Table of Contents
INTRODUCTION
Mental illness is a very prevalent issue of health in South Africa yet the country still lacks the required resources aa to execute a mental health strategy. However, the issue is more complex than that as it takes many forms and also considering the country’s history of Apartheid, which amongst factors such as diseases, abuse (physical, sexual or emotional), neglect, substance abuse, urbanization and not limited to violence have increased the prevalence of mental disorders in the country. Those who are most susceptible to mental illness include individuals living in poverty, who have an ongoing medical condition, who have been/are being abused or neglected as a child, who have faced traumatic experience and who use alcohol or drugs. Within the social work context, the most vulnerable population are considered to be in need of special attention through protection and advocacy.
Thompson M.L. (2006) stressed that whereas physical illness manifest in the body, mental illness manifest as certain types of behavior. In this sense mental illness cannot be diagnosed by biological tests, such as viewing a virus under a microscope, imagining the brain or doing blood tests. In their study of mental health Ritchie H and Roser M (2018) reported that at least 1-in-6 people (15-20 percent) have one or more mental or substance disorders with an estimation of 1.1 billion people in worldwide having a mental or substance abuse in 2016. This reveals that mental illness is one of many, if not most, burning issues which requires utmost attention both internationally and in South Africa as well. This assignment will focus on a mental health community programme, and covers the purpose of the programme, model adopted analysis of legislation and policies with regard to their strength and weaknesses, and social work intervention.
Thompson M.L. (2006) indicated that mental illness is difficult to define as the determination of what constitute a mental illness changes over time. Galdresi S. et al (2015) defined mental health as a “dynamic state of internal equilibrium which enables individual to use their abilities in harmony with universal values of society. Basic cognitive and social skills; ability to recognize, express and modulate one’s own emotions, as well as empathize with others; flexibility and ability to cope with adverse life events and function in social roles; and harmonious relationship between body and mind represent important components of mental health which contribute, to varying degrees, to the state of internal equilibrium.” Finally, the World Health Organization (WHO) describe mental health as a state of well-being which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” A complete cure of mental disorder is difficult to define and can only be attained gradually with time.
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NATURE AND EXTENT OF MENTAL ILLNESS
Sunday Times (2014) reported that at least one third of all South Africans have mental illness and shockingly, 75% of them will not get any kind of help as most people struggle to come forward with mental health problems due to the stigma attached to mental health or do not know where to get help. Even if reported, “South African healthcare resources are wholly unequipped to handle the burden placed on them” stated the South African College of Applied Psychology (SACAP), 2018. These claims were reiterated by the South African Depression and Anxiety Group (SADAG) which reported that less than 16% of sufferers receive treatment for mental illness. Another factor contributing to this is the lack of specialty of the psychiatric nurses within the district hospitals since there’s shortage of staff and it is necessary to rotate nurses through all areas of the hospital. Due to this, the nurses working with patients of mental disorders have varying range of knowledge and experience with mental illness.
The lack of intermediate care once the patient has been discharged from the hospital is one of the contributory factors towards the prevalence of mental illness as services such as support groups, special housing and supported employment are evidently nonexistent in South Africa. Follow up is a pre-requisite for chronic cases as the Mental Health Care Act of 2002 stated, but South Africa lack the necessary resources, as mentioned above, so this care is never provided. Once these patients’ treatment within the mental health facility is completed, they are returned to the care of their families and communities of dwelling and they’re informed of the discharge instruction. However, most of these patients fail to adhere to these instructions and they, mostly, fall prey or regress to the mental illness again.
BACKGROUND
Ritter L & Lampkin S stressed that it is important to describe the history of the treatment of mental illness to understand the sources of the stigmas and to learn from previous attempts to improve the health of the mentally ill. The history of mental illness within the South African context is pretty complex and controversial and include violence, ambivalence, discrimination, torture, suffering and fear. These characteristics are the major contributory factors to movements to improve the treatment and services for the mentally ill.
