Where to get help for your battered psyche

The Covid-19 pandemic and subsequent lockdowns dealt a further blow to mental health in a country already struggling with the issue, with many people losing loved ones as well as their businesses and jobs.

However, if there was one positive effect that came out of the unprecedented event, says Krystle Kemp, project manager at the SA Depression and Anxiety Group (Sadag), it was that it drew much-needed attention to mental health. “I say this with reservations, but, with many people losing people, they became more focused on their mental health,” she says.

Whereas before the lockdown the Sadag helplines received an average of 600 calls a day, this figure went up to 3,000 a day and now sits at about 2,500. The helplines are manned by trained counsellors and some are available 24/7. A Sadag survey on the effects of Covid-19 on mental health published earlier this year found that among the 1,214 respondents, the challenges experienced during lockdown included: anxiety and panic (55%); financial stress and pressure (46%); depression (40%); poor family relations (30%); feelings of suicide (12%); and substance abuse (6%).

Sadag is one of the nongovernmental, nonprofit organisations offering a helping hand to a nation in dire need of care. In addition to its toll-free helplines, it hosts more than 160 support groups run by trained counsellors. These range from groups focused on depression to ones that deal with anxiety, trauma, post-traumatic stress disorder (PTSD), substance abuse, bipolar disorder, post- and perinatal depression; support groups for loved ones and family members of those with mental illness; grief and bereavement; men’s mental health; chronic illness; HIV/Aids; and student support.

Another NPO offering free services to the public is Cape Mental Health, whose more than 20 programmes assist people with psychosocial disabilities including mental and emotional disorders such as depression, schizophrenia, bipolar mood disorder and PTSD.

These organisations, staffed mainly by volunteers, are stepping in to help the many people in SA who are caught between a state health system that is on its knees and private healthcare that is so expensive it excludes most of the population. With private clinical psychologists charging anything upwards of the medical aid rate of R1,194.70 an hour and psychiatrists charging anything from R3,500 to R5,000 for an initial one-hour consultation, only those individuals with top-tier medical aids can buy the mental healthcare they need.

In addition, there is a shortage of mental health professionals in SA, with only one psychologist for every 100,000 people and one psychiatrist for every 300,000 people.

Amid heated debates around the proposed National Health Insurance (NHI), SA’s severely underfunded and incapacitated state health system has come under increased scrutiny. This includes the state-funded psychiatric hospitals, such as Tara — the H Moross Centre in Johannesburg, Valkenberg in Cape Town and King Dinuzulu in Durban, which have a low availability of beds, long waiting lists and stringent conditions of entry.

According to a report published in Spotlight for Section 27, the budgets cuts on health spending are bound to have far-reaching negative effects. “The aggressive fiscal consolidation path that SA’s government has undertaken over the past decade in response to increasing debt service costs as well as weakening economic growth has only compounded the under-resourcing of the public health system,” the report says.

“In 2018, UN Committee on Economic, Social and Cultural Rights (CESCR) experts expressed concern that the austerity in our budget could further exacerbate inequality and restrain the redistributive capacity of our fiscal policy.

“In the [2023/24] fiscal year, the National Treasury cut the health budget by 4.9% in real terms. Even during the pandemic, the 2021/22 health budget was slashed by 2.2% in real terms. It is unlikely that this trend will improve.”

The report adds that government is asking the nation to brace itself for even poorer health services.

As a result, it is becoming difficult for state health institutions to deliver adequate services: “Not only do budget cuts constrain the ability of the health system to provide quality healthcare, but they also reduce capacity to bolster the quality of spending. SA has a chronic underspending problem, where billions of rand that were allocated to funding the implementation of social programmes are returned to the national departments and the National Treasury annually ... For the 2022/23 fiscal year, the Gauteng health department, for example, underspent R1.6bn of its district health services budget, which includes HIV/Aids treatment services. In the same year, underspending of the health budget by the Eastern Cape resulted in the department losing out on conditional grant funding,” says the Spotlight report.

Some relief is offered by the various credible NPOs, such as Sadag and Lifeline, which unceasingly need to raise funds to provide mental health services.

Sadag offers only telephonic counselling, with callers speaking to counsellors on duty, though they are unable to have follow-up calls with that counsellor. Lifeline offers a limited number of one-to-one counselling sessions. However, like many cash-strapped NPOs, Lifeline has had to reduce its service offering and close some of its branches.

For those who want to see a qualified and registered professional, the Psychology Today website is a valuable resource. The general counsellors, clinical psychologists and social workers listed on the site are all verified by Psychology Today and registered with the Health Professions Council of SA (HPCSA).

The Association for Supportive Counsellors and Holistic Practitioners (ASCHP) is an alternative listing to the HPSCA. Its website lists more than 500 members who are specialist wellness counsellors working in faith-based and community-based NPOs, the SA Police Service, counselling call centres, hospitals, clinics and emergency services.

Through the ASCHP you can access online service provider Virtual Care, with a booking system for psychologists, addiction counsellors, trauma counsellors, social services, medical professionals and recovery coaches.

If you’re looking to save money by booking a number of therapy sessions upfront, log into Headroom, an SA-based listing of mental health professionals registered with the HPCSA and the SA Council for Social Services Professions.

Employers can do a lot to help their staff navigate the increasing challenges of living in a country in transition, with a struggling economy and vulnerable to the effects of volatile world events. Employee assistance programmes and annual wellness days have become standard in many organisations, but one company that is offering more than that is Johannesburg-based Auxo Digital, which since June 23 has instituted 10 mental health days annually for all staff.

These are additional, fully paid leave days, over and above annual and sick leave entitlement, says Auxo Digital business development lead Njabulo Mthombeni. “This was in response to what we observed as the emergence of burnout in the team. We are an ambitious start-up — currently a full-time team of six young people — but ambition unchecked very often results in burnout, especially in a start-up environment. The mental health days initiative was initiated to promote healthier working habits, and manage the team’s energy over the year.”

Conventional thinking is that this is a nice-to-have that would please the staff but cost the organisation. However, Mthombeni says the opposite is true: “The results have been fantastic. We’ve seen an increase in efficiency in most business functions — especially in terms of customer delivery. It’s also created a more positive overall culture and attitude towards mental health. 

“Staff feedback has been good — the saying around the proverbial water cooler is that people come back glowing the week after their mental health Friday. Another thing I’ve heard is that it is bragging rights to sometimes envious friends and family — ‘you’re so lucky’, ‘I wish I had that’ and the like.”

It’s possible that companies vying for the title of employer of the year will now have a new hurdle to clear.

He adds: “What is important to note is that mental health to us is not inherently a negative thing. In the same way that one has regular check-ups with a doctor for physical health (and accordingly may be prescribed glasses or insulin), with no stigma associated, we view mental health through the same lens.”

There is a growing trend worldwide towards a four-day work week, and Mthombeni says Auxa Digital’s decision was a result of studies by 4 Day Week Global. Trial results found a 25% revenue increase in companies that adopted the four-day programme as well as a 35% decrease in employee resignations, with 92% of companies wanting to continue the programme after the trial.

Mthombeni says his company has no regrets: “Of course an actual four-day work week is probably decades away, but the provisional evidence was strong enough to consider one day every month a sound business decision.”  

List of mental health resources: