The need for mental health care highlighted on World Mental Health Day

10 Oct 2011 - 12:00

People suffering from mental illness in low and middle-income countries like South Africa have little access to mental health treatment, increasing the ‘treatment gap’. Universities and provincial government in the Western Cape join forces in the hope of closing this gap.

It is well known amongst mental health experts and policymakers that there is a growing burden of mental illness globally. While most people affected by mental illness in high-income countries have the good fortune of receiving care, those in low and middle-income countries (including South Africa) lack the resources available to access effective treatment. This has created a gap between the number of people living with mental illness, and those who receive appropriate treatment, commonly referred to as the ‘treatment gap’.

Because of this treatment gap, the coverage of mental health services in disadvantaged countries needs to be expanded, while ensuring this is achieved in a cost-effective manner. More so than in many other areas of health, it has been shown that mental health services can be highly cost-effective to set up. In order to identify the cost and resources required to scale-up or develop mental health services, particularly for child and adolescent mental health, researchers have also developed a model which can be used and adapted to assist planners and policy-makers to use sound evidence in their decision-making.[1]   

In South Africa, researchers have hailed the post-apartheid human rights based approach to mental health policy and legislation. However, the new policies and laws have not been implemented equally well in all provinces, with widespread inequality in the resources available for mental health care between provinces.[2]  In the case of the Western Cape, members of the provincial Department of Health and academics in universities involved with psychiatric services and training enjoy a healthy collaboration, meeting regularly, including every year on World Mental Health Day to discuss new research. This year, they will meet at the Lentegeur Psychiatric Hospital in Mitchell’s Plain.  

Charlene Sunkel, a mental health activist living with mental illness (schizophrenia), shares her personal experience of mental health services in the Gauteng province of South Africa:

“I was fortunate that at the time of onset I was on a medical aid scheme that allowed me to see a private psychiatrist for treatment. It was only when my condition deteriorated to such an extent where I needed to be hospitalised and my medical aid only covered part of a private institution, which forced me to access the Government mental health system. I had numerous admissions to various State psychiatric hospitals, where in some of them I witnessed and experienced emotional and physical abuse. This led me, amongst other things, to become an activist for mental health since 2003.”

On the issue of discrimination against those with mental illness, Charlene identified stigma as a huge problem. This results in patients not accessing treatment or seeking any help. Other difficulties patients like herself have to deal with in public clinics include:

  • Waiting times of up to 5 hours, which affect the employer-employee relationship for those who are employed;
  • Long waiting lists for the clinic psychologist of up to a year;
  • Lack of medication which results in many patients relapsing; and
  • Distrust and discomfort felt by patients as a result of the rotating psychiatrists, who change every 6 months.

It is for these reasons that mental health researchers have developed a model for implementing community mental health services in South Africa. This model is a human rights based approach to delivering mental health care near to places where people live and work, as well as improving accessibility of services.[3]    

In order to improve mental health services, Charlene suggests that more funds need to be made available. Referring to the competition for public resources with HIV/AIDS, Charlene says that it is ‘ironic that many people with HIV/AIDS develop mental health problems, and at some point, will access mental health services’.

To ensure that South Africa improves the number of people trained and qualified in mental health care, the Department of Psychiatry and Mental Health at the University of Cape Town (UCT) conducts extensive training of psychiatrists and mental health researchers, with the ultimate goal of ensuring better mental health care. Such training occurs in the Division of Public Mental Health, as well as in a range of more clinical divisions (see website below for more information).                                                                                                                                                

Not only has the Department been actively engaging in research in the field of mental health globally and in Africa, but also, working hard to ensure that world class mental health research is used by policymakers in low and middle income countries around the globe.

One such example is that of the Centre for Public Mental Health, a unit in the Department, which is home to the PRogramme for Improving Mental health carE (PRIME). PRIME is a global research group of mental health experts and policymakers, which includes the WHO, the Centre for Global Mental Health (incorporating London School of Hygiene & Tropical Medicine and King’s Health Partners in the UK), and Ministries of Health and academic institutions in five low and middle-income countries (Ethiopia, India, Nepal, South Africa and India). In response to the clear need for a solution to the ‘treatment gap’, PRIME’s main goal is to expand the coverage of mental health services. This will, it is hoped, contribute to improving the socioeconomic conditions and quality of life of those affected by mental illness.

For more information on training, visit the Department of Psychiatry and Mental Health web page on                         

If you are affected by mental illness in South Africa, and would like to join Charlene (Central Gauteng Mental Health Society) in advocating for change in mental health, please contact her on +27 11-614 9890 or email


[1] See Lund et al (2009). Scaling up child and adolescent mental health services in South Africa: Human resource requirements and costs. Journal of Child Psychology & Psychiatry 50: 1121-1130

[2] See Lund et al (2010). Public Sector Mental Health Systems in South Africa: inter-provincial comparisons and policy implications. Social Psychiatry Epidemiology 45:393-404

[3] See Lund & Flisher (2009). A model for community mental health services in South Africa. Tropical Medicine & International Health Vol 14 No. 9 PP 1040-1047