The South African Federation for Mental Health (SAFMH) runs an information and support desk through which parties making enquiries can liaise with SAFMH about mental health service provision and referrals. All enquiries and requests for support are documented and analysed on a continuous basis to keep abreast of the developments and challenges in the mental health field.
SAFMH receives enquiries through various platforms, including the organisation’s website, emails, telephone calls and social media (Facebook, WhatsApp and Twitter). Through these enquiries, SAFMH has managed to identify recurring challenges affecting members of the public in accessing mental health services. The challenges that have been identified are outlined below. (PLEASE NOTE that the challenges outlined here are solely based on feedback the organisation receives from the public, and is thus a reflection on the wealth of information SAFMH receives through this function of the organisation and not the outcomes of empirical research):
- Development of community services: Mental health care users (MHCUs) are often admitted to hospitals where they receive medical treatment and support. However, when the MHCUs are discharged, there is often a lack of support as family and community members do not know how to offer the required support. MHCUs also often receive their monthly medication without any psychosocial support going hand-in-hand with their medication. These issues showed that there was a need for community services which offered psychosocial support and other types of community-based support services required by MHCUs, especially after hospitalisation. Developing community services would mean that MHCUs could receive support within their reach. MHCUs constantly experience challenges related to the availability of such services.
- Residential facilities for youth with severe behavioural problems: There are challenges with residential facilities not being open to accommodating young people (under the age of 18) with severe behavioural problems. This could be addressed by making sure that young people have access to adequate mental health services and that facilities have the capacity to support young people with severe behavioural problems.
- Referral pathways for learners with special educational needs (LSEN): Parents are often informed that their children are not coping at mainstream schools and would probably need to be placed in an LSEN school. Such parents are faced with difficulties because most mainstream schools do not provide referral pathways to professionals and organisations that could offer psycho-educational assessments. These parents need to be made aware of the reasons their children are not coping at mainstream schools and be assisted effectively with the most appropriate information and options available.
- Facilities for persons with disruptive mental health conditions: Non-compliant MHCUs with severe behavioural problems (e.g. young people with Conduct disorder, Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Impulse Control Disorder, and Severe Intellectual Disability with Epilepsy and adults with Schizophrenia, Bipolar and Borderline Personality Disorder) often experienced challenges with finding suitable facilities for their care. These MHCUs displayed violent and aggressive behaviour and had poor treatment adherence, and as a result, struggled finding placement in a residential facility. They also struggled to be transferred to specialised tertiary hospitals for long term care. The general feedback commonly given was that the condition was not severe enough to warrant admission to specialised tertiary hospitals.
- Lack of choices available between private and public services: SAFMH also received enquires where family members and MHCUs complained that they could not afford private health services as the prices were exorbitant. The same people often also did not want to use public services because of bad experiences or were of the opinion that public health facilities were inefficient. These MHCUs and their loved found themselves at a dead-end.
- Involuntary admission: Involuntary admission is when a person with a mental disability is admitted into hospital without voluntarily agreeing to do so due to being a danger to themselves or others. The person is usually involuntarily admitted because they are unable to make the decision to voluntarily admit themselves at that point in time. A few individuals who experienced challenges with involuntary admission mentioned the difficulties in carrying out an involuntary admission procedure mainly because of the involvement the South African Police Service (SAPS) and the negative perception that people had about SAPS. The role of SAPS in involuntary admissions is stipulated in Section 40 of the Mental Health Care Act 17 of 2002. The SAPS have a responsibility to ensure that patients are transported to the nearest health facility, if they are believed to can inflict harm upon themselves or others around them. Sometimes, family members have had MHCUs in their care involuntarily admitted beforehand, and the MHCUs recovered and were discharged. The involvement of the SAPS during involuntary admission sometimes caused tension between the MHCU and their family members. When MHCUs relapsed, family members became reluctant to try the involuntary admission procedure again where the MHCU needed to be involuntarily admitted. Family members often had to decide between either keeping the peace with the MHCUs in their care or having them properly treated.
- Volunteering: The major challenge with obtaining a volunteer opportunity was that potential volunteers needed to have qualifications, skills and experience working in the mental health sector. The majority of these enquiries were received from those residing in Gauteng. There were also other enquiries received from those residing in other provinces but were looking for volunteer opportunities in Gauteng. Finding suitable volunteer opportunities proved to be difficult as the opportunities were not always available. SAFMH is currently collecting information pertaining to challenges and opportunities in the non-governmental organisation (NGO) sector related to volunteering. These are NGOs that specifically work with mental health. SAFMH believes this information will help shed light into how the NGO sector reacts to potential volunteers and the challenges of having volunteers be part of their daily operations.
- Placement related enquiries: The public reported placement facilities for MHCUs being expensive, having long waiting lists, and MHCUs not fitting the criteria for admission because of reasons including age, diagnoses or the MHCU’s condition being too severe for a residential facility.
- Hospital treatment and the revolving door syndrome: The revolving door syndrome refers to MHCUs being hospitalised and prematurely discharged, the MHCUs possibly getting a bit better but then ending up relapsing again and needing to go back to hospital because of their mental health problems not being adequately dealt with during the first hospitalisation. Premature discharge is mostly due to lack of beds and therefore patients are discharged before the complete treatment period. Challenges reported to SAFMH in this regard related mostly to MHCUs being discharged from hospital without recommendations for further mental health care. This resulted in MHCUs relapsing and frequently being readmitted to hospitals. Family members were often left with little or no idea on how to support a MHCU after their discharge from the hospital. There was a lack of community based services and support. Lack of ongoing support in the community results in stress, lack of treatment adherence and no proper community integration plan which results in relapse.
- Inadequate services for mental health issues at higher learning institutions: A lack of adequate mental health services at higher learning institutions were reported by students and also a lack of support with regards to stigma and discrimination against students with a mental illness.
- Referrals: On occasion, some individuals require SAFMH to directly refer them or their loved ones straight to a specialised tertiary hospital or a psychiatrist, which the organisation is unable to do. A referral to a specialised tertiary hospital can only be made by professionals in a general hospital. Referrals to psychiatrists can only be made by general practitioners or psychologists. The referral processes are also different for the public and private sector. The public needs more understanding about referral processes.
SAFMH continues to learn about challenges in the mental health care sector through the experiences of the public who use SAFMH’s services. The challenges outlined in this article are some of the recurring issues that need the attention of policy makers and also the general public. SAFMH welcomes enquiries or more information from the public on any of the issues raised above.
(Project Leader – Mental Health Support, SAFMH)
Tel: 011 781 1852
Please note that, until further notice, SAFMH will only be available for phone interviews and email enquiries.
- Mental Health Care Act 17 of 2002. (2005). Juta and Company, Ltd.