by Jené Pretorius
Mental health statistics in South Africa presents an alarming picture of what is happening at grassroots. According to the National Mental Health Policy Framework and Strategies Plan 2013-2020 neuropsychiatric disorders are ranked third in their contribution to the burden of disease in South Africa, with only HIV&AIDS and other infectious diseases ranking higher (Bradshaw, Norman & Schneider, 2007). Only 27% of South Africans who report severe mental illness ever receive treatment, when taking into account the high incidence of under-reporting, this statistic in reality can be much higher. Moreover mental healthcare concerns such as substance-use problems, depression and anxiety are commonly related to a HIV positive status. Statistics South Africa (2018) reports that an estimated 13.1% of the total population is HIV positive, and approximately one-fifth of South African woman between the ages of 15 and 49 years are HIV positive. The high HIV statistics are disconcerting from a mental health perspective in that over 40% of individuals living with HIV have a diagnosable mental disorder (The South African College of Applied Psychology [SACAP], 2018).
Statistics released by the South African Depression and Anxiety Group (SADAG) reveals that with regards to mental health specifically as many as one in six South Africans suffer from anxiety, depression or substance-use problems (SACAP, 2018). And globally the situation is so dire that The World Health Organisation (WHO) reported, in 2013 already, that we are faced with a human rights emergency in mental health. With regards to the human rights of South African citizens the society at large is protected by the Bill of Rights (1996), contained in chapter 2 of the Constitution. Which stipulates that all South African citizens have the right to healthcare and access to information. Two components vital to addressing mental ill-health and the awareness creation thereof.
The high rates of adverse contextual circumstances such poverty, unemployment and violence in SA further increases the risks related to mental ill-health at grassroots level (Wyatt, Thames, Simbayi, Stein, Burns & Maselesele, 2017). The mentioned statistics permits the reader only a glimpse into the growing realisation that the lack of mental healthcare in SA is undeniably taking its toll on society and communities at large. However, regardless of the numerous statements, articles, discussions and complaints on the state of mental healthcare in South Africa no feasible solutions for this crisis has yet been offered within existing literature.
In ironic contrast to the gloomy picture presented above the mental health treatment and interventions that are available in SA, are mostly accessible to only a very select minority of the population. This is not due to a lack of trained professionals, but rather due to the majority of qualified and registered psychologists choosing to work in private practice. In doing so the majority of mental health professionals are largely offering services to the minority of the South African population who can either afford expensive medical aids, or have the financial capacity to be personally responsible for expensive, private psychological services. This leaves the majority of the South African population without access to even basic mental healthcare services such as containment, debriefing, short-term counselling or referral. This majority population are also commonly more at risk of being exposed to conditions of poverty, violence and increased risk of illness and disease which in turn increases the likelihood of mental ill-health (Statistics South Africa [StatsSA], 2017).
Furthermore mental health services within rural areas are in an even worse state, as most resources within the public mental health system is located in urban areas where approximately 65.3% of the South African population reside (World Bank Trading Economics, 2016). This means that the primary burden of mental healthcare within urban areas are placed on community-based professionals and providers such as clinics and the healthcare workers employed at clinics, which are notoriously understaffed and overworked (Mataboge, Beukes & Nolte, 2016). Alternatively lay counsellors, support groups, community leaders and family members often are forced to fulfill crucial roles in this instance by providing care, support and information when institutionalised help is unavailable.
Taking the above statistics and statements into consideration one can conclude, beyond any doubt, that the state of SA’s primary mental well-being finds itself in a severe predicament. However, despite the severity of this crisis the resources currently available have to date been unable to address the confronting crisis.
Unemployed Registered Counsellors and their role as first line of defense
The rationale for the qualification and registration category of Registered Counsellors, as outlined by the Health Professions Council of South Africa (HPCSA) is as follows: “to meet the needs of South Africa in order to make primary psychological services available in diverse settings thereby enhancing psychological well-being of the public” and “to provide a variety of psychological services at the primary healthcare level” (Health Professions Council of South Africa [HPCSA], 2013, p. 2). Within the scope of practice of Registered Counsellors their role is described as one that is preventative, promotional and supportive in nature (HPCSA, 2013). When taking into consideration the high prevalence of mental health concerns and illnesses in SA the magnitude of value and positive contribution that Registered Counsellors can have at grassroots level in this regard is undisputable.
