In the wake of the Life Esidimeni tragedy that saw more than 100 mentally ill patients lose their lives, World Health Day on 7 April 2017 was significant for the South African mental healthcare community with the year’s theme focussing on depression.
The World Health Organization estimates that the total number of people living with depression increased by 18.4%1 between 2005 and 2015 and that depression is the biggest cause of disability worldwide. More than 80% of this disease burden is among people living in low- and middle-income countries like South Africa. The Alan J Flisher Centre for Public Mental Health (CPMH) drives various research programs to produce evidence-based recommendations on how to treat depression and other mental illnesses cost-effectively whilst putting patients’ needs first, by using integrated care.
One of the research programmes hosted within the Centre, the Programme for Improving Mental Health Care (PRIME), developed a district mental healthcare plan (MHCP) in South Africa that integrates mental healthcare for depression, alcohol use disorders and schizophrenia into standard care for chronic physical conditions. This collaborative care approach ensures that people receive supportive and ongoing care in the community and health facilities, while being able to access specialist services and inpatient care when needed. PRIME’s research has shown that this healthcare model is feasible within the South African context.
This form of integrated care can also be applied to the maternity setting. Rates of antenatal and postnatal depression and anxiety in South Africa appear to be far higher than those in high income settings and even in other low- and middle-income settings. The Africa Focus on Intervention Research for Mental health (AFFIRM) randomised controlled trial has studied the benefits of using community health workers to provide counselling for perinatal depression in Khayelitsha.
The Centre’s Perinatal Mental Health Project (PMHP) has shown that routinely integrating screening and counselling services into maternity health services can help mothers with perinatal depression. Depression is a major public health issue and an important economic issue.“It can no longer be ignored by policy makers,” says CPMH Director Prof Crick Lund. “Solutions are available, and we know more about what needs to be done than ever before, for example by providing care in primary healthcare and community settings. But we need the political will and commitment, especially from provincial Departments of Health to implement our national Mental Health Policy Framework (2013-2020)”.
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