The history of psychiatry in South Africa spans back to the first settlement by Europeans in the Cape of Good Hope in 1652. Gillis L (2012) emphasized that the development of psychiatry in the country falls into 3 phases with some overlaps. The phases include a period of expediency and restraint during the early stages of the occupation of the Cape by the Dutch East India Company; the second, which could be referred to as the psychiatric hospital era, was under the control of the British from the earlier part of the 19th century towards the beginning of the 20th century; and the third, generally speaking, is the modern period since then.
The Dutch East India Company
They were the first to make efforts to deal with mental illness among early settlers and passing soldiers and sailors at the Cape. Minde M (1975) revealed that accommodation for the behaviorally disturbed was in a basic structure not distant to the first Van Riebeek fort; which was enlarged in 1674 but proved to be not good enough, and when a new hospital was built in 1699 not distant to the Company Gardens, mentally ill patients were moved ‘into small enclosed bedsitting room for keeping the so called “mad” isolated. Under the British colonial government the Somerset Hospital was built in 1818 and it brought with it a new hope. A few beds were reserved for ‘lunatics’ whom amongst the physically ill were treated. As we know, psychiatric diagnosis did not exist then and the mentally ill were simply referred to as ‘insane’, ‘lunatics’ or ‘mad.’ They were critically thought to be possessed.
It is reported that living conditions in the early years were horrible; ‘buildings were falling apart, overcrowded and infested’, patients lived in filth and management was unsympathetic. It was quite usual to find them kept in dark insanitary cells, filthy, covered in rotten wounds and chained to iron rings. The appointment of Dr. J C Minto saw the situation improved somewhat, he deemed mechanical restraint unnecessary to use unless isolation had been tried, he considered that “kindness and decision is found generally to restore order, and he improved living conditions and established employments for patients, making mats and baskets for sale.
The Psychiatric hospital era
According to Gillis L (2012) ‘the situation changed towards the end of the 19th century when it became clear that temporary lock-up and restraint arrangements and containment in police cells were not adequate or in keeping with current ideas.” New concepts led to the building of devoted institutions for the mentally ill, based on British and American models; these had extended wings for the wards and closed courtyards where necessary. It was considered that mental hospitals, then called asylums, should be placed in some sort of a garden or park setting as fresh air, pleasant surroundings and useful occupation would aid recovery. There were no effective drugs and no cures other than the natural abatement of symptoms as treatment was very limited.
These institutions were administered by the so-called Lunacy Laws and particular regulations dealing with the mentally ill which differed in the Boer Republics; but, with Union in 1910, the responsibility for psychiatric hospitals was entrusted centrally in the state Department of Health which was also responsible for new legislation (the Mental Disorders Act of 1916). Patients were now better housed and cared for but the protective orientation remained, i.e. to lodge, secure and care for the physical and mental needs of people who were psychotic. As time went on, however, overcrowding built up again – a constant feature of South African institutions owing to the combination of the chronic nature of many mental illnesses, the lack of effective treatment and that there were no other resources available.
The modern period psychiatry
Since the era covering the changeover of the 19th into the 20th century, each new diagnostic has opened up enquiry and experimentation. The Diagnostic and Statistics Manual (DSM) and International Classification of Disease (ICD) have teamed up, so to say, and we can now examine in detail each diagnostic entity in terms of development, course, outcome, and therapeutic effects of a particular psychotropic drug or therapeutic agent (Gillis, L. 2012).
However, prior to 1997, mental health in South Africa was mainly institutionalized, and little emphasis was placed on the development of curative therapies (Wikipedia). The South African government moved to deinstitutionalize mental health care following the White Paper Act in 1997, mental health care was then relegated to the primary care setting. Although the country has moved towards deinstitutionalization of mental health, current data indicate the goal of deinstitutionalization and effective primary health care has still not been fulfilled
