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Chances are, in South Africa, if you’re suffering from a serious mental illness you will struggle to see a psychiatrist. City Press reports that at 1.52 psychiatrists per 100,000 population, the reality is that many patients will rarely be seen by one. If you’re a parent of a child who needs psychiatric evaluation, you will struggle even harder because, according to the newly released World Health Organisation (WHO) country profiles on mental health, there are only 0.08 child psychiatrists per 100 000 population.

The report says added to that, the profile shows that despite there being policy framework on mental health – the Mental Health Act 17 of 2002, as well as the National Mental Health Policy Framework and Strategic Plan 2013/2020 – there is still no suicide prevention strategy. This is despite the number of high-profile suicide deaths in the country last year alone.

The report says with a total expenditure of less than R100 per person per year on mental health and government spending only 3% of the total healthcare expenditure on mental health, experts agree that these figures point to a dire need for the renewal of focus and a change in strategy.

“There are definitely not enough psychiatrists and even more so not enough child psychiatrists. The reality is that many patients rarely see a psychiatrist, unless they are admitted to a psychiatric ward (of a public facility),” Bonga Chiliza, a professor and president of the SA Society of Psychiatrists, is quoted in the report as saying. “It also means that many people with complex illnesses will not be managed as they should be and that is why we find so many who are undertreated or ‘missed’ in terms of diagnosis.”

More than 150 country profiles of mental health resources were published by the WHO, based on data given by the member states. The report says they are intended to provide a national-level snapshot of the existence of policies, plans and laws for mental health, human and financial resources available and the type of facilities that provide care.

The South African profile reflects that per 100,000 people, there are 16.56 mental hospital beds and 4.33 general hospital psychiatric beds. While the profile noted that it did not have the total number of healthcare workers specifically tied to mental health in both governmental and non-governmental facilities as it wasn’t reported, the SA Federation for Mental Health (SAFMH) said those “blank spaces” pointed to poor record-keeping, as well as monitoring and evaluation on the part of government.

Nicole Breen, spokesperson for SAFMH, is quoted in the report as saying: “Unfortunately a large portion of the profile is accurate. The plight of mental healthcare patients in our country is severe. Under-resourcing, in particular, is a problem, as well as an astounding lack of qualified professionals.”

“The profile illustrates the low numbers of beds, wards and forensic units in relation to the number of people it captures as having a mental illness, (which is) a challenge for many mental healthcare patients who require urgent and intensive attention. The profile, however, fails to note the contributions made by non-governmental organisations (NGOs), which play an important role in caring for people with mental illnesses and intellectual disabilities within community care settings.”

The report says while Chiliza was loathe to criticise the fact that the country didn’t have a suicide strategy, Breen said having a policy would be important as it would set out a road map towards effectively tackling the issue of suicide and diminishing its prevalence.
“Policies generally bring law to life, making it implementable. Enacting a policy that is issue-specific and in line with other national and international imperatives, and steeped in research will enable state departments, NGOs, citizens and other parties to understand what their role is in ameliorating the plight of those who are suicidal, as well as in supporting those left behind when a loved one has committed suicide.

“Suicide is a specialised issue that requires a specialised response,” she explained. On this basis, she said, a separate strategy or policy would be extremely positive.

The report says both, however, agreed, that a lot still needed to be done in the country in so far as mental health is concerned. “What we are pushing for is a mental health programme fund, wherein which money will be set aside by government just for mental health,” Chiliza said, adding that “they did it for HIV and it worked very well. We would like something similar … right now.”

“I think the provinces themselves aren’t even sure how much they spend towards mental health. We think they spend even less than 1%, so a lot more can really be done.”

Breen said in the report that there also needed to be a concerted effort in investing in community-based care, alongside the hospital setting. “Quality community-based care is out of reach for the vast majority of mental health patients. Facilities are often unable, owing to more effort being put towards funds for food and operational costs, to offer proper rehabilitation programmes or equip their residents with skills so that they can either live completely independently or in a less restrictive environment. This becomes another form of warehousing.

“Investment is needed to ensure that mental health patients are able to not only survive in these facilities, but thrive, leading lives of dignity and accessing all of the services they need.”

By Fred Roffey

Early each year we see the super-rich and their companies attending the World Economic Forum in Davos, Switzerland. It is splashed across world media.

And each year we get the same platitudes, with some exceptions, from speaker after speaker and they still come up with no real plans for the future.

A big exception was billionaire Bill Gates, who made the case for governments and individuals to fund global health initiatives in developing countries. One of the many initiatives of his own foundation has been to spend about $10 billion on the Global Fund to Fight Aids, Tuberculosis and Malaria.

However, during the conference time the collective wealth of those attending increased by $2,5 billion a day, but the super-rich and companies are paying lower rates of tax than they have in decades, according to anti-poverty charity Oxfam.

And during that time thousands of people around the world, many of them women and children, paid the ultimate price of poverty with starvation, pain or death.

