Integrated approach needed for community-based mental healthcare, webinar told

22 Sep 2022

‘At the community level, non-governmental and other grassroots organisations should be involved in mental health services,’ a webinar to discuss a recent government white paper was told.

A move to community-based healthcare, specifically for mental health, would help to reduce the stigma associated with mental illness because community and family involvement would be integral parts of the plan.

That is the thrust of the government’s White Paper on the Transformation of the Health System, which was discussed at a webinar hosted by the South African College of Applied Psychology (Sacap) on Thursday.

“At the community level, non-governmental and other grassroots organisations should be involved in mental health services. Communities should be actively involved in the planning and implementation of community-based mental healthcare services, as well as substance abuse prevention, management and rehabilitation,” said Sacap’s Natalie Donaldson.

Clinical psychologist, lecturer and trainer Professor Tirusha Naidoo told those in attendance that the majority of her work is in community settings and she sees first hand what South Africa’s real mental healthcare needs are. She said that it was important to first address the question: What is mental illness?

Naidoo said that the issue crystalised during the Covid-19 pandemic and that she noted that recently the definition of mental illness had become broader, which she said was quite concerning because once people’s regular stressors from life were labelled as mental illness, the responsibility for mental healthcare shifted to individuals.

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“We must move towards community-based interventions,” said Naidoo, explaining that the Department of Health was not well integrated with other departments, such as Social Development, and was more focused on severe mental health disorders like schizophrenia and bipolar disorder, which cannot be treated in communities by laypeople, but need professional intervention.

Community-level mental healthcare works better with less severe mental health issues and contributes to mental health having less of a stigma.

Naidoo pointed out that there was an issue of over-referral because of a lack of education of staff and that the area of mental health was seen as “too difficult”.

She highlighted the problem of capacity, saying that “the pandemic has taken a lot of resources. Patients are being discharged sooner than they should be, before they are well enough to get back into the community.”

Grisel Pretorius, a project coordinator of the Friends of Valkenberg Trust, said her organisation tries to be a bridge between mental health institutions and the community. She said they try to tackle the needs of mental healthcare users that are not met in clinical programmes. These needs include teaching people skills like cooking, sending patients on training courses that would enable them to earn money and assisting them with their CVs.

She pointed out that as a result of the focus of the health system on deinstitutionalisation, her organisation filled the “in-between space” and helped patients reintegrate better into society. Pretorius said it was imperative to look at the environmental factors that affect the individual’s recovery and to stop the “revolving door pattern” that saw patients relapsing.

She said one of the biggest issues they dealt with was substance abuse because of the complex problems often faced in the outside world.

“In our current situation of a lack of resources, we need to see what we have around us can offer, and what is important is to create a new way of being … collaborators and to break down the hierarchy of the ‘professional’ and those with degrees or not.”

A community-based mental healthcare interview has to address the vulnerabilities of individuals, said Lindiwe Dlamini, a social worker in private practice and a community development practitioner.

She stressed that there were multiple factors that affected mental health. “Safety and security are important; of late we are not safe in our homes … our cars.”

Dlamini said the community development programmes she participated in had recognised that the failure of their programmes was often the result of unaddressed mental health issues which had necessitated the bringing in of multidisciplinary teams and using community-based counsellors.

She said the community-developed programmes in which she participated had implemented a “check-in” method to assess the mental status and wellbeing of participants, which she said was contributing to the mainstreaming of issues of mental health.

“More than ever you cannot work in isolation — the benefits of working multisectorally is the ability of pooling resources and expertise together and mobilising resources together because each sector has different networks,” said Dlamini. DM/MC

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