Queer Mental Health in South Africa in Mental Health Awareness Month

Queer Mental Health in South Africa in Mental Health Awareness Month

Queer* mental health in South Africa in Mental Health Awareness Month

Written by Pierre Brouard, Research Associate at the Centre for Sexualities, AIDS and Gender (UP), SGD secretary and PATHSA board member

Some would argue that in the face of cis-heteronormativity and ongoing acts of harm towards queer people, the idea of queer mental health is an oxymoron, unachievable in the face of systems and structures of exclusion. On the other hand, queer survival and queer thriving are acts of resilience and rebellion, to be welcomed and nurtured, especially by those who practice in the mental health space.

October is Mental Health Awareness Month in South Africa and World Mental Health Awareness Day is commemorated on 10 October. The South African Federation for Mental Health’s theme for 2024 is “Access and Inclusion: why community mental health is important”.

Through this lens we can ask pertinent, even troubling, questions about the nature of queer life in South Africa and whether queer people feel included in social and community life, are seen by politicians and policy makers, and have access to the personal, social and economic resources to live lives of dignity and wellness.

While queer people are not a monolith, inhabiting multiple identities across race, class, ethnicity, ability etc., they face significant marginalisation in [mental] health care planning and delivery (see Luvuno et al). Very few health facilities offer queer-targeted resources, and this is compounded by the lack of healthcare workers who are skilled in dealing with queer health issues. Further, there is erasure of queer people in the healthcare system through a lack of data on how queer people utilise public facilities, minimal practice guidelines and insufficient policies.

The lack of data extends itself to, for example, HIV prevalence (and its psychosocial sequelae) in queer people, because sexual orientation (and gender identity) data is not collected on large-scale, population-based HIV prevalence surveys and censuses. And the few studies conducted have small sample sizes and were often conducted in urban areas, disadvantaging queer people in rural spaces.  This lack of data on health, and arguably mental health, of queer people means that designing programmes and developing related policy guidelines is a challenge. South Africa’s recent census was critiqued for this very failing.

If queer people’s mental health is to be taken seriously a number of key steps should be prioritised.

Firstly, we need to acknowledge that while all people can experience challenges in mental health (for endogenous and exogenous reasons), the marginalisation of queer people through forms of stigma and prejudice, and acts of physical harm, add an extra burden. The Minority Stress literature provides an evidence base for this burden.

Secondly, we need to improve the training of providers of a range of mental and physical health services (in public and private settings) so that the care they offer moves beyond tolerance towards a focus on thriving and development. The Sexuality and Gender Division of PsySSA offers such training, with feedback showing significant shifts in attitude and practice. This should be bolstered by specific policies and programmes and not be seen as a “hoped for” outcome of general training in vague notions of ubuntu or [sometimes reluctant] “acceptance” of diversity.

And thirdly, we need to collect better data about queer mental health – its antecedents, its manifestations and the resources, skills and human assets needed to make it a reality.

Queer mental health is more than a “nice to have”, it’s a marker of a society that attends to the needs of everyone. How we treat minorities speaks volumes about the perils of majoritarianism, noting that the mental health of a society is a collective venture.

*I use ‘queer’ as both an umbrella term for people on the spectrums of sex, sexuality and gender, and as a way to describe those who challenge the dominant social norms, values and conventions of mainstream society.

PsySSA Practice Guidelines for Working with Sexually and Gender Diverse People Revision

PsySSA Practice Guidelines for Working with Sexually and Gender Diverse People Revision

Just over five years ago, the PsySSA Practice Guidelines for Working with Sexually and Gender Diverse People were published. This landmark document has had a significant impact on the LGBTQIA+ field, influencing psychology, trans healthcare, public health, and global health sectors. The PsySSA African LGBTI+ Human Rights Project, spearheaded by the Sexuality and Gender Division (SGD), is in the process of revising these guidelines to reflect the latest developments in the field. A crucial component of this revision is the contribution from psychology professionals. Your insights and experiences are invaluable to ensuring that the revised guidelines reflect the latest advancements and best practices in the field.

