There's little help available to ease the anxiety of jobless
The Life Esidimeni tragedy spotlighted the extent of mental dysfunction in SA and put on the national agenda the imperative of improving mental health services. But little help is available for the country’s biggest mental health problem: the anxiety caused by unemployment.
Prof Melvyn Freeman, chief director for noncommunicable diseases at the Department of Health, says increasing services for severe mental disorders will not help most people suffering from common mental health disorders such as depression, adjustment disorders, post-traumatic stress disorders, anxiety disorders, mood disorders and alcohol and drug abuse.
Only 5% of the health budget is allocated to mental health, yet an estimated 16.5% of adult South Africans are living with such challenges. A global study presented at a mental health summit in Johannesburg in 2017 showed that 30% of people report life-long psychiatric disorders, while one in three will be affected by a mental illness in their lifetimes.
"Most of the budget goes to serious mental disorders, which affect about 1%-2% of the population. It goes into averting a Life Esidimeni kind of crisis," Freeman says.
"It means people being in very expensive care for the rest of their lives. And some people need that kind of care. But that means that there is even less budget for dealing with things like depression, which might affect 10% of the population."
An estimated 17-million South Africans suffer from common mental health problems.
Sandy Lewis, head of psychological services at Akeso Psychiatric Clinics, says there is "no recognition of the growing incidence of mental health [disorders] in society — 5% of the budget [allocated to mental health] and 17-million people [suffering from common mental health problems]; already there is such a vast discrepancy."
Unemployment has a significant impact on mental health.
Statistics SA has reported that although the level of unemployment dropped by one percentage point in the last quarter of 2017 after climbing for 14 years, 9.2-million South Africans do not have a job. As retrenchments and corporate restructuring continue unabated, many people are struggling with trauma, stress and anxiety. Depression is at a record high.
"Depression is about to become the most debilitating illness for people across the world," says Lewis. "It is the illness that renders you more dysfunctional than any other, including physical illness.
"If you sideline mental health and believe it is not important like other diseases that kill, you are really missing the point, because there may not be a direct link between mental illness and mortality, but mental illness renders people incredibly dysfunctional," Lewis says.
Human resources consultants and facilitators hired to support retrenched employees describe a compassionless world and an increasing need for psychological services. Retrenchments and restructuring are often brutal processes with little regard for the impact on employees.
Dr MA Kanda, who studied neuropsychiatry at Kinshasa University and now runs mental health clinics in South African rural areas, says the mental health impact of unemployment and poverty is transgenerational: mental health problems are inherited by children living in poverty. Promises of jobs that don’t materialise are "invisible violence", he says.
"It is a vicious cycle," Freeman says. "Poor mental health does lead to unemployment and unemployment does lead to poor mental health. There’s a known drift of people with mental health problems towards poverty and unemployment.
"The unemployment situation in the country is abnormal … that makes it that much more difficult if you have mental health problems because there are so many other people in the queue," Freeman says.
"At the same time there is a fair amount of evidence that shows that if you are unemployed it does lead to depression and other mental health problems," he says.
Prof Steven Friedman, director of the Centre for the Study of Democracy at the University of Johannesburg, says the sterile debate about job creation must change. "If you create an expectation that the only way people can earn a dignified living is in the formal sector, then obviously there is a huge amount of disappointment and the effects which the psychologists describe," Friedman says.
"People engaged in backyard industries and various industries on the streets are regarded as unemployed and problematic. But you could take the view that they are actually productive people who are potentially part of the solution."
A new mind-set about the meaning of unemployment could have a positive spin-off for mental health. Instead of sweeping street traders off the streets, there should be deregulation. Informal traders should be connected to the private and public sectors to get the resources they need, he says.
Kanda agrees. "The power to create work is the power to develop ourselves and make ourselves fully real."
Lewis says work is intrinsically important to human beings. "We’ve got a massive informal sector and it is about time we recognised it," she adds.
But Freeman says people with mental health problems have limited potential to be creative and build businesses. "They don’t have the capacity or energy to create a livelihood. They would be further prejudiced," he says.
"You have to intervene from both sides: you have to change the unemployment situation and then you have to change the mental health situation because by doing that you help with the employment situation."