Mental illness in south africa: one psychiatrist for 150,000 patients

One third of the South African population is considered mentally ill. Treatment and care services are sometimes inhumane.

High unemployment, poverty, lack of belonging in the townships underlie many illnesses Photo: dpa

South Africa urgently needs better care for the mentally ill. Since the end of apartheid a quarter of a century ago, no new facilities for psychiatry have been built. This puts a great strain on normal hospitals, health experts recently confirmed at a conference in Johannesburg. One in three South Africans will become mentally ill in their lifetime,.

"Our capacity is extremely limited," says Professor Bernard van Rensburg, president of the South African Society of Psychiatry (SASOP). "We need more staff and teams that can provide psychosocial support in communities. There is a huge shortage, especially in communities and rural areas."

A 2012 study by Eugene Allers found that there are only 320 practicing psychiatrists in South Africa – an average of one for 150,000 people. About 200 of the 320 work in the private health care system, which covers only 15 percent of the population. While the private 200 psychiatrists treat 33,000 patients, 440,000 more sufferers would have to share the remaining 120 in the government system.

"Eighty percent of vulnerable groups don’t have health insurance," van Rensburg says, explaining the shortage in the state system: "In Johannesburg, we have four districts, and there’s only one psychologist in each."

According to van Rensburg, South Africa is following the global trend: the number of mentally ill people is increasing. Bipolar disorders affect one percent of the 56 million South Africans. Depression is much more common, as are anxiety psychoses – often in conjunction with alcohol abuse. The high HIV infection rate has an additional impact.

Only one patient died of a mental illness

According to studies, around 30 percent of South Africans will suffer from mental illness in their lifetime, and 17 million are currently mentally ill. Particular factors in South Africa include the legacy of apartheid and severe social inequality. High unemployment, poverty, violence and lack of belonging in rapidly growing townships underlie many illnesses.

Significantly, the country’s largest psychiatric scandal has so far produced only limited consequences. The deaths of 94 psychiatric patients in Gauteng province around Johannesburg had come to light in February in a report by the health authority’s ombudsman.

More than 1,300 psychiatric patients had received care at facilities run by the public-private agency Life Esidemeni – a chain of nursing homes for the chronically ill – but were then transferred to 27 nongovernmental facilities that had no doctors or qualified staff and sometimes did not even have food, water, medication or heating. Some did not have operating licenses.

According to the investigation report, only one of the patients died of mental illness. The others died of heart attacks, epileptic seizures, starvation, gangrene, dehydration and diarrheal diseases. Conditions were worst at the Precious Angels home – where one-third of transferred patients died within a month.

Cause of death: natural death. – Doubtful.

The report speaks of chaotic conditions, starting with transport on the backs of vans. According to the report, the facilities would have had 112 rand per patient (8 euros) available daily; at the Esidimeni clinic, the figure had previously been 320 rand.

The Gauteng health minister had resigned at the time, and the head of the Johannesburg health department had also been suspended. Investigations are still ongoing, and there is a threat of legal action for gross negligence.

Gauteng’s new health minister, Aaron Motsoaledi, is still waiting for the final report of the investigation, which began in March. "When the tribunal’s report is available, the minister can initiate what is necessary," his spokesman Joe Maila said Tuesday. In May, the minister had closed 14 of the province’s 27 mental health facilities.

For the bereaved families, that’s taking too long. "We are really upset," says Lucas Mogwerane, whose brother died in one of the facilities a year ago. The death certificate says the cause of death is natural causes. He doubts that.

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