London - Another unintended consequence of the Covid-19 pandemic, combined with the fallout from the Ukraine conflict with its devastating impact on food and fuel supplies and rising prices, the fragile recovery of the global economy towards pre-pandemic normality which has led to a worldwide cost-of-living crisis, is the sharp rise in mental health cases, especially for anxiety, depression and suicide.
In the first year of the pandemic, the global prevalence of anxiety and depression increased by a massive 25%, according to the World Health Organization (WHO).
All countries irrespective of economic status, wealth or quality of health-care ecosystems, are affected.
We all know a family member, relative, neighbour or friend who is afflicted by a faceless illness, whose impact can be as debilitating as it is destructive, deluding and soul destroying.
Extreme economic uncertainty coupled with the shocks of supply chain disruptions, rising food prices partly fuelled by food inflation, very often double the headline inflation; catastrophic events such as pandemics, earthquakes, climate change manifested by droughts, floods, plagues of pests, hurricanes, bush fires et al; and conflict, puts great pressure not only on the psyche of citizens, but also on governments in resource allocation for which different sectors are in fierce competition.
Historically, mental health has been the Cinderella of the public health ecosystem, a stigma that psychologically still prevails. Similarly, there is insufficient gender differentiation in the data, given the increasing participation of women in the workforce.
At the 2023 South African Mental Health Conference in Gauteng late last month, Deputy President Paul Mashatile encapsulated a microcosm of the current state of mental health in the country.
“As experts in the field,” he told delegates, “all of you are aware of and undoubtedly concerned about the rise in mental health cases in South Africa. More concerning is that only 27% of our fellow compatriots who suffer from mental illness receive treatment.
The rest do not. There also exists a deficit in our society’s understanding of mental health, causes of illness and treatment.
This leads to stereotyping those who suffer from mental health illness and obstructs the human solidarity necessary for us to become each other’s keepers.”
Nowhere has the impact of mental health been felt as much as in the workplace.
Globally, says the WHO, an estimated 12 billion working days are lost in productivity every year to depression and anxiety at a cost of $1 trillion annually.
Research at the WHO shows that depression and anxiety is correlated with the occupational phenomenon called “burnout”, regarded as a potential predictor of broader mental health challenges.
Burnout, according to the McKinsey Health Institute (MHI), “is driven by a chronic imbalance between job demands (for example, workload pressure and poor working environment) and job resources (for example, job autonomy and supportive work relationships).
It is characterised by extreme tiredness, reduced ability to regulate cognitive and emotional processes, and mental distancing.”
A new MHI survey published at the end of last month finds that a higher share of Gen Z respondents reported poor mental, social, and spiritual health compared with other generations – Millennials, Gen X and Baby Boomers.
Some 27% of Gen Z respondents (out of a sample of some 42 000) reported a negative social media engagement and impact on their mental health.
The irony is that across generations, more than one out of five are using digital mental health programmes. The reported use of digital mental health programmes in the past 12 months in 26 countries, including South Africa, is revealing.
Some 19% of respondents in South Africa are using digital mental health programmes, with those in China (43%), Egypt (40%), India (36%) and Saudi Arabia (34%) the highest users.
South Africa adopted a new National Mental Health Policy Framework and Strategic Plan 2023-2030 in April, three years after the previous one expired in 2020.
While the new mental health policy is generally welcomed, mental health-care professionals warn about the mismatch between policy ambition and implementation, historically the bane of health policy initiatives.
To Mashatile, “the successful implementation of the Mental Health Policy Framework and Strategy will depend on the integration of mental health services and support to community-based and facility-based interventions and programmes.
The campaign should aim to de-stigmatise mental illness and emphasise the importance of early detection, treatment and support.
By changing the narrative on mental illness, it is possible to make it more comfortable for individuals to seek help.”
Health Minister Joe Phaahla at the same conference reiterated that gaps in the country’s mental health services are not because of a lack of policy and plans, but due to implementation issues and the shortage of resources and psychiatrists.
Others also question the delays in decision-making and a general lack of understanding of what mental health is, the scale of the phenomenon and the measures needed to mitigate it.
There are several social factors prevalent that contribute to and exacerbate mental health cases in South Africa.
These include crime, violence, substance abuse, historical trauma, unemployment, poverty, and disease. This was evident during the pandemic, when the psychological impact of the restrictions coupled with economic hardships saw a large increase in mental health cases, including widespread depression and anxiety, particularly among the youth.
South Africa has also been pioneering new models and collaborative approaches to tackling mental health issues.
The WHO’s World Mental Health Report 2022 highlights several promising initiatives from South Africa.
These include: non-specialist counselling programmes that can boost the capacity of frontline mental health services and greatly improve care when implemented within primary care facilities and other community-based settings.
One programme in the Northern Cape saw primary care nurses identify people with depression among patients with chronic disease in a collaborative care programme, which saw clinically significant reductions in symptoms at 12 months follow-up.
Task-sharing is cost-effective.
One modelling study in KwaZulu-Natal concluded that task-sharing with competent non-specialists could substantially reduce the number of health-care providers needed to close mental health-care gaps at primary level, at minimal additional cost.
Future-proofing mental health strategies should include a recognition that returns on investment for early clinical interventions can be substantial, especially for depression and anxiety.
The evidence is overwhelming.
Studies also show that integrated mental health packages that combine multiple interventions for promotion, prevention and care can bring significant returns, especially when productivity gains and the value of wider social benefits are considered.
In South Africa, an integrated chronic disease management model has been developed to increase systems efficiencies and cost-effectiveness, and deal with comorbidities. The model is supported by Adult Primary Care, a clinical decision support tool that primary care providers can use to deliver comprehensive, quality clinical care to adults in every consultation.
“The model,” says WHO, “is innovative in that it enables care providers to treat all chronic conditions – both physical and mental – together. So, for example, rather than running separate clinics for diabetes, hypertension, HIV and mental health, the primary care facility uses routine consultations to provide chronic care for all these conditions at once.”
South Africa has both high rates of HIV and mental health conditions.
According to official data, around 13.2% or 7.8 million people in South Africa are living with HIV, and 28% to 62% of people living with HIV suffer from mental illnesses.
Parker is an economist and writer based in London.