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MENTAL ILLNESS AWARENESS MONTH: UNDERSTANDING THE DISTINCTIONS AND TRENDS IN MENTAL HEALTH AND MENTAL ILLNESS

By Dr Litha Fatsha Advanced Specialist Healthcare Facilities Strategy Unit

Mental health and mental illness are often used interchangeably, yet they are distinct concepts. Mental health refers to our overall psychological well-being, encompassing our emotions, thoughts, and feelings, and it affects how we handle stress, relate to others, and make choices. In contrast, mental illness involves diagnosable conditions that impact a person's thinking, emotional state, and behaviour, such as depression, anxiety disorders, bipolar disorder, schizophrenia, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).

In South Africa, the significance of mental illness as a public health issue cannot be overstated. The South African Depression and Anxiety Group (SADAG) reports that one in three South Africans will experience a mental illness in their lifetime. However, the stigma surrounding mental illness leads many to hesitate in seeking help, resulting in delayed diagnoses and treatments that exacerbate these conditions.

Mental illness is often misunderstood and viewed as something to fear, a problem for someone else if one is not directly affected. Sometimes it can be seen as a sign of weakness or personal failure, with many erroneously believing it is not a real illness or something that individuals can simply "snap out of." This pervasive stigma has far-reaching consequences, making it difficult for those affected to maintain relationships, fully engage in society, and secure employment, often leading to discrimination and social isolation.

The COVID-19 pandemic has further intensified the mental health crisis in South Africa. The widespread stress, anxiety, and depression induced by the pandemic, coupled with disrupted access to mental health services, have highlighted the urgent need for robust mental health interventions.

Data from the Medscheme universe, an AfroCentric Group Company, over the last decade reveals a 27% increase in mental health prevalence based on claiming patterns, with depression rates surging by 38.7%.

Such statistics indicate the critical necessity of addressing mental health issues in South Africa. Gender disparities in mental health are also evident, with females more likely to seek help and file claims for mental health illnesses at a prevalence of 16.5% compared to 11.2% for males.

This discrepancy can be attributed to societal expectations and gender norms that discourage men from seeking help for emotional distress. Similarly, depression shows a higher prevalence among females (9%) than males (5%).

Age-related trends indicate that mental health prevalence peaks between the ages of 35-54, likely due to the pressures of work and family life, and another peak occurs after 75, potentially linked to loneliness and dementia-related mental illnesses. Addressing South Africa's mental health crisis requires a comprehensive and multi-faceted approach.

Expanding access to mental health services is crucial, involving an increase in the number of mental health professionals, integrating mental health care into primary care settings, and utilising digital health solutions to reach both the insured and uninsured can go a long way in ensuring access to care.

Furthermore, making mental health services more accessible in an out-patient care setting and through the multi-disciplinary team of healthcare professionals – the general practitioner, psychologist, psychiatrist, occupational therapist, social worker and even physiotherapist at times. Affordability through alternative therapy sessions like group counselling and virtual therapy sessions, reduced cost of medications are some of the ways access to care can be improved.  New models of treating more people with the minimal available resources, both human and financial is required in order to meet the ever-increasing demand.

Raising awareness and reducing stigma surrounding mental health are also paramount. Public education campaigns specifically around framing the conversations about mental illnesses and health are crucial, community outreach programmes, and workplace initiatives can help normalize conversations about mental health and encourage help-seeking behaviour. Supporting patients and their families on this journey is paramount as mental illnesses left unchecked may have a ripple effect on patients and members of their families, increasing stress and anxiety in both.

Workplaces have an equal responsibility to take cognisance of mental health, failing to do this can cost the economy up to 4.8% of the country’s GDP with increased incidences of loss of productivity.

On a more practical level, who can forget the Life Esidimeni tragedy where over 140 state mental health patients died following their transfer out of Life Healthcare Esidimeni hospital to various NGOs in 2015.  Without getting into the politics of the tragedy, focus can be placed on the paramount importance of care coordination between a patient’s family, primary healthcare practitioners and the required financial investments into getting desired outcomes for patients. This is a lesson for both public and private healthcare sectors if we place the patient at the heart of care.

Despite the challenges, there are actionable steps to combat mental illness in South Africa. Education and awareness can play a pivotal role in reducing stigma. Improved access to mental health services and making them more affordable can ensure that more people receive the help they need. By providing comprehensive support to patients and their families, we can create a more inclusive and supportive society.

As we collectively address these issues, we can pave the way for a society where mental health is prioritised, stigma is diminished, and everyone has access to the care necessary to thrive. This holistic approach is essential for building a future where mental health is integrated into the broader health care agenda, ensuring that every individual receives the support they need to live fulfilling and healthy lives.