Department of Health Presentation to the Portfolio Committee on Health State of Mental Health and Mental Health Services in SA Plans for way forward 12 June 2013 - PowerPoint PPT Presentation

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Department of Health Presentation to the Portfolio Committee on Health State of Mental Health and Mental Health Services in SA Plans for way forward 12 June 2013


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Title: Department of Health Presentation to the Portfolio Committee on Health State of Mental Health and Mental Health Services in SA Plans for way forward 12 June 2013

Department of HealthPresentation to the
Portfolio Committee on HealthState of Mental
Health and Mental Health Services in SAPlans for
way forward12 June 2013
  • Mental disorders are associated with significant
    distress and impairments of human functioning.
    This includes ability to work, learn and interact
    with people. Impacts are felt not only be the
    individual him/herself but by their family and
  • The World Health Organization at the Alma Ata
    conference in 1978 defined health as a state of
    complete physical, mental and social well-being
    and not merely the absence of disease or
    infirmity. The message is that no health can be
    achieved without mental well-being.
  • WHO has recently gone further than this by
    asserting that mental health is key to

Prevalence of mental disorder
  • 12-month prevalence of adult mental disorders in
    South Africa -16.5 (SA National Stress and
    Health Survey 2002)
  • 12-month prevalence of child and adolescent
    mental disorders in the Western Cape 17 (no
    national data)
  • For People Living with HIV and AIDS the
    prevalence of mental disorder was found to be 43

1-2 of population suffer from severe mental
disorder ie schizophrenia, bipolar disorder. The
remainder suffer from common mental disorders
such as depression, anxiety disorder, substance
dependence.   Measuring diagnosable mental
disorder does not capture the disturbed psyche
of many people in SA. About 14 of the global
burden of disease has been attributed to
neuropsychiatric disorders and while this figure
is slightly lower in developing countries because
of the high burden from other diseases, the
numbers of people suffering from mental disorder
is very high. Around three quarters of people
in South Africa that suffer from a mental
disorder do not currently receive any mental
health intervention
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  • When looking at mental health in SA we must
  • - Association between poverty and mental health
  • - Large numbers of children orphaned by AIDS and
    other diseases.
  • - Militarized individuals that have returned to
    civilian life without psychological and social
  • People that in their youth were part of
    liberation campaigns involving violence and in
    strategies such as freedom now, education later
    that excluded them from completing their
    education. We also now have the
    intergenerational impacts on the children of
    these individuals.
  • A number of people were severely tortured under

  • Significant numbers of unemployed people who have
    become immobilized by their circumstances
  • - Significant othering of people (race, class)
    both historical and current.
  • -Infants and children that receive minimal
    bonding and love from parents.
  • -People that work such long hours (or who are
    away from home for long hours) that have little
    interaction with their families.
  • - Stigma and discrimination

Key impacts on mental (ill) health and suffering
  • As citizens we are constantly bombarded with
    incidents of-
  • - Rape, including rape of young children (as
    young as 2 years old), people with disability and
    older persons (even 90 year olds)
  • - Gratuitous violence and murders
  • - Family murders
  • - Mass murders
  • - Violence by police officers
  • Violence by young men on other young men
  • It is not possible to separate out the internal
    dynamics of individuals from their social and
    economic conditions, a history of Apartheid etc.
  • The past and present conditions live in people.

Outside in and inside out!
  • Social determinants of mental ill health.
  • There can be little doubt that social and
    economic conditions impact on mental health and
    that changing this will improve mental health.
    (Outside in)
  • Mental health determinants of social and economic
  • On the other hand if peoples internal world is
    damaged it makes it very difficult for them to
    act on the world in a way that changes that world
    in a positive way. It is necessary to change the
    psyche to achieve better social and economic
    development. (Inside out)
  • Our approach not only to mental health but to
    development as a whole
  • has to involve both an Outside in and inside

Mental Health Care Act of 2002
  • 3. The objects of this Act are to-
  • (1) regulate the mental health care environment
    in a manner that-
  • (i) makes the best possible mental health care,
    treatment and rehabilitation services available
    to the population equitably, efficiently and in
    the best interest of mental health care users
    within the limits of the available resources
  • (ii) co-ordinates access to mental health care,
    treatment and rehabilitation services to various
    categories of mental health care users and
  • (iii) integrates the provision of mental health
    care services into the general health services

