South Africa has a critical shortage of mental health services for children and teenagers.
This is according to a University of Cape Town and SA Medical Research Council evaluation of the costs of mental services and programmes in the country.
Released on Thursday – World Mental Health Day – the study offers, for the first time, a national reflection of the state of mental health spending.
It also sheds light on inefficiencies and constraints emanating from existing mental health investments in SA.
The study found that despite most mental disorders having their onset before the age of 18, there was a “an exceptional gap in terms of the service availability for children and adolescents”.
“Collectively, 93.2% of inpatient mental health admissions in SA were for adults aged 18 years and older, with only 6.8% of mental health admissions being recorded for those below 18.”
The study found that, similarly, the proportion of adults receiving outpatient mental health care in the country was 94.2%, compared with only 5.8% of those under 18.
According to the World Health Organisation (WHO), suicide is the second leading cause of death among people aged 15-29.
The SA Depression and Anxiety Group (Sadag) has been inundated with requests from primary and high schools to conduct awareness about suicide in particular.
Researchers Sumaiyah Docrat, Donela Besada and Crick Lund also found that there remained a “critical shortage” of child psychiatrists, with only three of the nine provinces – namely the Western Cape, Free State and Gauteng – reporting any such professionals working in the public sector.
Overall at a national level, there were on average 0.31 public sector psychiatrists per 100,000 – with the Western Cape reporting the highest availability of psychiatrists at 0.89 per 100,000 and Mpumalanga reporting the lowest, at 0.08 psychiatrists per 100,000 people.
The total cost of inpatient and outpatient mental health services and transfers from contracted hospitals to NGO mental services across all provinces amounted to R8.37bn in the 2016/17 financial year.
This represented 5% of the total health budget for that period.
The study also found “huge disparities between provinces in allocation of mental health resources”.
“Inpatient care is the main form of care, comprising 86% of the cost of mental health care. This is a reflection of our historical legacy and a focus on psychiatric hospitals and curative inpatient care…
“We must not reduce investments in psychiatric hospitals until adequate primary care and community-based services are developed, and the quality of care and infrastructure are improved in hospitals at all level of the health system.”
The researchers said “adequate attention” must be paid to the “potential savings that may yield from reducing re-admission rates for all hospitals which cost the health system R1.5bn in the 2016/17 financial year.
“It must be recognised that most re-admissions are as a result of systemic failures in transition from hospitals to the next source of care within the community,” the study said.