Registered Counsellors are trained and fully capable to provide psychological services to the diverse population of SA, and to also provide interventions that support and promote well-being within community contexts (HPCSA, 2013). Community context in this sense includes communities, families, social groups, and individuals. Registered Counsellors are furthermore skilled psycho-educators who have completed an approved 6 month practicum in addition to the academic requirement of completing a 4 year B.Psych or Honours in Psychology degree (HPCSA, 2013). Ironically however, individuals who passed their Registered Counsellor board exam with the HPCSA remain grossly unemployed. In October 2018, the total of Registered Counsellors with the HPCSA amounted to 2482, with a further total of 2862 students registered within the category of Student Registered Counsellor (HPCSA, 2018). However it is common knowledge within mental health circles that Registered Counsellor faces an iconic struggle in locating and securing employment. I myself have faced this struggle together with numerous others who are eager and able to work as mental health professionals and serve the South African communities, but in reality are struggling to pay off study loans while facing unemployment. The frustration regarding this topic is of such an extent that frustrated Registered Counsellors and other mental health professionals have lend themselves to social media platforms. Where an outcry for the dire state of primary mental healthcare as well as the employment struggle of Registered Counsellors have been made. A recently founded Facebook Page and Youth Organisation named: “Lack of Psychologists and Registered Counsellors South Africa” attracted a substantial amount of attention and support from mental health professionals all over SA. Among the grievances that were raised are the prominent concern of Registered Counsellors who remain unemployed, even after graduating either from a Bachelor of Psychology or Psychology Honours, and successfully passing the HPCSA Registered Counsellor Board Exam.
The decolonisation of primary mental healthcare
The current state of mental healthcare in South Africa can be categorised as being colonialist in nature. Meaning that Westernised and historical ways of doing remain the norm within the South African mental healthcare sector with primary mental healthcare remaining inaccessible to majority of the South African population. As mentioned previously, to a large extent primary mental healthcare is obtainable only to a select few who consist of the economic means to access privatised mental healthcare.
Upon considering the above body of work, a solution to the imminent problem seem to be at hand, readily available for the South African Department of Health to implement without preposterous expenditure or drastic reform within the healthcare sector. A multitude of Registered Counsellors remain unemployed, pleading on all possible accounts for employment opportunities. All of them being mental healthcare professionals who are readily trained and qualified to assist in psycho-educating, supporting, informing and empowering South African individuals and communities at large. Communities who are in dire need of not only primary mental healthcare, but also psycho-education and awareness creation with regards to an array of mental health difficulties.
The solution to providing primary mental healthcare to the majority of South Africans, and aiding in the high unemployment rates of trained and qualified South Africans, especially that of Registered Counsellors may be less complicated than expected. By placing Registered Counsellors in all Public Schools, Clinics, and Hospitals in SA mental health treatment and interventions would be more widely accessible both within urban and rural communities of all statures. And in the process a large amount of unemployed South African youth will be granted the opportunity to put their expensively gained skills into practice.
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Health Professions Council of South Africa. (2018). Statistics. Retrieved from https://www.hpcsa.co.za/Publications/Statistics
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The South African College of Applied Psychology. (2018). The shocking state of mental health in South Africa in 2018. Retrieved from https://www.sacap.edu.za/blog/counselling/mental-health-south-africa/
World Bank Trading Economic. (2016). South Africa – rural population. Retrieved from https://tradingeconomics.com/south-africa/rural-population-percent-of-total-population-wb-data.html
World Health Organisation. (2013). Mental Health Action Plan 2013-2020. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/89966/9789241506021_eng.pdf;jsessionid=274C4BA0471FCE63D28972435315C486?sequence=1
Wyatt, G. E., Thames, A., Simbayi, L., Stein, D. J., Burns, J., & Maselesele, M. (2017). Trauma and mental health in South Africa: Overview. Psychological Trauma: Theory, Research, Practice, and Policy, 9(3), 249.