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31 July 2017 - July Psychosocial Disability Awareness Month

As Psychosocial Disability Awareness Month draws to an end, the SA Federation for Mental Health wants to reiterate our call for the upscaling and integration of community mental healthcare services across South Africa. Throughout the month of July SAFMH, as well as our Mental Health Societies across the country, advocated for existing community mental health services to be upscaled and to receive increased support, as well as for mental health services to be integrated into existing health systems, thereby maximising reach and minimising costs. It is important however that advocacy for this important cause does not stop at the end of this awareness month, but that it continues until mental health is treated as a priority by Government and other stakeholders in the health sector.

A recent report released by the South African Society for Psychiatrists (SASOP) on the state of care in the various provinces highlighted once again the poor state of mental healthcare currently available to mental healthcare users.

The report found:

  • There are only six public sector psychiatrists serving the whole of Limpopo province
  • Hayani hospital in Limpopo, a 390-bed mental health specialist hospital, currently has no psychiatrist.
  • In all provinces, psychiatrists have to admit children and adolescents unlawfully into adult psychiatry wards.
  • In Kwa-Zulu Natal, a massive specialist staffing crisis exists where only 20 of the 45 specialist posts are filled.
  • No province currently has organised community-based psychiatric services.

SAFMH was hopeful that following the Life Esidimeni tragedy, Government would prioritise the implementation of the Mental Health Policy Framework and Strategic Action Plan (2013-2020), as well as the upscaling of mental healthcare nationwide. However to date this has not been the case. For example, one of SAFMH’s Mental Health Societies, Port Elizabeth Mental Health, this year received a funding cut of 57% by the Department of Social Development, seriously impacting their services and the organisations sustainability. Government cannot claim to be committed to rectifying tragedies like Life Esidimeni, while also making massive funding cuts to other mental health projects.

As this awareness month ends, SAFMH would like to again call on Government to provide increased support and funding for community based mental health services, as well as for the integration of mental health services into primary healthcare on a community level, to ensure that mental healthcare users are able to receive the quality treatment they deserve.


Marthé Kotze

Programme Manager: Information & Awareness

SA Federation for Mental Health

This email address is being protected from spambots. You need JavaScript enabled to view it.

011 781 1852


05 July 2017

The SA Federation for Mental Health was recently alerted to a column published by an online news agency, which seemed to link South Africa’s high crime rates with mental illness. While we commemorate Psychosocial Disability Awareness month during the month of July, SAFMH feels it is important to address these misconceptions and their potential negative consequences on the lives of people living with mental health disorders.

The idea that people with mental disorders or disabilities are more prone to violence than other members of society is one of the most strongly held and harmful misconceptions that still exists in our society, and one that is often enforced by media reporting. It is important to recognise the potentially devastating effects that these false beliefs can have on the lives of those living with mental disorders, as it can lead to increased levels of stigma and discrimination, social exclusion and the denial of basic human rights.

The media can either contribute to the belief that mental illness contributes or leads to crime, or help to fight it, through their reporting. Throughout the years many international studies have been done on the portrayal of mental illness in the media, and how this portrayal affects public perceptions. Studies have shown that negative media reporting leads to the perception that mental illness is linked to violence, crime, unpredictability, being a danger to self or others, or that people with mental disorders are passive victims deserving of pity. 

However through positive and fair reporting the media also has the power to help shift public perceptions about mental health, and reduce stigma and discrimination.

Here is what research has found regarding the link between mental illness and violence:

  • “The combined evidence from these studies indicates that…persons with psychotic diagnoses are less likely or at least no more likely to commit violence…a history of delusions and a diagnosis of paranoia were unrelated to future violence.” - Harris, Grant T. and Marnie E. Rice. "Risk Appraisal and Management of Violent Behavior". PS 48.9 (1997): 1168- 1176.
  • "…the vast majority of people who are violent do not suffer from mental illnesses." - American Psychiatric Association. (1994). Fact Sheet: Violence and Mental Illness, Washington, DC: American Psychiatric Association.
  • "People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime.” - Hiroeh, Urara et al. "Death by Homicide, Suicide, and Other Unnatural Causes In People With Mental Illness: A Population-Based Study". The Lancet 358.9299 (2001): 2110-2112.
  • “People with severe mental illnesses, schizophrenia, bipolar disorder or psychosis, are 2 ½ times more likely to be attacked, raped or mugged than the general population." - Hiday, Virginia Aldigé et al. "Criminal Victimization of Persons with Severe Mental Illness". PS 50.1 (1999): 62-68.