We are particularly interested in receiving feedback on:

  • Practical examples from your professional experience
  • Ethical dilemmas and how they were navigated
  • Clinical issues encountered and resolutions
  • Frequently asked questions
  • Narratives and stories that highlight the diverse experiences of working within this area

Your expertise and input will significantly contribute to the comprehensive and meaningful update of these guidelines, ultimately benefiting professionals and the communities we serve.

To share your insights, please complete our brief survey, which includes five targeted questions designed to gather your valuable feedback.

To participate, please visit: https://forms.gle/w5rECa9ZpABeC8At9

Responses are requested by 20 February 2024.

PsySSA Commemorates 16 Days of Activism against Gender-Based Violence 2023

PsySSA Commemorates 16 Days of Activism against Gender-Based Violence 2023

The 16 Days of Activism for No Violence against Women and Children Campaign: What this Means for People with Disabilities

The 16 Days of Activism for No Violence against Women and Children Campaign has been a central event which annually highlights the kinds of abuses faced by women and children, including physical, emotional, financial, and sexual abuse (South African Government, 2023). This year’s theme is aimed towards “Accelerating actions to end gender-based violence & femicide: leaving no one behind”. The event takes place between crucial historical dates, 25 November (International Day for No Violence Against Women) to 10 December (International Human Rights Day). The event also foregrounds other key commemorative days within the 16-day period, including World AIDS Day on the 1st of December as well as the International Day for Persons with Disabilities on the 3rd of December (South African Government, 2023). As much as the 16 Days of Activism event holds significance for all marginalised groups, this paper is intended to highlight what the 16-day period means for People with Disabilities (PwDs).

Globally, it is estimated that PwDs number more than 1 billion people worldwide (Puce et al., 2023). While the world has recognised the need to build strategies for women and children facing gender-based violence (GBV), there is still limited attention allocated to strategies for women and children with disabilities, particularly for disabled women[1] in intimate relationships (Peta, 2017; Rugoho et al., 2022; Rugoho & Maphosa, 2015). GBV describes acts of physical, verbal, emotional, sexual and economic harm towards a group of individuals based on their gender (Tappis et al., 2016). These incidents for disabled women and children may include physical mishandling or abuse, use of demeaning slurs, controlling behaviours, rape, or withholding of their grants by a family member or partner (Humphrey, 2016; Nixon, 2009; Saxton et al., 2021).

Disabled women and children experience a series of overlapping and reinforcing forms of marginalisation tied to what is often a socially subordinate status as women or children, as well as a society designed around and for able-bodied people. Rugoho & Maphosa (2015) estimate that disabled women are twice as likely to experience GBV than women without disabilities. While children with disabilities (CwDs) are 2 to 4 times more likely to experience child sexual abuse than their non-disabled peers (Klebanov et al., 2023). What is more is that because PwDs are often excluded from family discussions, seen as an inconvenience in public spaces, as well as the limitations in mobility and accessibility within the built environment, reporting of GBV by PwDs becomes harder to present due to fear that they will not be believed or actively discouraged from reporting by family members (Peta, 2017; Rugoho et al., 2022; Rugoho & Maphosa, 2015). 

This year’s 16 Days of Activism theme, “Accelerating actions to end gender-based violence & femicide: leaving no one behind”, presents an explicit opportunity for disabled women and children to be prioritised regarding their experiences of GBV.  Action is needed in terms of awareness, advocacy, as well as strategic interventions to be responsive to the needs of disabled women and children facing GBV (Peta, 2017; Rugoho et al., 2022; Rugoho & Maphosa, 2015). For example, a collaborative, intersectoral response from police, social services, media, as well as the broader community, can bolster a network of knowledge, resources and social capital to foster protection of disabled women and children from perpetrators of GBV. This includes, most importantly, prioritising the voices and lived experiences of people with disabilities and actively involving organisations and stakeholders from within what is often a diverse range of disability communities to lead these interventions.