All this has led to growing calls for a wealth tax. In its latest report, Oxfam said inequality was at record levels and called for a wealth tax to level the playing fields.

It pointed out that the wealth of the world’s billionaires increased by $900 billion last year, while the wealth of the poorest half of humanity, 3.8 billion people, fell by 11 percent.

“Billionaires now have more wealth than ever before. Between 2017 and 2018, a new billionaire was created every two days,” said the report.

It added that last year 26 people owned the same as the poorest half of humanity.

The People’s Health Movement (PHM) in Cape Town has joined the call for more effective taxation of individuals and companies as a way of helping to create global health care.

Karen Meyer-Borochowitz, Executive Director of DementiaSA, has signed – on behalf of DementiaSA – a statement by PHM which appeals to national governments to review public health systems to ensure they meet the needs of their populations. (See DementiaSA Signs Global Health Care Statement in this issue.)

In the statement, PHM urges effective taxation to ensure that all individuals and corporations pay their fair share of taxes to enable the funding of services beneficial to health.

It also urges the regulation of tax havens and evasions.

RICH GET RICHER, POOR GET POORER

It is time the world had an annual conference to focus attention on the appalling state of global health care and to urge the introduction of a wealth tax.

The extreme gap between rich and poor is undermining the fight against poverty and damaging economies as well as fuelling public anger across the globe, according to Oxfam South Africa spokesperson Jabulile Buthelezi.

She said recent reports were important as they highlighted the plight of millions living in poverty, and showcased the difference between the haves and the have-nots.

“People are dying because we do not have enough doctors, medicines and nurses servicing the public health care system, which is underfunded. Poor women and children are hit the hardest. Women spend hours caring for children, the sick and the elderly when public services fail.”

GROWTH OF MAJOR DISEASES

To make matters worse, chronic diseases and conditions are on the increase. According to the World Health Organisation, chronic disease prevalence has shown regular growth over the past decade.

An ageing population and changes in societal behaviour, such as negative health habits, are contributing to a steady increase in common and costly long-term health problems.

The middle class is growing, automation accelerating and people are adopting a more sedentary lifestyle. This is pushing obesity rates (with all the related conditions) and cases of diseases such as diabetes upward.

Dementia is very much included in these problems. About 3% of people between the ages of 65-74 have dementia, nearly 20% between 75 and 84, and about half of those over 85 years of age in the Western World. Every three seconds, someone in the world develops dementia.

Hardest hit are developing countries with poor health care facilities for dementia, shortage of doctors and nurses, and slow diagnosis.

The time for an annual conference on world health care is now overdue.

DementiaSA has taken a major step in recognising the important role the People’s Health Movement (PHM) in Cape Town plays in achieving health care for all people in every country.

On behalf of DementiaSA, the Executive Director, Karen Meyer-Borochowitz, has signed a statement by PHM which appeals to national governments to review public health systems in various ways to ensure they meet the needs of the population.

Karen joins well over 155 organisations from 45 countries who are signatories, plus more than 265 individuals from 40 countries.

The statement refers to the Astana Declaration on Health Care held in Astana, capital of Kazakhstan, on October 25 last year, when representatives of UN member countries met to reconfirm their commitment to world health.

Karen points out there is a reference to NCDs (non-communicable diseases)  and the WHO (World Health Organisation) has declared dementia an NCD, yet in South Africa dementia is not recognised as an NCD.

The Astana Declaration regards primary health care (PHC) as a cornerstone of universal health coverage (UHC) , whereas the PHM believes PHC is broader.

The Declaration recognises that it is “ethically, politically, socially and economically unacceptable that inequity in health and disparities in health outcomes persist.”

However, the PHM says “nowhere are the fundamental economic and political causes responsible for this as well as for widening inequalities worldwide explicitly stated.”

The PHM statement continues: “Attaining the highest possible standard of health is a fundamental right of every human being, as stated in the Constitution of the World Health Organisation .

“In 1978, world leaders made the historical commitment to achieve health for all through Primary Health Care in the Declaration of Alma-Ata.

“We express the need for urgent action by all international agencies and governments, all health and development workers, and the world community to protect and promote the health of all the people of the world.”

Included in the PHM statement are the following:

1. Attainment of the highest possible level of health is a most important worldwide social goal whose realisation is the responsibility of governments and requires the action of many other social and economic sectors in addition to the health sector. People’s health depends on working and living conditions that promote flourishing lives and a healthy and protected environment.
2. Equitable economic and social development will require rejection of the currently dominant neo-liberal paradigm and establishment of a sustainable and equitable economic order globally and nationally. Among other interventions, regulation of financial flows and of tax havens and evasions are urgently needed.
3. Effective and accountable global governance for health is required to realise PHC. The statement says this should include means of effective taxation to ensure that all individuals and corporations pay their fair share of taxes to enable the funding of services beneficial to health.