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By Dr Marion Morkel, 19 August 2021
People are stressed, anxious and grieving. Lockdowns and loss have magnified depression. In a deeply unequal society like South Africa, the virus laid bare an existing mental healthcare service gap and the shocking public health crisis in the country. While psychiatric services took an unavoidable step back during the successive lockdowns, they now have a crucial role to play.
It has been a devastating time. People are, by nature and necessity, social. Many have experienced the inability to be at a loved one’s side during their final moments. There’s also limited capacity to grieve together – a Zoom funeral can never replace a real-life coming together. There’s fatigue over the disease, pandemic protocols, and the incessant uncertainty. There’s survivor guilt – ‘Why did I survive and not my friend or family member?’ And then, there’s long COVID-19 and the inability to feel normal, months down the line, when everyone expects a full recovery. Many have reported depression, sleep disturbance, impaired concentration, and more.
Being ‘locked’ in our homes has had consequences too. There’s been an increase in gender-based violence. People have faced severe substance withdrawal. There’s a feeling of displacement as some everyday rituals are lost and social connections are severed. Statistics released by the South African Depression and Anxiety Group (SADAG) show the negative mental impact of quarantine. Young people are living in a bubble – quarantined in body and mind.
At Sanlam, we’ve seen an increase in the use of mental health services by our team. We’re seeing more healthcare workers presenting with mental health issues – and PTSD in particular. Already, 20% to 30% of the US’s healthcare workers are considering leaving the profession. And 4 in 10 nurses are contemplating leaving their roles as well. South Africa is likely to see similar trends. Down the line, Sanlam is expecting to see the delayed impact of COVID-19 on mental health in the claims environment. Collectively, we are going to be paying due to this pandemic for a long time.
Positively, it may shine some much-needed attention on our lack of mental health resources and facilities in this country. And the dire need for more people to have greater access to care.
Siphelele Nguse and Douglas Wassenaar’s Mental health and COVID-19 in South Africa shows that prior to the pandemic (2018), 1 in 6 South Africans already suffered from anxiety, depression or a substance use disorder, with 60% of people possibly dealing with post-traumatic stress. However, just 27% of South Africans with severe mental disorders receive treatment. The same paper says that just 5% of the national health budget goes to mental health (for 2019) and only 50% of public hospitals with ‘mental health services’ actually have a psychiatrist. Perhaps the pandemic has given us an opportunity to turn this around. Now’s the time to show collective will to broaden the reach of psychiatric services.
Naidu suggests that the pandemic may mean that more people present with post-traumatic stress; mood, anxiety and obsessive-compulsive disorders; and phobias. A 2020 study by the Human Sciences Research Council found that 33% of South Africans were depressed, with 45% feeling fearful and 29% facing loneliness in the first lockdown. People could access counselling, but many defaulted on appointments due to the risks perceived with in-person consultations. We are likely to see more consequences from these missed sessions.
Now’s the time for a focussed response from mental health workers. Nguse and Wassenaar say we need mental health to be front and centre of policy frameworks and national strategies. It needs to be part of the national plan for recovery, with an emphasis on reaching our most vulnerable through consistent counselling and care. We must explore all avenues of alternative interventions as well, including the opportunities brought about by telemedicine.
From an insurance perspective, we embarked on a mental health support programme for our clients last year. Through a series of webinars, the programme aimed to help them navigate the stresses of our COVID-19 world, from balancing family and work life, to managing grief during a pandemic. We also expect to see an increase in mental health-related claims, not only as a primary diagnosis but as an existing comorbidity when individuals are diagnosed with a severe disease.
Reabetsoe Buys, a psychologist based in Johannesburg, suggests that individuals take time for self-care and prioritise their holistic health. Here are her five suggestions for looking after one’s mental health right now:
Here are some hotlines to call if you need someone to speak to:
SADAG: 0800 567 567
Adcock Ingram Depression and Anxiety Helpline: 0800 708 090
Lifeline South Africa: 0861 322 322