To ensure that no one is left behind during the 16 Days of Activism, it is crucial to make a unified effort that incorporates the voices of disabled individuals, both individually and collectively. The principle of ‘nothing about us without us’ should guide the definition and formulation of guidelines, policies and interventions, aligning them with the specific needs of the disabled community (Peta, 2017; Rugoho et al., 2022; Rugoho & Maphosa, 2015).

          References

  • Humphrey, M. (2016). The intersectionality of poverty, disability, and gender as a framework to understand violence against women with disabilities: A case study of South Africa. International Development, Community and Environment (IDCE).
  • Karimu, A. (2017). Exploring the sexual and reproductive health issues of visually impaired women in Ghana. Reproductive health matters, 25(50), 128-133. https://doi.org/10.1080/09688080.2017.1333893
  • Klebanov, B., Friedman-Hauser, G., Lusky-Weisrose, E., & Katz, C. (2023). Sexual abuse of children with disabilities: key lessons and future directions based on a scoping review. Trauma, Violence, & Abuse, 00(0): 1-19. https://doi.org/10.1177/1524838021995975.
  • McKenzie, J. A. (2013). ‘Disabled people in rural South Africa talk about sexuality’, Culture, Health & Sexuality 15(3): 372-386. https://doi.org/10.1080/13691058.2012.748936
  • Nixon, J. (2009). ‘Domestic violence and women with disabilities: Locating the issue on the periphery of social movements’. Disability & Society 24(1): 77-89.  https://doi.org/10.1080/09687590802535709
  • Peta, C. (2017). Gender Based Violence: A “Thorn” in the Experiences of Sexuality of Women with Disabilities in Zimbabwe. Sex Disabil 35, 371–386. https://doi.org/10.1007/s11195-017-9485-9
  • Peta, C., Mckenzie., J., Kathard, H., Adrica, A. (2017). We are Not Asexual Beings: Disabled Women in Zimbabwe Talk About Their Active Sexuality. 10. https://doi.org/1007/s13178-016-0266-5.
  • Puce, L., Okwen, P. M., Yuh, M. N., Akah Ndum Okwen, G., Pambe Miong, R. H., Kong, J. D., & Bragazzi, N. L. (2023). Well-being and quality of life in people with disabilities practicing sports, athletes with disabilities, and para-athletes: Insights from a critical review of the literature. Frontiers in Psychology, 14, 1071656. https://doi.org/10.3389/fpsyg.2023.1071656
  • Rohleder, P., S. Braathen, L. Swartz, and A. Eide. (2009). HIV/AIDS and disability in Southern Africa: a review of relevant literature. Disability and rehabilitation 31(1): 51-59. https://doi.org/10.1080/09638280802280585
  • Rugoho, T., & Maphosa, F. (2015). Gender-based violence amongst women with disabilities: A case study of Mwenezi district, Zimbabwe. Gender Questions, 3(1), 97-113. https://hdl.handle.net/10520/EJC181460
  • Rugoho, T. O., Stein, M. A., Wright, P., & Broerse, J. E. (2022). The Experiences of Sexually Abused Women with Disabilities Who Consulted Services in Zimbabwe: The Intersection of Disability, Gender, and Poverty. Dignity: A Journal of Analysis of Exploitation and Violence, 7(3), 2. https://doi.org/10.23860/dignity.2022.07.03.02
  • Saxton, M., Curry, M.A,. Powers, L.E., Maley, S., Eckels, K., Gross, J. (2021). “Bring my scooter so I can leave you”: A study of disabled women handling abuse bypersonal assistance providers. Volume https://doi.org/10.1177/10778010122182523.
  • South African Government. (2023). 16 Days of Activism 2023. Available at https://www.gov.za/16DaysOfActivism2023.
  • Tappis, H., Freeman, J., Glass, N., & Doocy, S. (2016). Effectiveness of interventions, programs and strategies for gender-based violenceGBV prevention in refugee populations: An integrative review. PLoS currents, 8, ecurrents.dis.3a465b66f9327676d61eb8120eaa5499

[1]   Although the use of person-first language (i.e., people with disabilities) as opposed to identity-first (i.e., disabled people) is seen as respectful language, identity-first language is also accepted by various disability stakeholder groups as it encompasses the various aspects of PwDs’ lives which subject them to discrimination and oppression (Puce et al., 2023). Therefore, in this paper, I will use the term ‘disabled people’ intentionally for advocacy reasons.