With these facts in mind, it is crucial that the media reports responsibly on cases involving persons with mental disorders or disabilities. Speculation, inaccurate or one sided reporting can do an incredible amount of damage and help to increase stigma and discrimination.

Trying to link South Africa’s high crime rates with mental illness or disorders such as foetal alcohol syndrome (which is not a mental illness but rather a developmental disorder), is unfounded and reckless, as it endangers the lives of those who are already vulnerable and face discrimination and abuse. SAFMH would like to encourage all members of the media to report fairly and accurately on mental health and all related factors, and to make use of tools such as the SAFMH Media Guide for Responsible Reporting on Mental Health to guide them in terms of terminology or topics they may not be sure of. Media practitioners are also encouraged to contact SAFMH if they require information, statistics or other assistance. 


The SAFMH Media Guide for Responsible Reporting on Mental Health can be accessed here.



Marthé Kotze

Programme Manager: Information & Awareness

SA Federation for Mental Health

This email address is being protected from spambots. You need JavaScript enabled to view it.

011 781 1852





July Psychosocial Disability Awareness Month


Every year July is commemorated as Psychosocial Disability Awareness Month, and this year the South African Federation for Mental Health is focusing on the need for upscaling and integration of community mental health care services.

The death of 94 mentally ill patients who were transferred from the Life Healthcare Esidimeni facilities to unlicensed NGO’s by the Gauteng Department of Health has placed the spotlight on the many problems existing within the current mental health system in South Africa. South Africa has good policies and legislation for mental health care, such as the Mental Health Care Act and the Mental Health Policy Framework and Action Plan 2013-2020, but the implementation of these policies remain a challenge. Mental health services have in many cases not been integrated effectively into other primary health services, and as a result mental health remains largely marginalised and underfunded. It is important to recognise that the Life Esidimeni tragedy is an example of a symptom of a mental health care system that does not provide adequate treatment or services to the many South African’s who need mental healthcare, along with a poorly-implemented deinstitutionalisation policy.     

Community-based mental health organisations provided crucial services, and without them thousands of Mental Health Care Users (MHCUs) would not receive the treatment and care they need. These community-based organisations are however largely dependent on the support of Government, the private sector and their communities in order to be able to provide effective services. It is necessary for primary health services such as Clinics and Hospitals, as well as social services such as social workers, community care workers, District Health Teams, private sector organisations such as medical schemes, pharmaceutical companies and private sector psychologists and psychiatrist to collaborate more effectively with community-based mental health organisations to provide the services that MHCU need.

Integration of these various services can help to improve access and facilitate the use of services, as well as preventing duplication of services. This collaboration and integration of services can also help to facilitate effective deinstitutionalisation. Deinstitutionalisation is a process of replacing psychiatric hospitals with community-based mental health services for people diagnosed with a mental disorder or intellectual disability.

Throughout the month of July, SAFMH and our Mental Health Societies and partners will be advocating for increased support and funding for community based mental health services, as well as for the integration of mental health services into primary health care on a community level. 

The following are recommendations regarding the increased support, and upscaling of resources for community based mental health organisations, as well as for the improved integration of mental health services:

  • Mental health services must be prioritised and developed with an equal level of high importance across all provinces in South Africa, and across rural and urban areas
  • Existing human and infrastructure resources need to be utilised as efficiently as possible and additional resources need to be developed and or prioritised
  • Services and resources at community level should be developed in consultation with MHCU, their families, NGO’s and other key partners/stakeholders/decision makers/service providers to ensure the development of such services is done in an informed and collaborative way
  • The prioritisation, implementation and monitoring of the MHPF at provincial level is essential, and provincial Departments of Health need to be held accountable for failure to do so
  • Savings generated through budget cuts in tertiary Psychiatric Care Facilities need to be used to support community-based care and to ensure that MHCU have access to high-quality care
  • Government needs to address the pervasive shortfalls in resources needed to adequately facilitate deinstitutionalisation policy requirements
  • South Africa needs to see the development of a range of comprehensive community-based mental health services to ensure that MHCU are provided with a range of community-based services
  • South Africa requires more consistent and more comprehensive subsidisation of community-based services, with adequate increases and timely payments of subsidies to ensure continuity in community-based mental health service delivery
  • Government also needs to look at the types of subsidies/funding opportunities that are made available to NGOs; what is required, in addition to post-funding, is more programmes funding for community-based organisation to aid in the development of more concerted service project development for MHCU
  • Treatment and rehabilitation of MHCU should be integrated into a system of Psychosocial Rehabilitation (PSR). These PSR systems should focus on areas such as skills training, peer support, vocational services and community resource development, to ensure that MHCU receive support and services enabling them to reintegrate into their communities


