Dr Olive Shisana

Honorary Professor UCT

Message from the co-chair of the South Africa Mental Health Conference

The 2021 Mental State of the World report identified South Africa as the lowest-ranked country based on mental wellbeing. Despite the absence of recent national and research data on mental health, the manifestation of drivers of poor mental health is evident. South Africans live in a country with factors conducive to developing poor mental health. Social and structural drivers are contributing to the observed declines in mental health.

These include very high levels of violence, poverty, unemployment, and inequality. Poverty harms mental health and often manifests as psychological distress, inability to concentrate, depression, anxiety, and suicide. Inequality, a close associate with poverty, also contributes to deteriorating psychological wellbeing. Furthermore, unemployment is associated with depression, anxiety, hopelessness, restlessness and feeling of worthlessness which are markers of poor mental health. These triple challenges of poverty, inequality and unemployment put the nation’s mental health at risk.

These challenges occur in a society already traumatised by apartheid, which destroyed the family structure through migrant labour models continuing to this day. As a result, most children live in homes with absent fathers, and women face the pressure and the stress of raising children alone. Such experiences impact women’s mental health and deprive children of a gender-balanced life, negatively impacting social relations and mental health, often manifesting as childhood trauma.

Political violence, killings, and violent protests create fear and instability in society, leading to anxiety and insecurity. Furthermore, killings and lootings in July 2021 and the recent spate of random shootings leading to injuries and deaths further contribute to mass fear and anxiety when frequenting social spaces.

Compounding these drivers of poor mental health is the advent of COVID-19, which led to premature mass deaths and high morbidity, making many feel anxious, unsafe, and psychologically distressed. An extended period of isolation and limited opportunities to socialise contributes to poor mental health by depriving many social interactions, leading to anxiety and depression. COVID-19 contributed to the decline in the mental health of the population. Massive corruption during the pandemic has also further negatively impacted the collective well-being of South Africans.

Climate change and consequent flooding in the country, causing injuries and deaths, have left many with mental scars. In addition, many people were left homeless and were accommodated in communal settings with little privacy. Consequently, many remained without homes, lost valuable possessions, and felt hopeless, anxious, and insecure.

All these social determinants and high rates of poor mental health occur in a country with highly inadequate mental health services. Only 4% of the national health budget is allocated to mental health, and 78% of the budget is spent on psychiatric hospitals, leaving minimal funding for community-based services. The poor mental health status continues despite the stated vision of the National Mental Health Policy and Strategic Framework 2013-2020, which aimed to improve the mental health of South Africans by 2020. The low rate of psychologists and psychiatrists per population is reason to be concerned about the capacity of the country to provide mental health services for a psychologically wounded society. Moreover, most of these mental health professionals practice in the private sector serving the few who have medical aid, leaving the majority without services.

South Africa faces a mental health pandemic that can no longer be ignored. Although one out of every five South Africans will require mental health services in the coming year, most will never be able to access such care. However, the national HIV/TB epidemic response has demonstrated how South Africans can overcome what appears to be insurmountable public health challenges when we focus the attention of all stakeholders on finding innovative solutions.

The time has come for South Africa to convene a national mental health conference to share experiences and research that will assist the country in assessing the state of mental health in our country, structural, social, behavioural drivers, services required, policies, and human and financial resource needs. We plan to gather thousands of South Africans from all sectors and researchers and implementers from other countries to share ideas on what we can do to address the drivers of poor mental health status in our country. This conference will support the recently launched Masiviwe movement that aims to bring all stakeholders together to create a broad social movement to improve mental health and access to services.

We hope scientists, academics, practitioners, implementers, innovators, people with lived experience, support groups and the broad civil society will submit abstracts that will contribute to putting a spotlight on mental health and advancing knowledge. We also encourage national and provincial policymakers and government officials will attend to share their views and learn from evidence to be presented at the conference.