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EDITORIAL

Mental Health and Society’s Perceptions

The deaths of mentally ill 
patients transferred from Life 
Esidimeni health facilities 
in Gauteng province, South 
Africa to 27 unlicensed non-
governmental organizations 
(NGOs) is a sober reflection of 
how we as a society perceive 
and care for mentally ill people. 
As of 15 February 2017, the 
Health ombudsman Professor 
Malegapuru Makgoba reported 

that the death toll of these transferred patients from Life 
Esidimeni to the 27 unlicensed NGOs was above 100. In a 2003 
report, the World Health Organization (WHO) estimated the 
magnitude and burdens of mental illness globally as follows: 1

a. As many as 450 million people suffer from a mental or 
behavioural disorder.

b. Nearly 1 million people commit suicide every year.

c. Four of the six leading causes of years lived with disability 
are due to neuropsychiatric disorders (depression, alcohol-
use disorders, schizophrenia and bipolar disorder).

d. One in four families has at least one member with a mental 

disorder.

The report further explains that family members are often the 

primary caregivers of people with mental disorders, the extent of 

the burden of mental disorders on family members was difficult 

to assess and quantify, and was consequently often ignored. 

However, it does have a significant impact on the family’s quality 

of life. In addition to the health and social costs, those suffering 

from mental illnesses are also victims of human rights violations, 

stigma and discrimination, both inside and outside psychiatric 

institutions.1 

In 2007, the South African National Department of Health and 

WHO in a joint report indicated that, “mental illness was very 

prevalent in South Africa, yet the country lacked many of the 

necessary resources and policies needed to execute an effective 

mental health strategy”.2 The report did not provide information 

on the prevalence of mental illness. However, it listed a number 

of contributory factors namely violence, communicable disease, 

and urbanisation which have increased the prevalence of mental 

disorders in the country.2

In another South African study, of the 16.5% of people suffering 

from mental disorders, only 25% had received treatment.3 The 

study reported that the very factors that contributed to this high 

prevalence of mental illness also served to inhibit its treatment. 

Cortina MA, et al in their meta-analysis of ten studies on the 

prevalence of child mental health problems in sub-Saharan 

Africa documented that 14.3% of children were identified as 

having psychopathology. They concluded that one in seven 

children and adolescents had significant difficulties, with one 

in ten (9.5%) having a specific psychiatric disorder.4 The latter is 

of serious concern as we don’t focus on mental health care in 

children in most countries in the African subcontinent.

WHO defines mental health as the promotion of well-being, 

prevention of mental disorders, and treatment as well as the 

rehabilitation of people affected by mental disorders. However, 

in most societies, mental illness is associated with stigma, 

labelling, discrimination, and exclusion of the mentally ill. For 

the society’s perception to change towards the mentally ill, 

it must be educated that mental illness is treatable, requires 

empathy and compassion. Managing the mentally ill in highly 

specialised institutions may have its advantages but there is the 

need to review the appropriateness of managing the patient at 

home and community with support from visiting health care 

practitioners. Community Supported Recovery Services (CSRS) in 

mental health are gaining attention across the world, delivering 

greater knowledge and evidence of improved life outcomes for 

people living with significant mental illness.5 In South Africa, 

deinstitutionalisation of mentally ill patients, needs urgent 

review with the hope of integrating the mentally ill patients 

within their families, homes and communities (not in unlicensed 

NGOs). 

Prof. Gboyega A Ogunbanjo 
Editor: SAFPJ 

References
1. World Health Organization. Investing in Mental Health (2003). http://www.who.

int/mental_health/media/investing_mnh.pdf (accessed 25 Feb 2017)

2. Ministry of Health South Africa & World Health Organization (2007). WHO-AIMS 
Report on Mental Health System in South Africa. 

3. Inge, P, Arvin B, Victoria C, Sithembile M, Crick L, Sharon K et al. The Mental Health 
and Poverty Research Programme, C. Planning for district mental health services in 
South Africa: a situational analysis of a rural district site. Health Policy & Planning, 
2009; 24(2): 140-141.

4. Cortina MA, Sodha A, Fazel M, et al. Prevalence of Child Mental Health Problems in 
Sub-Saharan Africa: A Systematic Review. Arch Pediatr Adolesc Med. 2012; 166(3): 
276-281. doi:10.1001/archpediatrics.2011.592 

5. Mental Health Council of Australia. Innovative Models of Mental Health Care 
in Australia and Overseas (2006). https://mhaustralia.org/sites/default/files/
imported/component/rsfiles/mental-health-services/Smart_Services.pdf (ac-
cessed 25 Feb 2017)