Are mental illnesses adequately funded?

According to statistics released by the South African Depression and Anxiety Group (SADAG), as many as one in six South Africans suffer from anxiety, depression or substance-use problems (excluding conditions such as bipolar or schizophrenia). Unfortunately most people are not getting the help that is needed. Alina Hardcastle takes a look at the stigma surrounding mental illnesses and whether or not these illnesses are being supported by medical schemes.

The stigma

Despite the advancements in psychiatry, Yoav Van der Heyden, a clinical psychologist based in Cape Town, highlights that there is still a stigmatisation and misunderstanding of psychiatric disorders. “It’s very difficult for people without any intimate experience of psychiatric disturbances to comprehend what it means to have something “going wrong” in one’s thoughts and sensations. People are in general willing to accommodate disabilities that they can see, whereas many psychiatric disorders appear as… laziness, negativity, manipulation, cowardice, and aggression… “

Dr Elsabé Conradie, general manager at the Council of Medical Schemes (CMS), adds that patients not only suffer from their disease but from the impact of stereotypes, misconceptions and prejudices about their illness.

Van der Heyden feels that this lack of understanding of mental diseases directly contributes to the low levels of funding.

Underfunded health care

The World Health Organisation (WHO) says that health systems have not adequately responded to the burden of mental disorders. As a consequence, the gap between the need for treatment and its provision is wide all over the world. In low-income countries between 76% and 85% of people with mental disorders receive no treatment for their disorder. In high income countries, between 35% and 50% of people with mental disorders are in the same situation.

Conradie addresses that funding of psychiatric illnesses in state hospitals is not receiving the priority it deserves, considering the amount of funding and attention currently given to other chronic illnesses like HIV/AIDS, TB, diabetes and hypertension.  She says: “Specialised psychiatric hospitals are inadequate and provinces like Mpumalanga and Northern Cape have none. Seventy two hour observations are done in facilities that are not adapted to needs of psychiatric patients.”

Lack of funding and qualified care is a problem in South Africa. Earlier this year, thirty six psychiatric patients that were transferred from Life Healthcare Esidimeni died while in the care of the NGOs (non-governmental organisations) in which they were placed by the Gauteng Health Department. This was disclosed by Gauteng Health MEC Qedani Mahlangu in an oral reply to questions from Jack Bloom‚ DA Gauteng Shadow Health MEC‚ in the Legislature.

The psychiatric patients were moved into 122 NGOs after the department cancelled its long-running contract with Life Healthcare which looked after about 2‚000 patients.  Bloom has informed as the issue is now being investigated by the Health Ombudsman Professor Malegapuru Mokgoba. He adds that some autopsies have been done but the findings have not yet been revealed although a number of residents claim that they died from hunger and neglect.  He adds, “The Gauteng Health Department cancelled the long-running contract with Life Healthcare Esidimeni for budgetary reasons and also because they said they wanted to deinstitutionalize mental health patients.”

He states that there is a case for deinstitutionalization, but it needs to be done carefully and is not suitable for all patients.

SADAG

Moneybags also chatted to Zane Wilson, chairman and founder of SADAG, who informs that so many so people are starting to drop the stigma surrounding mental illnesses which means that more individuals are coming forward for help. Unfortunately this comes at a price. SADAG currently has fifteen toll-free lines and receives 400 calls daily. Wilson informs us that to employ one counsellor for one year costs on average of R120 000. SADAG does not receive government funding and without an official sponsor, mental health support and advocacy group has to pay these operational costs. Wilson says that they are looking for four or five large companies that will assist them in helping thousands of people who feel helpless and hopeless.  Discovery Health has recently committed R1 million to SADAG’ suicide helpline.

Private sector

With regards to the private sector, medical schemes must cover certain conditions regardless of the cover the members choose. The list of conditions is known as the Prescribed Minimum Benefits (PMBs). Most schemes only fund medicine for bipolar mood disorder and schizophrenia, as these are the conditions with a medicine algorithm as per PMB chronic disease list.

According to Heidi Kruger, Justmoney’s independent medical expert, PMB contain several mental conditions (which are not classified as chronic) including:

  • Abuse or dependence on psychoactive substance, including alcohol
  • Acute delusional mood, anxiety, personality, perception disorders and organic mental disorder caused by drugs
  • Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse
  • Alcohol withdrawal delirium; alcohol intoxication delirium
  • Anorexia nervosa and bulimia nervosa
  • Attempted suicide, irrespective of cause
  • Brief reactive psychosis
  • Delirium: amphetamine, cocaine, or other psychoactive substance
  • Major affective disorders, including unipolar and bipolar depression
  • Schizophrenic and paranoid delusional disorders
  • Treatable dementia

Conradie says: “State hospitals are overburdened by the number of patients that require treatment. Since the PMB Regulations limit the treatment for most conditions to 21 days in hospital treatment or 15 out-patient psychology sessions, except Bipolar Mood Disorder and Schizophrenia, very ill members who require long term admission are referred to the state facilities.”

Should mental illness be looked at in isolation?

Van der Heyden feels that public sector funding of psychiatric and psychological services suffers because it falls almost completely within medicine/health. “Mental illness would be better serviced if it had its own branch that could access various sectors, especially social services, the judiciary, housing, policing and correctional services.”

Profmed advises that South Africans take the necessary precautions to ensure good mental health, by maintaining a balanced lifestyle and knowing when to take some time off when needed. Good mental health can also be achieved through following healthy eating patterns and exercising regularly to manage stress.

Do you need help?

Contact your medical scheme to find out how you are covered.  You can also contact SADAG, who provides free telephonic counselling and work on referral option of the caller to be able to get support, therapy and diagnosis from a professional/ or government hospitals and clinics across South Africa. They offer support groups throughout the country and regularly participate in Wellness Days for small, medium and large business. You can visit their website or contact them on 011 234 4837.

Alternatively call:

Mental Health Information Line – 0800 567 567
Suicide Crisis Line – 0800 567 567 or SMS 31393
Akeso Psychiatric Response Unit 24 Hour – 0861 435 787
ADHD Helpline – 0800 55 44 33
Destiny Helpline for Youth & Students – 0800 41 42 43
Department of Social Development Substance Abuse Line 24hr helpline – 0800 12 13 14 or SMS 32312



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