  • (b) regulate access to and provide mental health
    care, treatment and rehabilitation services to-
  • (i) voluntary, assisted and involuntary
    mental health
  • care users
  • (ii) State patients
  • (iii) mentally ill prisoners
  • (c) clarify the rights and obligations of mental
    health care users and the obligations of mental
    health care providers and
  • (d) regulate the manner in which the property of
    persons with mental illness and persons with
    severe or profound intellectual disability may he
    dealt with by a court of law.

Implementation of policies and measures by State
  • 4. Every organ of State responsible for health
    services must determine and co-ordinate the
    implementation of its policies and measures in a
    manner that-
  • ensures the provision of mental health care,
    treatment and rehabilitation services at primary,
    secondary and tertiary levels and health
    establishments referred to in section 5( 1)
  • promotes the provision of community-based care,
    treatment and rehabilitation services
  • promotes the rights and interests of mental
    health care users and promotes and improves the
    mental health status of the population.

Current mental health services
  • We are someway towards achieving the goals of the
    legislation (and policy), but there is no doubt a
    long way to still go!

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Hospitals conducting 72 hour assessments
61 of total hospitals conduct 72hrs assessment
68 of district hospitals 72hrs assessment
31 of regional hospitals conduct 72hrs assessment
45 of tertiary hospitals conduct 72hrs assessment
100 of central hospitals conduct 72hrs assessment

Human resources in the country
Psychiatrists 0.28 per 100 000 population
Psychologists 0.32 per 100 000 population
Nurses (in psychiatry) 10.8 per 100 000 population
Social workers 0.4 per 100 000 population
Occupational therapists 0.13 per 100 000 population
  • There are 2692 clinical psychologists registered
    with the HPCSA (and 1619 Counseling). So only
    around 14 of registered clinical psychologists
    are in the public sector.

Prevention and promotion
  • Up to now we have tended to place more emphasis
    on care, treatment and rehabilitation than
    prevention and promotion. Main resources in
    mental health go into hospital services.
  • Examples of current actions-
  • As part of Re-engineering of PHC we have included
    screening of emotional problems in school
  • We transfer resources each year to the SA
    Federation for Mental Health for Advocacy and
    health promotion.

Substance Abuse
  • Demand and harm reduction through DoH
    interventions are critical components to health
    and development.
  • The DOH has its sector Mini-Master Plan that it
    is implementing as part of the Central Drug
    authority Master Plan

Drug Master Plan (Central Drug Authority)
  • Health Mini-Drug master plan
  • Warning labelling (Foodstuffs and Cosmetics Act)
  • Screening focus on emergency rooms, Ante-natal
    services, HIV and TB services
  • Detox in general hospitals (and in primary care
    for some people)
  • Work with Social development (Welfare) in
    getting people into community rehab programmes.
  • Specialist treatment centres should be restricted
    only to those that really need them.

APRIL 2012 (following Mental Health Summit)
  • Hereby commit to-
  • Promoting mental health as an important
    development objective
  • Eliminating stigma and discrimination based on
    mental disability and promoting the realisation
    of the United Nations Convention on the Rights of
    Persons with Disabilities (2006)
  • Full implementation of the Mental Health Care
    Act, 2002 (Act No. 17 of 2002) and changing the
    legislation where this is needed
  • Ensure collaboration across sectors and between
    governmental and non-governmental organizations,
    academics and with other stakeholders to improve
    mental health services

  • Providing equitable, cost-effective and evidence
    based interventions and thereby ensure that
    mental health is available to all who need it,
    including people in rural areas and from
    disadvantaged communities.
  • Integrating mental health and substance abuse
    services into the general health service
  • Providing mental health and substance abuse care
    to people within communities while referring to
    higher health care levels where clinically
  • Ensuring that all users of mental health
    services participate in the planning,
    implementation, monitoring and evaluation of
    mental health services and programmes.

