When celebrities such as rapper HHP, 7de Laan actress Vuyelwa Booi, and Strictly Come Dancing host Roxy Burger openly speak about their mental-health problems, it can be seen as little triumphs for the fight against the stigma of mental illness.
Stigma is perhaps the biggest barrier to mental-health care; this stigma manifests particularly in a phenomenon known as social distancing, whereby people with mental issues are avoided and isolated from others.
Eradicating the stigma and social distancing related to mental illness needs to be a top public health priority in order to improve nation-wide mental health, attitudes toward it, and care of mentally ill patients as well as reduce a major economic “burden”.
The recent bungle that saw more than 100 psychiatric patients die as a result of neglect after being moved from Life Esidimeni Centre to poorly resourced community-based facilities shocked South Africa. Gauteng Health MEC Qedani Mahlangu ordered the move to cut costs. She has since resigned.
The tragedy demonstrates that mental health is not a priority, but, instead, is disregarded and undermined in the state’s health budget’s “burden of disease” scale.
However, according to the WorldHealthOrganisation (WHO) and World Economic Forum, mental illness represents the biggest economic burden of any health issue in the world, costing US$2.5 trillion in 2010; this burden is projected to cost US$6 trillion by 2030, with two-thirds of these costs attributed to disability and loss of work related to mental-health issues. And yet, shockingly, of the 450 million people worldwide who suffer from mental health conditions, the majority do not receive any form of care.
In my Psychology Honours research and thesis (2001), I explored the attitudes of women on the Cape Flats who had received psychological treatment. My findings included that many of my interviewees believed that people held negative attitudes and stereotypes about mental illness, labelling them as “crazy” if they knew that they had gone to see a psychologist.
From a young age, children hear adults referring to others who are different to them as “mad” or “weird”; these labels stick and are carried into adulthood.
This bias is not limited to people who are either uninformed or not connected to people with mental illness; a case in point is the Life Esidimeni tragedy.
Health ombudsman Professor Malegapuru Makgoba investigated the deaths and found that many of these patients died of dehydration, starvation and seizures. This shows that they were not given the most basic humane care including food, water and their prescribed medication.
Negative attitudes and stereotypes of mental illness often manifest as social distancing. In particular, when people feel that an individual with mental illness is burdensome or even dangerous, the result is often fear and increased emotional and social distance. This may result in the experience of social isolation and loneliness on the part of person with mental illness. The experience of social rejection and isolation has the potential for harmful effects such as poor mental and physical health and even early mortality.
Also, as people begin to experience symptoms of mental health conditions such as anxiety or depression, stigma may lead to suppressing these feelings, all of which have been linked to the worsening of well-being.
This stigma also complicates the care and resources available to people with mental illness. In the “Attitudes toward Mental Illness” report (2012), the Centers for Disease Control and Prevention (CDC) in America noted that stigma could lead to lower prioritisation of public resources and poorer quality of care. Mental-health conditions are not typically screened in most health-care settings, losing an important opportunity for care.
If people are provided with proper mental-health care at appropriate facilities, much of the burden of disease to the family, community, workplace and state would be alleviated or prevented.
What can we do to help?
Increased awareness through education is probably one of the most important things that can be done to counteract negative stereotypes. Many mental-health practitioners and organisations, such as the South African Depression and Anxiety Group (SADAG), have fought to reduce stigma. In America, an activist/journalist for mental health, Molly Knight Raskin received an award for mental-health journalism, and she is developing a movie, Still we Rise, to highlight the epidemic of global mental illness. She says there is only one thing standing in the way of our ability to care for mentally ill people: stigma.
It is also crucial that those on the front lines of working with people with mental illness receive the education and support needed to help manage their bias. Training more people across the medical field in mental-health issues creates the possibility of integrating mental-health screening in primary-care settings.
People with mental-health issues need to receive care comparable to those with physical-health issues.
Unlike many conditions, we actually have empirically supported treatments in the form of medication, psychotherapy and lifestyle behavioural programmes that have shown efficacy and cost effectiveness in treating mental illness.
Raskin wonders if there will come a time when we can talk about mental health issues in the supermarket aisles with concerned neighbours without speaking in hushed tones, as if we have something to be ashamed of. It is my hope that this will become a reality and for people not to be ostracised, neglected and isolated.
May we treat ourselves and others with compassion through developing greater awareness that we are all vulnerable to mental-health illnesses.
Carin-Lee Masters is a clinical psychologist in private practice. She cannot enter into correspondence with individual readers, but will try to answer as many queries as possible through this column.
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