SA's uncharted frontier: how to heal our psyches

Given their human and economic cost, imagine if we did not know what treatment worked best for HIV and TB, says clinical psychologist Debbie Kaminer.

"Mental disorders are not far behind them in prevalence. But we have a massive and urgent unmet need for treatment of mental disorders," said Kaminer, who works at the University of Cape Town's child guidance clinic.

"Three-quarters of people do not get any treatment, Western or traditional."

Kaminer led new research into scientific studies on the treatment of common mental disorders in South Africa, published this month.

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Between 2000 and 2015, only eight randomised controlled trials were conducted on depression, two on anxiety disorder and six on substance abuse, she found.

"We do not have the evidence we need on what works, is culturally acceptable and cost-effective in South Africa," she said.

"We have evidence of what treatments work well in developed countries but need more research here to guide us on what we should be offering."

Anxiety is the most common disorder among adult South Africans (16%), followed by substance abuse (13%) and depression (10%).

Dr Jan Chabalala, head of psychiatry at 1 Military Hospital in Pretoria who had a private practice in Polokwane for eight years, said 90% of his patients came in with depression, anxiety and stress.

"Whether white or black, Zulu or Sotho, the symptoms [for stress] are the same, though the expression may be different," said Chabalala.

"People [in townships] tend to use bodily symptoms and complain to their doctor about headaches, pain, nerves or palpitations when they are anxious and depressed. A Zulu patient may say, 'My spirit is low.'"

Men's depression is often picked up in rehabilitation programmes because they tend to turn to substances to cope.

The latest research by Kaminer's team exposed the scarcity of studies on mental-health treatments in South Africa, where culture and language influence their effectiveness.

Chabalala said: "I had a patient who was not getting better and she said it was because of her ancestors. I released her to follow her beliefs and when she came back to me, she was better. The treatment that worked was a combination of medication and following her beliefs."

Western treatments are important but we also need studies on what is culturally acceptable, he said.

block_quotes_start Depression doesn't have to be a lifelong diagnosis. Early support can minimise potential suicides block_quotes_end

Cape Town GP Dr Ellapen Rapiti, who has worked in Mitchells Plain for 40 years and has a mental-health diploma, said depression, anxiety, panic disorder and post-traumatic stress disorder were common among his patients.

"I treat a lot of PTSD in the awaiting-trial youth centre," he said. "I see youths who can't sleep, who have all shot and killed rivals and witnessed moms and dads being killed."

The latest research revealed a glaring gap in studies on the treatment of youngsters, yet callers to the South African Depression and Anxiety Group helpline are increasingly younger, said operations manager Tracy Feinstein.

"We encourage early intervention and speaking to a counsellor.

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"Depression doesn't have to be a lifelong diagnosis. Early support can minimise potential suicides."

Rapiti feels GPs should get more training in mental health so people can be treated in their communities.

No counsellors are available to children in most schools - a gap that has been recognised in the new mental healthcare policy, which aims to shift services into communities.

The depression and anxiety organisation has about 200 support groups that play an important role in encouraging people to deal with their disorders.

Feinstein said: "They do not replace group therapy. They are social, private spaces where individuals who experience similar diagnoses can share how to live with their conditions."

Professor Crick Lund, director of UCT's Alan J Flisher Centre for Public Mental Health, said Kaminer's work showed encouraging developments in treating mental health disorders. "Most of the studies showed significant clinical improvements, using a range of psychological interventions."