  • Fostering person-centred recovery paradigm that
    respects the autonomy and dignity of all persons
  • Increasing human resources to address mental
    health needs throughout the country through
    additional training across sectors, integration
    into general health care and through the National
    Health Insurance System
  • Developing and strengthening human capacity for
    prevention, detection, care treatment and
    rehabilitation of mental and substance use
    disorders and build links with traditional and
    complementary health practitioners.
  • Providing physical infrastructure that is
    conducive to the needs and human rights of people
    with mental disorders and disabilities

  • Reducing costs and increase the efficiency of
    mental health interventions, including making
    medicines more affordable, in order to provide
    essential health services
  • Establishing comprehensive mental health
    surveillance mechanisms, health information
    systems and dissemination processes to assist
    policy and planning.
  • Developing and supporting research and
    innovation in mental health.
  • Using the outputs from the summit to finalise
    the Mental Health Policy Framework 2012-2016 and
    to assist with its implementation and monitoring

And consequently to 1)Develop and implement a
mental health service delivery platform based on
community and district based models to ensure
that prevention, promotion, treatment and
rehabilitation services meet the needs of all
2)Implement with vigour the Health Sector Mini
Drug Master Plan 3)Establish at least one
specialist mental health team in each
district 4)Adequately fund mental health
services as per WHO recommendations 5)Embed and
increase mental health human resources within the
National Human Resource Plan 6)Develop a fit for
purpose plan for mental health infrastructure at
all levels
  • 7)Revise norms and standards in line with the
    service delivery platform
  • 8)Strengthen Mental Health Review Boards
  • 9)Establish a national surveillance system and
    appropriate monitoring and evaluation systems for
    mental health care integrated into the National
    Health Information System
  • 10)Establish a national suicide prevention
  • 11)Strengthen links with traditional,
    complementary and faith based healers and
    non-governmental organizations.

World Health Assembly Resolution 2013
  • A resolution on WHOs comprehensive mental health
    action plan 2013-2020 sets four major objectives
  • strengthen effective leadership and governance
    for mental health
  • provide comprehensive, integrated and responsive
    mental health and social care services in
    community-based settings
  • implement strategies for promotion and prevention
    in mental health, and strengthen information
  • evidence and research for mental health.
  • The plan sets important new directions for
    mental health including a central role for
    provision of community-based care and a greater
    emphasis on human rights.

Task team on mental health
  • Subsequent to the summit, under the stewardship
    of the Deputy Minister, a working group of
    stakeholders met to draw an action
    plan/strategic plan to implement the resolutions
    from the Summit.
  • Eight catalytic objectives were selected and are
    recommended by the task team for implementation.

Selected catalysts









Key challenges
  • Inadequate community care. People roaming the
    streets with mental illness mostly do not need
    hospitalization but good community care.
    (Hospitalisation of such people may not only
    constitute an abuse of their human rights but is
    more expensive than providing good community
    care, including housing, social support etc).

  • Stigma. People with mental disorder still are
    subject to discrimination and abuse. The answer
    to this is not to remove them from society (and
    thereby subject them to secondary punishment) but
    to integrate them through educating the public,
    providing facilities so that they do not cause
    harm to others etc.

  • Human resources. There are far too few trained
    professionals to meet need. More professionals
    must be trained but also we need to make best use
    of health staff at all levels through integrated
    mental health care and greater use of community
    health workers we need more equitable care
    between the private and public sectors as part of
    the NHI. (For example its just not acceptable
    that only 14 of psychologists are available to
    treat nearly 85 of the population)

  • Infrastructure. Some mental health facilities are
    not fit for human habitation and require
    revitalization or new facilities built. However
    we must balance this with establishing community
    based facilities.

  • Prioritization of mental health in annual
    performance plans. Mental health needs to be
    prioritized so that it becomes part of not only
    the national but provincial annual performance
    plans. Without this mental health will remain the
    Cinderella of health.
  • Neglect of mental health will impact negatively
    on physical health as well as mental health
    (given high co-morbidity). It will also impact on
    education, productivity, violence etc.

  • Thank-you (and look forward to assistance in
    improving mental health and mental health
    services in SA!)
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