Educating the innovators for community mental health promotion
The many tolls of COVID-19 will be counted and measured. It’s likely, though, that we’ll never get a clear picture of the pandemic’s impact on our mental health. Yes, the suicides are being tallied up, but mental health issues manifest in many more ways. Mental healthcare is the poor, neglected orphan of healthcare services. While there’s far more focus than there has ever been on the importance of mental health, the majority of people with mental health concerns do not access the care they need to heal and transform their lives. This is particularly the case in South Africa, where the need is staggeringly high and exacerbated by widespread chronic poverty, crime, unemployment, violence, disease, discrimination and domestic abuse. Now, COVID-19 has ushered in a sustained crisis of fear and anxiety, trauma and grief.
According to Dr Jaclyn Lotter, the Academic Dean at SACAP (the South African College of Applied Psychology), only around 15% of South Africans with mental health problems will receive some form of treatment in their lifetime. She says: “It is estimated that within our current model of mental healthcare, 0.39 psychiatrists and 0.69 psychologists are employed in the public sector for every 100 000 South Africans. By comparison, in Argentina, which is also a developing country, in 2010 there were an estimated 13.9 psychosocial providers employed by the state for every 100 000 people. Only 3% of the national health budget is allocated to mental health provision, equating to about R100 spent per person per year; and the majority of this budget goes to inpatient psychiatric care. This means that the one in six South Africans suffering from debilitating conditions such as depression, anxiety and addiction will not access the healthcare they need unless they can afford the high costs of private practitioners.”
Re-imagining the mental healthcare model
Boosting the budget for mental healthcare provision is essential, but Dr Lotter echoes top global thought leaders in her insistence that the highly medicalised, professionalised approach to mental healthcare is in itself too limited and unsustainable. “There needs to be a shift in understanding that mental health is affected by a broad range of factors, and is therefore not the sole domain of psychologists and psychiatrists,” she points out. “The triggers for mental health concerns are playing out in homes and schools, in places of study and of work, right in our communities. Alternative mental healthcare models are looking for solutions beyond traditional consulting rooms and clinics. Research in task-shifting has shown that lay counsellors who have been trained to provide specific interventions for common mental health problems such as depression and anxiety can achieve similar short-term outcomes to qualified mental health professionals. This is incredibly significant given the large proportion of people who will grapple with these issues at least once in their lifetimes. With strong referral networks in place, there is significant opportunity to make use of various levels of mental healthcare workers to help relieve the burden that our current healthcare systems cannot properly manage or sustain.”
Building a diverse mental healthcare workforce
In 2018, SACAP launched its first masters degree, a two-year MSocSci in Community Mental Health Promotion, which aims to develop strategic leaders and social innovators who can contend with South Africa’s social realities and pioneer new and more effective models of mental healthcare that are community-based. “There’s increasing awareness that creating multi-disciplinary spaces and recognising the interdependence of health and mental health creates opportunities to build holistic interventions and achieve a broader set of health outcomes,” says Dr Lotter. “When we properly take into account the social causes of health and mental health, then we can recognise the pivotal role that communities can play in addressing the barriers to their own well-being. This opens up avenues for community empowerment and transformation and the sharing of a deep understanding of social patterns that place communities at high risk of illness and harm. Collaborative spaces can be used to challenge these patterns with the aim of fundamentally changing the ways that communities function. This is at the heart of the MSocSci programme, which is multi-disciplinary, and draws students and educators across diverse social and health sectors. We don’t just look at mental health from a disease perspective, but also from one that is seeking out social transformation and finding sustainable solutions for mental healthcare and promotion at community level.”
Knowledge and skills for innovative community mental health
Alongside the globally recognised need for community-based involvement in the pursuit of health and well-being, a need has risen for strategic leaders and social innovators who can conceptualise, catalyse and organise mental health strategies and interventions that we have never seen the likes of before. This demands skillsets that are notably different from traditional mental health practitioners who work within the narrow confines of the medicalised model. Dr Lotter asserts that community mental health workers that can bring about social transformation need highly developed people skills and the ability to effectively lead. “We need to be developing high performance leaders with the specialised skills to draw knowledge, strengths and capacity that already exists in communities and who can work collaboratively to find and implement sustainable solutions,” she says. “Our MSocSci students are being dynamically equipped to engage with a broad range of stakeholders and produce relevant research that is aimed towards tackling the multidimensional determinates of mental health. Graduates of the programme are able to analyse complex health problems and produce multi-layered solutions, using practised skills and applied knowledge of community development and intervention, management and leadership. SACAP’s aim is to boost the country’s mental healthcare workforce with social scientists who are empowered to explore new ways of approaching health and well-being in South Africa with the ultimate goal of delivering responsive solutions to the mental health problems our country faces.”
The mental health fall-out from COVID-19 is going to ripple outwards over time. Without significant interventions and investments, the country’s mental healthcare system, inadequate before the pandemic, will never be able to deliver widespread, meaningful solutions. Implementing alternative models of mental healthcare and upskilling a diverse mental healthcare workforce offer the opportunity to reimagine South Africa’s mental healthcare landscape as robust and effective.