Latest news with #DepartmentofPsychiatryandMentalHealth
Daily Maverick
10-07-2025
- Health
- Daily Maverick
How frontline workers in KZN are helping fight the mental health crisis
South Africa does not have enough psychologists and psychiatrists to meet the mental health needs of everyone in the country. One solution is to train community healthcare workers to provide basic mental health support. Spotlight explores how one such task-sharing project is being scaled up in KwaZulu-Natal. It's a Wednesday morning in the Amajuba district near Newcastle in KwaZulu-Natal. Anna, a community healthcare worker, enters a government-subsidised house for her routine visit to the family living there. Anna is familiar with the households she visits and is aware that things are not going well in this home. She knows that one woman in particular is struggling with her mental health and may have depression. In addition to her basic healthcare training, Anna's been trained to use a special guide that helps families better understand mental health and detect when someone might need extra support or care. This is the hypothetical example given by Professor Inge Petersen, director of the Centre for Research in Health Systems at the University of KwaZulu-Natal. Anna may have been made up to illustrate a point, but the guide, called the Community Mental Health Education and Detection (CMED) tool, is real and has been adopted by the KwaZulu-Natal health department and is being used in the province. The initiative is part of a growing trend where different health tasks are shared among a wider range of trained workers, not just doctors or specialists. This task-sharing idea is that, since South Africa has far too few psychologists and psychiatrists to meet the needs of everyone in the country, other types of healthcare workers can share the load. Though community healthcare workers aren't qualified to prescribe scheduled medicines or treat serious mental health issues, they can provide some support and refer more complicated cases to others. 'It's no secret that our health services are under enormous strain,' says Professor Dan Stein, head of the Department of Psychiatry and Mental Health at the University of Cape Town. 'Given the resources, in psychiatry, we largely focus on serious mental disorders, and we're not able to address fully the common mental disorders — depression, anxiety and substance use disorders.' Even though reliable data on mental health in South Africa is sparse, available data suggest that the burden is substantial. A landmark epidemiological survey published in 2009 — the first large-scale population-based study of common mental disorders in South Africa — found that around one in six people had a mental health disorder in the preceding 12 months. Around three in 10 of the more than 4,300 people surveyed had at some point in their lives had a mental health disorder, and it was estimated that close to half of all people would experience one. In a more recent survey published in 2022, one in four people reported symptoms of moderate or severe depression, and around 18% reported symptoms of anxiety. In a study published in 2019, researchers estimated that less than 10% of people in South Africa were receiving the mental health services they needed. They found that in the public sector, there were 0.31 psychiatrists and 0.97 psychologists per 100,000 people, though there were large variations between provinces and between urban and rural areas. The researchers found that about 4.6% of the state's health spending goes to mental health, with around 86% of that spent on inpatient care. Green, orange, or red Returning to our hypothetical example in Amajuba, Anna greets the members of the household. In the room is Ma Mkhize, who lost her daughter recently. Apart from still grieving, she's very stressed about how she will support her daughter's three children. Ma Mkhize's sister and two young adult male family members are also present. 'While talking to the family, Anna likens mental health to a thermometer with a green, an orange and a red zone,' says Petersen. 'Anna explains that when people are in the green zone mentally, they're healthy; in the orange zone, they feel a bit stressed; and in the red zone, everything's becoming too much. Doing her best to normalise mental health conditions, she explains how people shift along this emotional health 'thermometer'.' Anna would then have read the story of Nontobeko — a woman whose husband lost his job three months ago, and who is constantly worrying about how she'll feed her children, is always tired, has a low appetite and struggles to sleep. 'Once she's read the story about Nontobeko, Anna asks the family if the story reminds them of someone in the household. If they say yes, she uses an algorithm developed to describe the symptoms, to determine whether Ma Mkhize should be further screened for depression at the local clinic,' says Petersen. The next step One of the keys to this approach is that community healthcare workers like Anna can provide support up to a certain level. It might be that no referral is needed and that support from someone like Anna is enough to help someone through a difficult period. But in Ma Mkhize's case, Anna has to refer. At the clinic, Ma Mkhize would see an enrolled nurse, who, besides checking her vital signs, like her blood pressure, also does a more in-depth mental health screening. The next step for Ma Mkhize would be to attend a consultation with a professional nurse at the clinic who assesses her for depression, using Adult Primary Care guidelines that include mental health conditions. 'If she's diagnosed as having a mental health condition, she will be referred to a psychological counsellor at the nearest community health centre for counselling; and/or to a primary healthcare doctor on the doctor's next visit to the clinic; or to a district hospital if symptoms are severe,' says Petersen. 'Layering mental health into the system' Signs are that the government, at least in KwaZulu-Natal, is buying into the idea of this type of task-sharing. 'Task-sharing assists us as a province with early detection and management of common mental health conditions,' says Dr Nikiwe Hongo, mental health director in the KwaZulu-Natal Department of Health. 'Early interventions are then provided to avoid catastrophic manifestations much later. We have employed mid-level registered psychological counsellors within primary healthcare facilities to assist with this. It helps avoid unnecessary referrals to higher levels of care, with few specialist resources available. We continue to roll out capacity building for early detection by household community health workers and intensive screening and assessment by nurses at the clinic level.' These programmes are the culmination of much previous work. For the past seven years, Petersen and her colleagues have been working closely with the provincial health department to increase access to mental health services for adults by integrating mental health into primary care. 