BHF Conference: Covid deepened SA’s mental health crisis to a national crisis

Since Covid 19 ended, helpline calls to the South African Depression and Anxiety Group, (SADAG) have increased by 400% (now at between 2500 and 3000 per day), a quarter of them suicide-related.

Cassey Chambers, SADAG’S Operations Director, told 1000 delegates to the 22nd annual Board of Healthcare Funders Conference in Cape Town this week that besides this, poor mental health was costing local companies between R170 and R200 billion per annum in lost productivity. With nine out of ten South Africans with a mental health issue having no access to care and one-third of the population estimated to suffer from a mental health issue at some point in their lives, it has become “an incredibly important issue.”

She was speaking in a plenary session entitled, “Collaboration to accelerate the necessary actions required for improved healthcare outcomes –in pursuit of a person-centric health system.”

Chambers said four of SA’s top insurers paid out over R52 billion in claims due to suicide in 2021 while only 40 of 336 hospitals had a mental health unit. There was a paucity of data on links between hospitals providing psychiatric care and community-based carers, while 86% of the State health budget was allocated to inpatient care, half of this was directed to specialised psychiatric hospitals.

This skewed emphasis resulted in 20% of the mental healthcare budget being spent on hospital re-admissions. Co-ordinated care was ‘essential’ to improve outcomes, she said, but the challenges were numerous. These included scanty patient health data/records and dismal information sharing, poor communication with specialists, and a lack of facilities, human resources, and training.

Covid induced psychiatrist exodus?

Chambers said that during Covid, one third of all South Africa’s psychiatrists (300 registered with the HPCSA) left the country, while most of those remaining had already closed patient bookings for this year. There was a dire lack of community mental health programmes in the country.

“Mental health treatment is not prioritised over other health conditions and it’s hard for patients to navigate information to access information on benefits. The platforms are complicated and the processes confusing. The different treatment guidelines in Prescribed Minimum Benefits, (PMBs), focus on the “or’ (limited choices), and not the “and,” she protested.

Mental healthcare was human resource-dependant for diagnoses, care, treatment, and rehabilitation and should be included in benefit packages for chronic illnesses, she asserted.

Co-morbidity risk

Available data showed that cancer patients had a 20% higher suicide rate and 30-35% of patients with cancer were at a higher risk for mental illnesses such as depression and anxiety. People with diabetes were two to three times more likely to develop depression and of these only a quarter of those with both conditions got treatment. A full 40% of women with infertility also had a psychiatric diagnosis.

Mental health had developed into ‘a national crisis,’ and needed “a village,” to embrace it, focussing on first line interventions of support and ongoing care – not merely hospitalisation.

“We need step down facilities with a focus on after care programmes after discharge, to decentralise mental health professionals, including accredited counsellors and psycho-education – once you can name it, you can tame it,” she said.

Compliance programmes were critical for better treatment adherence while the success of the healthcare system depended on the extent, “to which we can prevent illness and treat it effectively to prevent relapse,” she added.

Her ‘wish list,” included medical insurance and life insurers creating support programmes to intervene and help prevent loss of life, early mental health support programs for children, better awareness, and normalising mental health check-ups to bring them on a par with for example prostate or breast examinations. Greater investment by both sectors in community health projects was needed while a stronger focus on the mental health of healthcare workers would pay handsome dividends,

“With no or with damaged healthcare providers, there is no healthcare,” she stressed appealing to conference delegates to include mental health in their NGO sponsorships.

Addressing the same plenary theme, with a talk entitled, “Bringing the hospital home,” Dr Frederick Bester, Specialist Physician & President of the Faculty of Consulting Physicians of South Africa, FCPSA, said innovation was key.

“I often look after suicide attempts. I feel very sorry for them and realise they are a symptom of a very sick society. How do we bring up our children to prevent suicides?” he challenged his audience.

There would never be enough nurses or managers to serve everyone, so new technological applications like smart phones, wearable devices, integrated AI, virtual models for clinical trials, augmented reality, social media and “DIY biotech,” were all hugely helpful.

“We all carry super computers in our bags – they can serve as a huge tool to improve medical services. Take mobile devices helping integrate insulin delivery to patient bodies. We must also accept that Google is there. Don’t confuse a Google search with a medical degree, but we must accept that people go there. When I have to explain a diagnosis to a patient, I say ‘go home and Google it and then come back and ask your questions – that‘s the way to do it.”

Bester said people today lived in a world where you could send in a blood sample and obtain your entire genome sequence to assess bio-medical risks for example, colon cancer, while precision robots could operate on a patient with the surgeon sitting on another continent.

“We can get you out of a wheelchair and walking with bionics or have our cell phones tell us what’s going on in our bodies.”

His London, Port Elizabeth, and Cape Town-based company, Quro Medical, gave patients telematic technology to constantly monitor their health with minimal clinical support, supporting them for five days and providing 24/7 virtual vital signs monitoring and "virtual visits” for “check ins,” with continuous care on offer, short term oxygen provided and ambulance services on hand.

A full seventy percent of their patients chose this plan which included daily visits for three days, blood tests, wound dressings, medication, and fluids (via drip if necessary) and access to allied healthcare services, including physiotherapy.