PsySSA Commemorates 16 Days of Activism against Gender-Based Violence 2023

PsySSA Commemorates 16 Days of Activism against Gender-Based Violence 2023

16 Days of Activism for No Violence against Women and Children Campaign: Rethinking Power and Basic Human Rights

By Angeline Stephens, PhD

The theme for this year’s 16 Days of Activism for No Violence against Women and Children Campaign, “Accelerating actions to end gender-based violence & femicide: leaving no one behind,” along with the sub-theme, “Safe access for women to clean water: a basic human right”, is unsettling in its call for the fulfilment of a basic human right. It is unsettling in its shocking and shameful reminder that basic human rights are issues that we still need to fight for despite all the technological advancements of the fourth industrial revolution.

However, as I reflect on this theme, I am compelled to also reflect on the current genocide and violence in Palestine, where the majority of those who have died thus far are women and children. In a recent news report on Al Jazeera, it was reported that the concern now is not the incessant bombing that continues to kill people every day, but the threat of disease and death due to the lack of access to water, sanitation, food, medical supplies and medical care. The most vulnerable here are the children.

I reference what is happening in Palestine because the 16 Days of Activism is a United Nations campaign and thus reminds us of the global scale of violence against women, children and marginalised groups. A critical question that we must ask in seeking to end violence and femicide against women and children is, what sustains violence? Thus I also reference the current violence in Palestine because it brings into sharp focus the centrality of power in enacting and sustaining violence.

What the sub-theme for this year’s campaign highlights is that violence and power go beyond the physical enactment of violence to include other forms of violence. One such form of violence is economic violence which plays a critical role in maintaining the economic power base of some and the economic oppression of others and which underpins much of the violence that women and children experience. Economic oppression is a powerful mechanism that essentially dehumanises oppressed people and reduces oppressed people to being less than human.

A critical look at the United Nation’s 17 Sustainable Development Goals (SDGs) reveals that economic empowerment is necessary to attain most, if not all, the SGDs. Economic oppression is inextricably linked to political, social and historical oppression. However, if the link between the violence of economic oppression and other forms of violence is not explicitly foregrounded, then policy reform and resource allocation that works to address violence as a whole, will be limited.

In South Africa, women and children in mostly rural areas still do not have access to clean water and sanitation. While there are reports that record improvements in this area, the issue of access to water is often framed in relation to the water crisis and climate crisis, and its role in sustainable development. In instances where access to clean water is recognised as a basic human right, this recognition fails to recognise such lack of access as being symptomatic of a larger form of oppression and violence.

What this denial effectively does is to minimise or discount the psychological impact of economic violence on women and children, both in terms of its dehumanising effects, as well as its link to other more explicit forms of physical violence such as sexual violence, sexual favours and human trafficking.

Consequently, our responses to violence and femicide against women and children tend to be reactive and occur ‘after-the fact’. For example, the Domestic Violence Amendment Act 2021 (DVAA), in tandem with the Criminal and Related Matters Amendment Act, and the Criminal Law (Sexual Offences and Related Matters) Amendment Act, aims to strengthen the protection and support of vulnerable persons, and increase the scope for reporting and monitoring. However, these Acts focus on what happens after an incident of violence. While reporting and accountability are important in the understanding the complexity of violence, it would be equally important to ensure that such reporting does not simply equate to forms of surveillance. This is especially pertinent in light of the framing of the victims and survivors of violence as being vulnerable, without critically questioning how such vulnerability is created and sustained.