'Together with the department, we have developed and refined the way we are layering mental health into the system along the care cascade. Innovations have been introduced along the patient pathway, so that mental health is part of every contact a person might have with the healthcare system,' she says. 'Task-sharing as a policy is strongly supported by the World Health Organization, and South Africa has adopted it into our national policy framework and action plan, but the implementation has been a challenge,' says Petersen. She explains that while it's challenging to provide exact numbers of healthcare workers trained in KwaZulu-Natal, since trainers are equipped to train others within their own districts, the available figures suggest that several hundred have already been reached. The initiative has expanded beyond KwaZulu-Natal, with healthcare workers in one district in Limpopo and another in the Northern Cape currently undergoing training. 'A huge dilemma' Dr Ingrid Daniels, the CEO of Cape Mental Health and a past president of the World Federation for Mental Health, agreed that the gap between need and resources in mental health services was dire. 'A huge dilemma South Africa faces is the fact that social determinants such as poverty, unemployment and gender-based violence exacerbate mental health problems. 'This is further complicated by substance use, which is highly prevalent, contributing to the burden of disease. On one hand, we have an increasing prevalence of mental health issues among our population, and on the other, government-funded, state-run mental health services for 84% of our population which are under-resourced and often working among communities in dire circumstances,' she says. Daniels says a burning question is how South Africa's mental health services can be transformed to make them more accessible. 'Task-sharing is one of the best evidence-based interventions that have been very successful. It's successful because we have a serious human resource shortage for mental health in South Africa. On top of that, we have insufficient social workers, as well as insufficient psychiatrists. 'We're not going to narrow the treatment gap any time soon within the next decade or two, so task-sharing is critical because basically … you are providing the necessary knowledge and education to a community health worker,' she says. Ultimately, in the context of scarce mental health resources, Petersen says, 'Integrating mental health into existing health services provided by general healthcare workers through task-sharing is the only viable solution to closing the mental health treatment gap.' While all the experts Spotlight interviewed for this article seemed to agree with that view, the details of how to go about implementing the 'solution' are less clear-cut. It is in helping map this out that the work in KwaZulu-Natal is taking the field forward. DM
IOL News
03-06-2025
- Business
- IOL News
Understanding the hidden financial risks of gambling
Explore the alarming rise of gambling in South Africa, where over R1 trillion is wagered annually. This article delves into the hidden financial risks, particularly for low-income earners, and highlights the psychological toll of gambling addiction. Image: File picture. South Africans place over R1 trillion in bets annually, with R700 billion spent on sports betting alone. For many, particularly those with limited financial resources, the appeal of a big win can be incredibly tempting. However, the reality is often more complex. Instead of earning easy money, those who indulge in excessive gambling frequently face financial strain. In March, an online betting platform shared a story of someone turning an R4 wager into an astounding R83,701.54. While stories like this grab attention, the rise in online sports betting also brings important considerations. According to the National Gambling Board's 2022/23 gambling statistics, sports betting in South Africa has expanded significantly over the past decade, growing from under 10% of the gambling sector in 2009/10 to over half in 2022/23. What stands out is that 36% of those who gamble do so to pay off debts or cover expenses, according to the 2024 Old Mutual Savings and Investment Monitor. Among low-income earners (those earning between R8,000 and R15,000 per month), this figure rises to 41%, highlighting a concerning trend. Understanding the risks Despite rising costs of living and economic pressures, gambling has gained popularity, particularly due to the widespread use of mobile phones and internet access. This is especially evident among young African men. Advertising from betting companies further fuels this trend, increasing participation within this demographic. This can be risky, particularly for young people and low-income earners, who may see gambling as a way to improve their financial situation. However, losses can add up quickly, sometimes leading to financial stress. In a country already facing high unemployment and economic challenges, it's important to be aware of the potential financial pitfalls of gambling. A game of chance, not strategy Unlike investing, gambling is based purely on luck, yet many believe they can develop a winning approach. The truth is that the house edge ensures that bookmakers maintain a profit over time. For instance, when odds are at -110 on both sides of a bet, a bettor must risk R110 to win R100, meaning even skilled bettors face a statistical disadvantage in the long run. The belief that the system can be beaten can lead to risky financial decisions. Beyond financial losses, gambling can also take a psychological toll. It can lead to stress, anxiety, and even a cycle of chasing previous bets in the hope of recovering losses. A 2016 study by the University of Cape Town's Department of Psychiatry and Mental Health noted a significant association between suicidality and pathological gambling. It found that pathological gamblers were five to ten times more likely to have a history of suicide attempts than non-gamblers. Furthermore, gambling doesn't just affect individuals—it can have ripple effects on families, sometimes resulting in financial strain for loved ones. While gambling is legal, many people don't fully understand the long-term risks involved due to a lack of financial education. For those who feel their gambling habits might be affecting their financial well-being, Manyike advises seeking support. The South African Responsible Gambling Foundation offers free and confidential counselling services. Additionally, professional counsellors who specialise in gambling addiction can provide guidance. Gambling is not a reliable source of income, and without careful management, it can lead to serious financial setbacks. By increasing financial awareness and promoting responsible gambling, we can help people make informed decisions and avoid unnecessary financial risks. * Manyike is the head of financial education at Old Mutual. PERSONAL FINANCE
