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INSTALMENT 8: Mental health and the way forward in South Africa

29 Oct 2020

This brings to conclusion the mental health series published for the month of October. The SA Federation for Mental Health trusts that readers have found the series enlightening and that it will assist in ongoing advocacy for improved investment into mental health in South Africa.
We are also hereby launching the country profile that has been developed, which concludes with the following four recommendations for mental health campaigning in South Africa.
1. Improved representation of mental health care users at policy level – pushing for the re-appointment of a ministerial task team and advisory panel to track progress on mental health indicators by the 2013-2020 Policy Framework for Mental Health. However this advisory body lacks the representation of mental health care users (MHCUs). User-led advocacy groups need to be consulted in the evaluation of the existing guidelines as well as in the upcoming revisions and changes required in the upcoming framework.
2. Calling for stronger implementation of constitutional rights for mental health care users in South Africa
a. MHCUs do not have the right to participate in elections within South
Africa, which goes against their constitutional rights as South African citizens and the Mental Health Care Act 17 of 2002. The state has a responsibility to review and align this position as outlined in the country’s own human rights framework and in global recommendations made by the UN Convention on the Rights of Persons with Disabilities to respect the individual autonomy of MHCUs, including the right to make political decisions.
b. Advocate and disseminate a key finding of the South African Human Rights Commission – “Broader conversations about law reform of instruments such as the Mental Health Care Act and the Electoral Act are required. Particularly in light of their potential contravention of the UNCRPD and in light of ongoing debates regarding matters such as legal capacity”.
c. Focus on inclusion and the importance of highlighting Southern- African-led advocacy in the region by empowering MHCUs to share their stories.
3. Strengthening South Africa’s Mental Health Review Boards

a. Local investigations have found that Mental Health Review Boards have not been as involved in psychiatric units within general hospitals (where a large proportion of involuntary detentions take place), and report a lack of appeals from many units. This suggests that these governing bodies, which have been put into place to protect patients from inappropriate detention, are not being upheld according to the recommendations made by the Mental Health Care Act of 2002.
b. As a formal structure, its terms of reference must be clearly defined and strengthened in line with the National Health Act and the Mental Health Care Act 2002, and its independence and authority re- established.
4. Increased investment in mental health care systems – Irregular and weak monitoring systems for mental health are one of the contributors to resource misallocation in South Africa. National and provincial governments need to invest in the development of information systems with patient registers and a database by which to make evidence-based decisions, monitor and evaluate health care delivery.
In conclusion…
The World Federation for Mental Health (WFMH) states that the failure to invest in mental health has resulted in constraints on global health systems and has limited access to treatment, impacting on individuals’ rights to wellness and health, which has been exacerbated by the current pandemic. In a message by WFMH President, Dr. Ingrid Daniels states that: “the inadequate response to invest and increase access to mental health has resulted in gross failure to ensure that every global citizen can live fully integrated lives. According to Dr. Daniels, mental health continues to be misunderstood, ignored, stigmatised, underfunded and overlooked. COVID- 19 has in many respects been an equalizer and has placed at the forefront the critical need for good mental health interventions, responses and support during this time”.
This year’s WMHD’s theme called on global leaders to commit to ensuring that access to treatment for people with mental health disorders is expedited and that treatment is made more readily available to all the populations. The pandemic has shown that global health systems are not well equipped to deal with emerging illnesses as well as the increasing need for mental health care arising from crisis.
Now and going forward, SAFMH stands in unity with organisations that are calling on all governments across the globe to act swiftly in making mental healthcare a priority and ensuring that it is accessible to everyone everywhere. The investment should not only be in monetary terms, but also through support for initiatives and organisations that are already committed to mental health and the empowerment of communities through awareness campaigns. There is overwhelming international research that has shown the link between mental health and the economic performances of countries, and as countries forge the way for economic recovery post- COVID-19, investing in the mental wellbeing of their populations should also be a priority. SAFMH calls on the South African government to review existing policies on mental health, empower provinces through equitable allocation of resources and commit to higher levels of spending on mental health.
We unconditionally support the call from the WFMH: “Our call is a simple one – let us hold hands and unify our voices in moving the mental health investment agenda for increased focus and access to mental health and thereby making mental health a reality for all – everyone, everywhere”. But while it is a simple call, in that what is being asked for is clear and easy to grasp, achieving it might not be that simple as it requires concerted efforts from the South African government to start placing more emphasis on mental health – in 2020 and beyond.

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