people with lived mental health problems to share the best practices and strategies to improve mental health service provision and health seeking behaviour.
As we gather around the topic of mental health today, we need to be reminded about the importance of this area of health. We come from a past where this programme was not prioritized at the level that it deserves. It was not seen as being important as it should, even in resource allocation.
There were even those who referred to it as a Cinderella of the health system after the children tale story about Cinderella who was an orphan that was neglected and ill-treated.
We were all fixated in preventing deaths from pandemics like HIV and AIDS, TB and others without noting that mental health is central and determines the treatment outcomes for these and other chronic diseases.
The 2019 Global Burden of Diseases Study estimates that mental disorders remained among the top ten leading causes of burden of disease worldwide including in sub-Saharan African Region.
This confirmed the findings by the Medical Research Council in their 2006 burden of disease estimates that ranked neuropsychiatric conditions as 3rd in their contribution to the overall burden of disease in South Africa, after HIV and AIDS and other infectious diseases.
These estimates tell us that mental disorders make a substantial independent contribution to the burden of disease, not just in South Africa, but worldwide. The trends are similar worldwide.
The current socioeconomic challenges emanating from the effects of the COVID-19 pandemic and the increasing risk factors for mental illness have brought more strain on the mental wellbeing of all individuals.
Mental illness knows no racial boundaries as experts tell us that there are no differences between socially defined racial groups or cultural groups in the prevalence of mental disorders.
However, there are important gender differences where women are at increased risk of developing depression and anxiety disorders, whereas men are at increased risk of developing substance use disorders.
Suicide is also another challenge where we have seen children as young as six years committing suicide.
Although suicide is not always as a result of a mental illness with studies having shown that other factors like socioeconomic fallouts, poverty and certain personality traits contribute to suicide, mental disorders are also one of the main risk factors for suicide.
High levels of mental distress, poor coping skills and mental disorders like depressive disorders do drive people towards attempting to take their own lives or even succeeding in doing so. Whilst the health sector does not deal with actual completed suicide as these are dealt with by the law enforcement agencies, the health sector deals with suicide attempts that come to health facilities for treatment.
We have therefore introduced a new indicator on suicide attempts in our health information system from this financial year, 2023/24. This data will be used to determine trends and hot spots for attempted suicides to inform suicide prevention interventions.
Data is already showing that there are high levels of suicide attempts in the country. A total of 78 783 people were seen for suicide attempt in our health facilities during the period from 1 April 2023 to the end of August 2023. 78% of these were in this province of KwaZulu-Natal.
Ladies and gentlemen, mental health is not just an individual or personal issue but one that is critical to social and economic development requiring a multisectoral and all society approach in handling. The role of civil society, faith-based organisation, other sectors and collaboration with our traditional health practitioners in the prevention, care, treatment and rehabilitation of mental cannot be overemphasized.
We have made strides in increasing access to mental health services to ensure early detection and treatment. The following are among others:
- We developed guideline to identify and treat conditions including, at Primary Health Care level called the Adult Primary Health Care manual. This tool which uses algorithms, makes it easier for staff busy at primary health care to identify and treat mental illness including referring those that need higher expertise to manage.
- Psychotropic medications are included as part of the primary health care essential medicines list. This ensures that people identified at primary health care with a mental health condition that require treatment by medication do not have to travel long distances to hospitals but can receive the necessary medications at primary health care level unless their condition require higher level expertise that are not available at that level.
- The curriculum for training of community health care workers include training in basic mental health care skills so that they are able to identify symptoms of mental health problems in communities and refer to the clinic and also provide education to promote mental health and prevent mental illness.
- A conditional grant to contract mental health professionals (psychiatrists, psychologists, registered counsellors, occupational therapists, and social workers) to complement the already available staff was made available.
- As of this current financial year a total of R165 147 000.00 was allocated for the provinces to contract private psychiatrist, psychologists, social workers, occupational therapists, and registered counsellors to complement the already existing staff and render mental health services in primary health care. R33 453 000.00 is allocated to KZN province of which the province has spent 54% by end of September 2023. The provinces are also using this grant to increase resources for forensic mental observations.
