THE SA Society of Psychiatrists (Sasop) and the Psychiatry Management Group (PsychMG) are calling for a change in Prescribed Minimum Benefits (PMBs) to offer full cover for all mental health illnesses.
They say the PMBs, which should be frequently reviewed and updated, have not been reviewed since 2004.
Sasop chairperson and PsychMG director Mvuyiso Talatala said: “The fact that some mental health conditions are covered under PMBs, whilst others are not, is putting enormous financial pressure on patients… creating a situation where many either halt their treatment, or don't start in the first place, with catastrophic results for the individuals with mental health issues.”
PMBs cover medical conditions which medical schemes are compelled by law to cover the costs of.
Talatala says about 30 percent of the South African population will suffer from mental illness at some point in their lives.
And while bipolar depression and major depressive disorder are listed as PMB conditions, there are substantial differences in the funding of these conditions.
“Bipolar depression has full cover for both mood- stabilising medication and anti-depressants, while major depressive disorder patients still struggle with access to anti-depressants,” Talatala said.
Although all medical schemes pay for hospital admission of patients with major depressive disorder and bipolar depression for up to 21 days, as prescribed by the Medical Schemes Act, the funding of out-of-hospital care is poor for both conditions.
Sasop and PyschMG are in discussion with the Health Department on the issue, said spokesperson Joe Maila.