More proactive and preventative measures that are based on a critical understanding of violence against women, children and other marginalised groups, including persons with disabilities and gender and sexually non-conforming persons, takes us back to the issue of power. The issue of power becomes even more magnified when we consider persons who experience multiple oppressions. What do we need to do differently to change our responses to include more empowering ones that tackle the root causes of violence against women, children and other marginalised persons?

Pillar 5 of the National Strategic Plan on Gender-based Violence and Femicide (NSP GBVF), recognises “Economic Power” as a driver in addressing the enduring acts of violence that target women, children and other marginalised and vulnerable persons. However, I question its order and positioning as Pillar 5 out of six pillars. What might this suggest about how we understand and conceptualise the role of economic power in the eradication of violence?

Pillar 5 states as its “Economic Empowerment Outcome” that “Women, children and LGBTQIA+ persons are able to be free in public spaces, use transport freely and access resources that enable them to make healthy choices in their lives”. I contend that this outcome is limited in its scope of economic empowerment. It speaks to the freedom of movement, access to resources and making “healthy choices” and a set of accompanying deliverables.

While the inclusion of economic empowerment in the national strategy to address GBV and femicide is commendable and is certainly on the right track, many of its deliverables seem to lack teeth. For example, it uses language such as “Support and encourage the role of women, persons with disabilities and LGBTQIA+ persons as leaders in all sectors of society”, and “Raise awareness of women’s unpaid labour” but sets aside only 40% for the development of women, youth and SMMEs. What are the tangible ways in which marginalised groups are empowered to assume full economic freedom to make “healthy choices”? What do healthy choices actually refer to? And from whose perspective would such choices be considered to be healthy?

The point that I am making is that while our approaches to fighting GBV and femicide against women, children and marginalised groups do recognise some salient drivers of violence, our approaches do not adequately seek to dismantle drivers that are central to the enactment of violence. Economic empowerment and its enmeshment with power cannot be regarded as being separate from social cohesion and changing cultural and social norms. Fostering social cohesion requires that we recognise the intersections of the political, social, historical and the economic, and the institutions that sustain gender, economic and social inequities. These intersections must be mindfully and consciously responded to in our campaigns to end violence. Unless we actively and consistently strive to dismantle the multiple forms of power and violence within society, those who are positioned in less powerful ways will continue to be violated and oppressed in multiple ways. We will continue to assume by-stander roles while the violence, suffering, oppression and death continue.

Angeline Stephens, PhD (she/her) is a psychologist who works in student mental health in the College of Humanities, University of KwaZulu-Natal. She is also an executive member of the Sexuality and Gender division of the Psychological Society of South Africa (PsySSA). Her work is informed by feminist, critical and decolonial approaches to psychological praxis that recognises the interconnectedness between persons and contexts. She is particularly interested in the intersections of gender, sexuality, violence, citizenship, and work with marginalised people.

PsySSA Commemorates 16 Days of Activism against Gender-Based Violence 2023

PsySSA Commemorates 16 Days of Activism against Gender-Based Violence 2023

Reflection on the Criminal Law (Sexual Offences and Related Matters) Amendment Act 13 of 2021 for 16 Days

Recently, changes to the Criminal Law (Sexual Offences and Related Matters) Amendment Act, 2007, came into commencement. Some pertinent changes include the extension of the list of persons who are to be protected in terms of Chapter 6 of the Act and further regulation of the reporting duty of persons who are aware that sexual offences have been committed against persons who are vulnerable (South African Government, 2022).

The definition of ‘person who is vulnerable’, now includes a female under the age of 25 years who: (i) receives tuition at a higher education college, higher education institution or university; (ii) receives vocational training at any training institute, or as part of their employment; or (iii) lives in a building, structure or facility used primarily as a residence for any of the persons referred to in subparagraphs (i) and (ii) (Republic of South Africa, 2022).