Marthé Kotze

Programme Manager: Information & Awareness

SA Federation for Mental Health

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28 June 2017

In light of recent reports of dramatic, sudden cuts in NGO subsidies in Gauteng, the SA Federation for Mental Health condemns such ill treatment of NGO’s by the Gauteng Department of Health.

Media reports and complaints to our offices have brought to light the fact that the Gauteng Department of Health has failed to pay the monthly subsidies of a number of NGO’s caring for vulnerable mental health care users (MHCU) in the province for the past few months, possibly due to revised licensing guidelines that the Department has hastily put in place in response to the Ombudsman’s damning report on the Gauteng Marathon Project, which saw approximately 100 MHCUs lose their lives due to poor planning and execution by the Gauteng Department of Health.

These NGO’s now face possible closure, and the MHCU face being left destitute, as a result of the Departments actions. It is important to recognise that ultimately any ill treatment of NGO’s by the Department translates into ill treatment of MHCU, as they are dependent on the care and services that they receive from the NGO’s.

SAFMH National Director, Bharti Patel, says the Gauteng Department of Health is not showing its commitment to mental healthcare. “NGO’s have communicated their challenges – which range from not being issued with licenses to non-communication about subsidies - to the Gauteng Portfolio Committee on Health. The Department of Health promised to issue licenses to all of the affected NGO’s two weeks ago, and yet today we hear that licensing is still a problem and this is affecting subsidies. The Department of Health does not seem to be serious about improving mental health services despite the increased budget allocations which were announced after the Health Ombudsman’s report on the Life Esidimeni tragedy.” 

In the wake of the Life Healthcare Esidimeni crisis, the Gauteng Department of Health should be mindful not to again jeopardise lives through carelessness or poor, rushed administrative procedures. While SAFMH recognises the need for new and stricter licensing requirements for NGO’s to be implemented, these procedures should be implemented in such a way that the care of MHCU is not affected and that NGOs are given sufficient time to bring themselves in-line with new licensing demands placed on them by the Department of Health so that service standards may be raised realistically whilst ensuring that the process is managed effectively and is not to the detriment of MHCUs.

SAFMH calls on the Department to pay all of the subsidies owing to the various affected NGO’s, and going forward to manage the licensing process in a more consultative and realistic manner. Whilst we recognise the need for more stringent licensing procedures, such new measures should be implemented with the wellbeing of MHCUs in mind at all times. We call on all parties involved to remember that the most important aspect of this case is the wellbeing of the MHCUs, and we urge all stakeholders to place their interests first.



Marthé Kotze

Programme Manager: Information & Awareness

SA Federation for Mental Health

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Bharti Patel

National Director

SA Federation for Mental Health

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26 June 2017 

Every year 26 June is commemorated as International Day Against Drug Abuse and Illicit Trafficking. This year the SA Federation for Mental Health wants to draw specific focus to the issue of youth and substance abuse. Substance abuse often affects people during the years when they should be completing school or finding employment, and the entrapment of youth in drug and alcohol abuse, as opposed to engagement in legitimate employment and educational opportunities, poses distinct barriers to the development of individuals and communities.

Substance abuse among youth has severe effects on our communities and families, and has many potential physical and mental health effects for the users, such as increased risk of injury and death due to either violence or accidents; increased probability of engaging in sexual behaviour with high risk of teen pregnancy and transmittable diseases; and increased risk for suicidal behaviour and psychosocial disorders. Abuse of different substances is furthermore also often the reason for declining grades, high absenteeism and school dropouts as well as involvement in crime and gang-related activities.

Substance abuse can be common among people suffering from mental health conditions. People experiencing anxiety, depression, or other mental illnesses often turn to drugs or alcohol to find temporary comfort. These substances are also sometimes used as a coping mechanism for those enduring a great deal of stress or hardship, such as experiencing troubles at home or at school, or losing a loved one.

Using drugs or alcohol to deal with difficult feelings or symptoms of mental illness is sometimes called ‘self-medication.’ But it can make existing mental health problems worse. Studies have for example shown that people who consume high amounts of alcohol are vulnerable to higher levels of mental ill health.

