In the face of a mental health pandemic in South Africa, the share of the national public health budget allocated to mental healthcare is not only woefully inadequate, but could be better invested in prevention and care at the primary healthcare and community level.
The country has been hindered by significant gaps (financial investment) in initiating a sustained mental health response.
Responding to Finance Minister Enoch Godongwana’s 2023, the South African Society of Psychiatrists (Sasop) said it was concerned that mental healthcare continued to be underfunded while common mental health conditions, including anxiety and depression were on the rise.
“Mental healthcare continues to be allocated only 5% of the national public health budget and since the health budget itself is declining in real terms, the mental health portion is declining in monetary terms,” Sasop public sector national convenor, Dr Kagisho Maaroganye said.
Even though one in three South Africans experiences a mental illness and 75% of them are unable to receive treatment, Maaroganye claimed that mental healthcare professionals had noticed a sharp rise in common mental health issues "after Covid-19 ran through the country and caused both documented and untold misery for all citizens“.
As a result of this shift, common and curable mental health issues now account for more medical disability claims than physical illnesses and accidents.
However, the focus of the mental healthcare system is skewed towards more severe mental health conditions that affect less than 1% of the population, said Maaroganye.
The latest Mental State of the World report rated South Africans’ mental well-being as the lowest in the world, with the country’s “mental health quotient” steadily declining. South Africa also had the highest percentage (36%) of people experiencing emotional distress or struggling with mental health, an increase of 8% from 2020.
The combined effects of the Covid-19 pandemic, including social isolation, job losses, illness and threats to people's physical health, and family member deaths, are to blame for the widespread emotional distress and mental illness.
Maaroganye further states that the continuous under-funding of mental health care hampers prevention and diagnosis of mental illness, and limited access to treatment, coupled with shortages of mental health clinicians, a lack of experienced practitioners, insufficient resources to follow up and ensure compliance with treatment, all contribute to a persistent treatment gap.
“Insufficient attention to the mental health needs of expectant and new mothers, and of children and adolescents, suggests that the prevalence of mental illness is likely higher than indicated in surveys,” he said.
When it comes to the mitigation strategies that continue to afflict South Africans who are battling mental illness, we are aware that budget allocations are highly unlikely to be an exact science.
However, it is important that we recognise that providing necessary mental health services requires greater resources, which is vital given existing low allocations.
“South Africa’s mental healthcare budget, as a percentage of the overall health budget, is at the lower end of international recommendations for mental health spending, but it is also misdirected. Budget allocations are hospital-centric and reactive, with 86%of the budget allocated to inpatient care, and almost half that to specialised psychiatric hospitals.
“Instead of avoiding or offering early intervention and treatment for prevalent and frequent mental health illnesses like anxiety and depression before they deteriorate into more serious mental diseases, the focus is on treating the most severe conditions, which have a prevalence of less than 1%.
“While only 8% of the mental healthcare budget is allocated to primary healthcare, Sasop argues that it is at this level that community psychiatry can work to prevent mental illness and ensure early treatment that prevents mental health conditions from becoming disabilities.
“Community psychiatry offers the best prospects for optimal care for a stabilised mental healthcare patient in the community and prevents the cost of repeated hospital admissions,” Maaroganye said.
Within the constraints of the mental healthcare budget, Sasop has urged the government to concentrate investment in mental healthcare at the community psychiatry level to improve quality of life by enabling people with mental illness to retain their dignity, achieve or regain independence, and return to being productive members of society.