Effectively, if females from this group report rape or sexual assault there is now a legal duty to immediately report to the police when there is knowledge, a reasonable belief, or suspicion of an offence, irrespective of the wishes of the female reporting. Failure to report such offences can lead to a fine or imprisonment not exceeding five years, or both. According to the National Prosecuting Authority (NPA), sexual violence is not being addressed adequately and the belief is that by making reporting compulsory a “culture of reporting” will be created, signalling a zero-tolerance approach to sexual violence and warning perpetrators that sexual violence is a crime which will be stamped out

As we approach the 25th anniversary of South Africa’s initiation of the United Nations 16 Days of Activism for No Violence against Women and Children Campaign, we reflect on the power and impact of the current amendment. The 16 Days campaign focuses on raising awareness for the impact that gender-based violence and femicide (GBVF) has on women and children (South African Government, 2023). The government has also launched the National Strategic Plan on Gender-Based Violence and Femicide (NSP – GBVF) (2020-2030). We reflect here on how these programmes contribute to the shift that is needed from women and girls as victims of GBVF to men and boys as perpetrators of sexual violence, reflecting a society in need of intervention, healing, and transformation.

Or put differently, does this change in legislation contribute to women and girls’ survivorship of sexual abuse and violence? For example, the process of compulsory reporting will inevitably affect the agency and autonomy of women aged 19-25 and their readiness to engage with the criminal justice system. From our perspective, the current act also does not account for cases where women may be unsure if a sexual assault has taken place or whether they did provide informed consent. The act makes provision for reporting but this does not necessarily equal support for women or institutional accountability towards safeguarding and change.

The theme for this year’s 16 Days Campaign is: “Accelerating actions to end gender-based violence & femicide: leaving no one behind.” Overall, we believe that the amendments are a positive indication of the government’s serious commitment to curbing GBVF and the protection of women, who do indeed remain a vulnerable group in South African society. However, it remains debatable whether we are actively ensuring that our society is safer for women, or contributing to heightening their status of vulnerability. As we mark 25 years of the 16 Days Campaign, we hope this amendment and its implementation will be the start of a re-renewed exchange about accelerating change actions to end GBVF, not only ensuring women are not left behind but locating them at the forefront of the conversation.

         References

Divisional Webinar: The Domestic Violence Amendment Act 2021: Is it enough and what are its implications for psychological practise? – Recording Out Now!

Divisional Webinar: The Domestic Violence Amendment Act 2021: Is it enough and what are its implications for psychological practise? – Recording Out Now!

Divisional Webinar: The Domestic Violence Amendment Act 2021: Is it enough and what are its implications for psychological practise? – Recording Out Now!

Did you miss our divisional webinar: The Domestic Violence Amendment Act 2021: Is it enough and what are its implications for psychological practise?

Don’t worry! Watch the recording below!

Webinar Abstract

The Domestic Violence Amendment Act 2021 (DVAA), in tandem with the Criminal and Related Matters Amendment Act, and the Criminal Law (Sexual Offences and Related Matters) Amendment Act, aims to strengthen the protection and support of vulnerable persons, and increase the scope for reporting and monitoring.

However, the most recent crime statistics reveal an enduring pattern of violence that target women and other marginalised and vulnerable persons, and are increasingly perpetrated in places that are traditionally associated with safety, such as homes and schools. In light of the amended Acts and what they hope to achieve, we ask, to what extent does the DVAA benefit and protect vulnerable groups, in particular, women, children, queer persons, and persons with disabilities? What is the likely impact of the DVAA on the incidence of GBV and femicide, particularly for these vulnerable groups? Inter alia, certain functionaries (i.e. medical practitioners, health care personnel, social workers, educators and caregivers, who could mental health practitioners) who reasonably believe or suspect that an act of domestic violence has been committed against a child, a disabled person, or an older person must report such belief or suspicion to a social worker or the SAPS. What might need to be done differently and what are the implications for the work of psychologists, particularly in relation to the new assessment and reporting obligations?