According to reports published in the Journal of the American Medical Association:

  • Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse
  • 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness
  • Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs

It is vitally important that we educate our youth about the dangers of drugs and alcohol abuse, and that we provide them with the emotional and they need so that they do not develop the need to turn to substance use for comfort. It is also essential that parents, teachers and the youth themselves are educated about the signs and symptoms of substance abuse, so that they can identify it early on and get the affected person help as soon as possible.

SAFMH calls on all sectors of society to prioritise the support, education and protection of our youth against substance abuse, and to work together to safeguard their physical and mental health.

Signs of substance abuse -  

Behavioural changes:

  • Drop in attendance and performance at work or school
  • Frequently getting into trouble (fights, accidents, illegal activities)
  • Using substances in dangerous situations such as while driving or operating a machine
  • Engaging in secretive or suspicious behaviour
  • Changes in eating or sleeping patterns
  • Changes in personality or attitude
  • Sudden mood swings, irritability, or angry outbursts
  • Periods of unusual hyperactivity, agitation, or giddiness
  • Lacking motivation
  • Appearing fearful, anxious, or paranoid, with no reason

Physical changes:

  • Bloodshot eyes and abnormally sized pupils
  • Sudden weight loss or weight gain
  • Deterioration of physical appearance
  • Unusual smells on breath, body, or clothing
  • Tremors, slurred speech, or impaired coordination

Social changes:

  • Sudden change in friends, favourite hangouts, and hobbies
  • Legal problems related to substance use
  • Unexplained need for money or financial problems
  • Using substances even though it causes problems in relationships


Marthé Kotze

Programme Manager: Information & Awareness

SA Federation for Mental Health

This email address is being protected from spambots. You need JavaScript enabled to view it.



Every year the 7th of April is commemorated as World Health Day, to mark the anniversary of the founding of the World Health Organization. This year the theme selected by the WHO is Depression: Let’s Talk.

Globally it is estimated that 300 million people of all ages experience depression, and depression is currently the leading cause of disability worldwide. It is therefore crucial that people are educated about depression, and that all sectors of society are encouraged to speak openly and honestly about their experiences and struggles. Depression can affect anyone regardless of age, race, gender or socioeconomic status. The disorder can greatly impact a person’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends as well as the ability to function at school or work.

Although all aspects of society may be affected by depression, the South African Federation for Mental Health is appealing to Government, teachers, parents, social workers, and all members of society to place specific emphasis on the mental health of South African youth.  

The 2008 National Youth at Risk Survey which focused on children and adolescents between grade 8 and 11 found that one in four youth (24.7%) reported feeling sad or hopeless, and just under 18% had made at least one suicide attempt. Only 37.2% of youth who reported feelings of sadness had sought treatment from a counsellor or doctor.  World-wide suicide is now listed as the second leading cause of death among 15-29-year olds according to the WHO. Depression is associated with increased risks of substance abuse, unemployment, early pregnancy, and educational underachievement. It is crucial that young people experiencing depression feel safe and comfortable to open up about their struggles, and to seek the correct help and treatment they need.

Research has shown that there are a number of factors that make a person more likely to develop depression, these include environmental factors such as adverse childhood experiences like abuse or poverty, stressful life events such as the loss of a job, death of a loved one or exposure to physical violence. There is also a genetic and physiological component as first degree relatives of someone with major depressive disorder are two to four times more likely to develop the disorder. Depression often remains largely underreported by teens with studies finding that it often takes several years before depressed adolescents and children receive appropriate treatment. This treatment gap is in part due to stigma and fear of discrimination.

On World Health Day SAFMH calls on all South Africans to begin talking openly about depression, and to thereby combat the stigma and misinformation surrounding mental health. Young people struggling with feelings of depression, or any other mental health problems, are encouraged to seek professional help so that they can access the correct forms of treatment.


Symptoms of Depression to look out for:

•        Sad, low, or irritable mood or feeling nothing

•        Decreased interest or pleasure in activities

•        Change in appetite or weight

•        Sleeping more or less than usual

•        Feeling restless or slowed down

•        Fatigue or loss of energy

•        Feelings of guilt or worthlessness

•        Decreased concentration

•        Sense of hopelessness

•        Substance abuse

•        Recurrent thoughts of death or suicide


Marthé Viljoen

Programme Manager: Information & Awareness

SA Federation for Mental Health

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