World Mental Health Day: Schizophrenia patients need to be prioritised in mental health care
Everyone has a right to the best possible help with mental health, no matter who they are or where they live.
This encompasses the right to be safeguarded against threats to one’s mental health, the right to readily available, palatable and high-quality care, as well as the right to liberty, independence and inclusion in society.
Our physical and mental well-being are interdependent. However, one in eight people worldwide suffer from mental health disorders, which can have an adverse effect on their physical health, general well-being, interpersonal relationships, and ability to earn a living.
Teenagers and young adults are becoming more and more affected by mental health issues.
A person’s mental health condition serve never serve as a justification for denying them their human rights or for keeping them out of discussions about their own health.
Yet people with mental health issues continue to be subjected to a variety of human rights violations on a global scale.
Many people are excluded from communal life and subjected to discrimination, while others are either unable to receive the necessary mental health care or can only access care that infringes on their human rights.
According to the World Health Organization, while only affecting 1% of the population, schizophrenia is a severe mental disorder for which more than 80% of people do not obtain the necessary mental health care.
The WHO’s Comprehensive Mental Health Action Plan 2013–2030, the National Mental Health Policy Framework and Strategic Plan (2023–2030) of South Africa, as well as the South African Society of Psychiatrists (SASOP), all call for improving mental health care for people with schizophrenia on this Mental Health Day (October 10).
According to Dr Mvuyiso Talatala, the past president of SASOP, people with schizophrenia have a much higher chance of dying young and have life expectancies that are decreased by 10 to 20 years.
Additionally, because they have less access to mental health care, their quality of life and that of their families suffers.
The crippling mental illness schizophrenia is typified by psychotic episodes, which include hallucinations, delusions, disordered behaviours, and incomprehensible speech.
Schizophrenia can have negative effects on social, occupational, and interpersonal functioning if it is not treated promptly and effectively.
Although there is a dearth of exact information regarding the frequency of schizophrenia in South Africa, the difficulties patients face are obvious in our health-care facilities.
These issues include inadequate patient and family support, inadequate access to appropriate medications, little understanding of the illness among the general public, resource shortages within the health-care system, and the pervasive stigma associated with mental health problems.
Talatala highlights that stigma continues to be a key barrier to treating people with schizophrenia effectively. Despite the grave implications of untreated mental diseases like schizophrenia, the stigma is starkly visible in the inadequate funding for mental health care.
Surprisingly, less than 5% of South Africa's health-care budget – including private sector contributions – is devoted to mental health care.
This budget undoubtedly includes a sizeable chunk for those with serious mental diseases like schizophrenia, but it prioritises hospitalisation over community-based mental health programmes and district hospitals.
The community’s existing strategies and policies for ensuring equitable resource distribution are still not fully in place.
Additionally, injectable anti-psychotics, which are advised to guarantee treatment adherence, are still not frequently administered for schizophrenia patients.
Despite the fact that treatment algorithms for schizophrenia support comprehensive outpatient care, Talatala maintains that in the private sector, the Medical Schemes Act regulations mandate 21 days of hospitalisation per year for people with schizophrenia, with little guidance on outpatient care.
Medical insurance plans are frequently reluctant to pay for schizophrenia patients’ outpatient care.
The standard practice in the public health-care system is to treat people with schizophrenia only when they are gravely unwell and in need of hospitalisation.
Despite the fact that hospitalisation is the mainstay of schizophrenia treatment in South Africa, there are still not enough psychiatric beds available to meet the required target of 28 beds for mental health services per 100 000 people.
SASOP calls for improved community-based mental health care services for people with schizophrenia, which calls for more financing and better care delivery methods.
“This includes providing sufficient space for therapists in community-based clinics, implementing relapse prevention strategies for schizophrenia in both the public and private sectors, early diagnosis and treatment, preferably with injectable anti-psychotics, adequate treatment of schizophrenia and the management of substance use from the first episode, and better funding for community-based care to ensure treatment adherence and adequate psychosocial support,” said Talatala in an official statement.
Removing the stigma attached to schizophrenia necessitates that it be prioritised by medical and governmental programmes. In general, South Africa needs to improve its community mental health-care programmes to lower access obstacles for those who need them.
The South African Depression and Anxiety Group (SADAG) and You Are Not Alone (YANA) are two organisations that the general public can contact for support.