- Provinces are incrementally attaching mental health units to general hospitals to increase integration of mental health into the general health services environment and thus improve access as envisaged by the Mental Health Care Act, 2002 and the National Mental Health Policy Framework 2023-2030. Mental health units have been attached to 42 general hospitals, a departure from the old order where mental health services were only available in specialized psychiatric hospitals mostly situated far away from communities.
Furthermore, there are mental health infrastructure projects taking place in provinces. The projects include attaching mental health units to general hospitals, renovations, and refurbishments of psychiatric hospitals.
The increase in substance abuse in our country, especially among the youth, has created a new pandemic, destroying the future of our country. Ending this pandemic requires strong partnerships with all stakeholders including communities.
Whilst we have a Health Sector Drug Master Plan which, highlights responsibilities of the health sector in terms of the National Drug Master Plan that is led by the Central Drug Authority under the Department of Social Development dealing with the substance abuse pandemic requires a strong stakeholder partnership especially communities and young people.
More needs to be done on the prevention side and identification of the triggers to early initiation in collaboration with the Department of Social Development as a lead Department in this area. Mental health resources continue to be characterized by significant provincial variability, including the availability of specialised psychiatric hospital, and the unequal distribution of professionals rendering mental health services.
We are cognizant of the fact that rendering quality mental health care, treatment and rehabilitation services is not possible without sufficient and properly skilled human resources and relevant infrastructure.
Mpumalanga Province is still without a specialised psychiatric hospital and as a result, still requires assistance from Gauteng Province for specialised mental health services like State patients and forensic mental observation facilities. I am informed that plans to build a specialised psychiatric hospital in Mpumalanga Province are in place.
Ladies and gentlemen, when planning for this event, I impressed on the officials that mental health care users should be involved and be represented on the programme. We can’t talk about them without them.
We heard the perspectives from Ms Nqobile Hlatshwayo and Ms Asanda Mbonane talking about their experiences and journey as users of the mental health care services. Ms Hlatshwayo and Ms Mbonane I want to say that we are here to continue to improve the services that we render to you and many other people with lived mental illness experiences that you are representing here.
Mental health care users must enjoy the full benefits of our Constitution and Bill of Rights. They must also benefit from the liberties and freedom that all other people enjoy. Because of their condition and the stigma that they often have to face, they are often “voiceless” and it is critical that we give this group space to voice their needs and to participate in their care, treatment and rehabilitation policies and plans.
We cannot and should not fail our own who are vulnerable.
Ladies and gentlemen, in terms of strengthening Governance around Mental Health:
- The Mental Health Care Act among others prescribes establishment of Mental Health Review Boards, whose main mandate is to protect and uphold the human and health rights of mental health care users. These have been established in all provinces.
- All provinces reported to have established intersectoral mental health forums comprising of public and civil society stakeholders around mental health.
- At the national level, the Ministerial Advisory Committee on Mental Health established in terms of Section 71 of the Mental Health Care Act comprises of representatives from various stakeholders including the public and private sector, research institutions as well as civil society organisations and representatives of persons with lived experience of mental illness. The Vice Chairperson, Prof Zingela and some of the members are among us today. The Chairperson, Professor Rataemene tendered an apology due to another commitment.
- Furthermore, at a national level, there is an interdepartmental committee on mental health comprising of officials from stakeholder departments and civil society organisations to improve collaboration in the implementation of mental health projects as mental health is a cross-cutting service.
The Department further works closely with the Departments of Justice and Constitutional Development, South African Police Services, National Prosecution Authority as well as Correctional Services in terms of the health sector mandate emanating from the Criminal Procedures Act of 1977 as amended as well as the Child Justice Act of 2008 as amended.
In conclusion, I urge all of us to be more caring individuals and communities.
Our clinicians and professionals can assist with treatment of those that have mental health conditions requiring professional care, but we individually can and should do what we can to promote our loved ones’ mental health.
I thank you - Ngiyabonga
