One in three South Africans suffer from mental illness - most won't get any help
A special Sunday Times investigation has uncovered the shocking state of mental health in South Africa.
One third of all South Africans have mental illnesses - and 75% of them will not get any kind of help.
Juvenile mental patients who do receive treatment in state institutions risk being raped and housed in prison-like conditions.
At Gauteng's Chris Hani Baragwanath Hospital in Soweto, the female psychiatric ward houses 55 women in a dormitory-like environment.
"You only have two nurses on duty and there's little or no stimulation for these women. Now, if you're struggling with depression, these conditions are not ideal," said Dr Yusuf Moosa, head of clinical psychiatry at the University of the Witwatersrand.
More than 17 million people in South Africa are dealing with depression, substance abuse, anxiety, bipolar disorder and schizophrenia - illnesses that round out the top five mental health diagnoses, according to the Mental Health Federation of South Africa.
Despite the high number, the Department of Health annually spends only 4% - or R9.3-billion - of its budget to address the crisis.
This has prompted NGOs such as the South African Depression and Anxiety Group to refer to mental health as "the orphan" of the healthcare system.
The investigation uncovered other shocking details:
- An overwhelming 48% of new mothers suffer from postnatal depression;
- The head of the government's mental health services ascribes the meagre national health budget allocation to there being health problems that are more urgent, such as HIV/Aids - 43% of whom also have a mental disorder;
- A widow is suing the state after her husband plunged 14 storeys to his death after being admitted to Addington Hospital on Durban's beachfront;
- There is a severe shortage of specialised state hospitals;
- The mentally ill, particularly the young and the elderly, are sometimes rejected by their families;
- There is a lack of support for nongovernmental organisations; and
- There is a dearth of specialised state healthcare professionals such as psychiatrists, psychologists and psychiatric nurses.
Only 1% of beds in psychiatric wards are reserved for children or adolescents, which results in a one-month wait for a place and leaves youngsters like 17-year-old "Joseph" in a "junior prison" such as Vikelwa Reform School in Ogies, Mpumalanga.
"I was rude to my parents. I didn't want to go to school, so they sent me here," said Joseph outside his room at Vikelwa.
This is where 380 boys get locked up, 15 to a room, behind a steel door at night, and where rape and assault with crudely manufactured weapons are said to be common.
Many suffer from conduct disorder, which often manifests in children being unruly or aggressive.
"This place was built to be a prison," said one staff member.
Following an investigation by the South African Human Rights Commission, the facility is being closed down.
In line with the prison-like conditions, prison gangs have been formed with boys tattooing "26" or "28" on their bodies and conferring ranks on members.
"We have a severe lack of facilities for children suffering mental health problems," said Professor Ann Skelton of the Centre for Child Law. "We see a lot of children who are at the end of the road and who don't have any options available.
"Kids end up in the system because families can't cope any longer. They're often advised to report the child for a crime, otherwise they can't get them into a facility."
For adolescents and young men, 16 to 25 years of age is the "peak time" during which schizophrenia, attention-deficit hyperactivity disorder and bipolar conditions become apparent, according to Cape Town psychiatrist Dr Pieter Cilliers.
GPs around the country said they had seen an increase in the number of mentally ill patients.
Dr Lorraine Becker, a Rosebank, Johannesburg, general practitioner, said she saw more and more stress-related illnesses among her patients, accounting for 60% to 70% of her day's work.
"It affects everyone from women to children of all ages."
Many patients presented symptoms such as irritable bowel syndrome, repeat migraines or chest pains, said Becker.
With limited beds available in state facilities, those at the "severe" end of the mental health spectrum get admitted to hospitals, often either posing a danger to themselves or others.
There are 22 psychiatric hospitals in South Africa and 36 psychiatric wards in general hospitals.
Many middle-class South Africans spend up to R2700 a night to stay in private institutions. This excludes the costs of seeing a psychologist or psychiatrist.
Dr Melvyn Freeman, head of non-communicable diseases at the Department of Health, said: "We know we have a problem, but we have to take it in the context of South Africa, which has many problems. We have to look at the priority list.
"There is some mortality in mental health, but when you look at HIV thousands more are dying."
Freeman said his department was unlikely to get a significant increase in funding, which required the innovative use of current resources.
Part of this reorganisation, outlined in the government's Mental Health Policy Framework, has meant that general hospitals have opened psychiatric wards and clinics have taken on mentally ill patients.
Community workers, including priests and sangomas, are to be roped in to assist with out-of-hospital support for the mentally ill.
In post-apartheid South Africa, the government's efforts have moved away from institutionalisation towards outpatient care.
Currently, 85% of psychologists are in private practice, servicing 14% of the population, according to Freeman.
In severely under-resourced provinces such as Mpumalanga, advertised positions for mental health professionals stay vacant for months and salaries cannot be matched to those offered in the private sector.
Freeman said a professor of psychiatry could earn R1.5-million a year working for the government - but such a professional's annual salary in the private health sector could be as much as R5-million.
Doctors such as Moosa work in the public sector because it allows them time to teach.
"And someone has to look after people without medical aid," he said.
Freeman said the only way to effectively deal with mental health would be through the government's National Health Insurance, to which South Africans will eventually contribute directly.
But the implementation of the National Health Insurance is still a long way off - it has yet to be presented as a white paper and is currently being implemented at 10 pilot sites.
The earliest it could be implemented is in 2025.