Monday, October 27, 2008

African countries face mental health crisis

The Daily Triumph in Nigeria reports that more than 75 percent of people with mental health problems in Nigeria do not have access to treatment or care. And The Independent in South Africa reports that country is facing "a mental illness 'nightmare.'"

The Independent story says:

South Africa is facing a mental illness "nightmare" that could have disastrous consequences if funds are not made available and drastic action taken, warn researchers and medical authorities.

The University of Cape Town's Mental Health and Poverty Project has just released a report on the state of mental health policy and service provision in South Africa, the first of its kind.

Solly Mokgata, director of the SA Federation for Mental Health, said: "It's one of the country's biggest nightmares. An increase in crime, an embattled economy, poverty and a high prevalence of HIV/Aids are contributing factors."

He said a major problem was a lack of services, as well as the fact that many conditions which could easily be treated were not.

"A recent Lancet study showed that it would cost only $2 (about R22) a person a year to treat people suffering from mental illness."

The Medical Research Council says neuropsychiatric conditions rank third in the burden of disease facing the country. But the report said there was growing recognition that mental health was a crucial public health and development issue in the country.

The SA Stress and Health survey found that 16,5 percent of South Africans had suffered from common mental disorders such as depression, anxiety and substance abuse disorders in the past year.

There were no differences between racial or ethnic groups in the prevalence of mental illness, although it was more likely among poor people and those suffering from social deprivation: poor people tended to have more mental health problems and people living with mental disorders tended to have lower levels of education, employment and income.

The Mental Health and Poverty Project report warned mental health was not at the forefront of policy development and implementation in the health, education, employment, social development or other key sectors, and there is little co-ordination of mental health across these sectors.

Furthermore, there was generally poor implementation of existing mental health policy and legislation at provincial and district level.

Professor Dan Stein, head of UCT's psychiatry and mental health department, said it as important to note that mental disorders were more disabling than most physical disorders because they were long-lasting and severe, but were less likely to be treated than physical disorders.

But he said: "It is much cheaper to treat mental disorders than not to."

According to the SA Depression and Anxiety Group, one in every five people will suffer from a mental illness at some point in their lives.

Spokesperson Cassey Amoore said every 24 hours in South Africa, 22 people commit suicide and 220 people attempt suicide; 9,5 percent of teen deaths are due to suicide. Yet there are only 284 psychiatrists to care for South Africa's 46 million people, and nearly half work in the private sector.

She said: "South Africa is a crime-riddled country - up to six million people may be suffering from post-traumatic stress disorder."

Compared with 14 other countries (including Germany, France, Nigeria and Mexico), South Africa has the second highest prevalence of substance abuse and the seventh highest of depression. Why does South Africa spend such a low percentage of its health budget on mental health?

Amoore said: "We know how difficult it is for patients with psychiatric illnesses to get the appropriate help."We are trying to raise awareness in government that mental health should get more attention - and more money."

The chief executive of the group, Elizabeth Matare, said that the Aids pandemic "is a huge issue".

Much funding was pumped into research and prevention programmes, but mental problems were largely forgotten.

"We forget that with a diagnosis of HIV and Aids comes depression, anxiety and trauma. People with HIV are 36 times more likely to commit suicide."

The Mental Health and Poverty Project report said mental health needs to be prioritised and there should be an improvement in the implementation of mental
health policy and legislation.

There should be adequate funds for mental health services in the provinces, particularly for community-based care.