SA Federation for Mental Health
Universal Mental Health Coverage South Africa World Mental Health Month
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About World Mental Health Day World Mental Health Day (WMHD) is celebrated on 10 October annually. October is World Mental Health Awareness Month. This month provides an opportunity to re-spark and deepen the commitment we give to mental health as individuals, communities, and countries. Everyone has the right to access quality, affordable and culturally sensitive mental health services.
The Global Theme for 2023 is “'Mental health is a universal human right”, while the SA Federation for Mental Health (SAFMH)’s theme, adapted for South Africa, is “Universal mental health coverage in South Africa”.
Key Terms Health: This is a state of total mental, physical and social well-being. It’s not only about not being sick or not having an illness. Human Rights: As the name suggests, these are rights that everyone must enjoy, by the mere fact that they are human beings. These rights cannot be taken away from anyone, except in specific situations and according to due processes. For example, your right to liberty may be restricted if you are found guilty of a crime by a court of law and are sentenced to serve time in jail. Mental health is a human right, and access to mental health care or services is a human right. Mental Health: This is your emotional, psychological, and social wellbeing. Mental health is your health, and everyone has mental health. Mental Health Condition: This is clinically diagnosed by a mental health care professional, based on significant disturbance in your cognition, emotional regulation, or behaviour. Examples include depression, anxiety, schizophrenia and bipolar. Stigma: An attribute or condition that severely restricts a person’s sense of self, damaging their selfworth, social connections and sense of belonging. This is experienced by labelling, stereotyping, separation, status loss, and discrimination in the context of a power situation. Universal Health Coverage (UHC): This is the idea that everyone, everywhere should be able to access the highest attainable standards of health without suffering financial hardship.
Unpacking SAFMH's Theme The world is accepting the concept of universal health coverage. Mental health must be an integral part of Universal Health Coverage. Nobody should be denied access to mental health care because she or he is poor or lives in a remote place.” Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization
SAFMH fully supports UHC. We want to see the right to health – including mental health – realised for all in South Africa. This is a human right. During October 2023, and on World Mental Health Day in particular, we call attention to how UHC also means universal mental health coverage because a person’s health includes their mental health. Currently, there is a large gap in the coverage of care for mental health conditions in South Africa. It’s estimated that less than 1 in 10 people living with a mental health condition in South Africa receive the care they need. The way to tackle this gap is to integrate and expand access to quality, rights-based, evidence-based, culturally-sensitive, and cost-effective mental healthcare into UHC efforts and existing health services. We are not alone in this call. In 2019, member states of the political declaration of the UN high level meeting on UHC committed to: “Implement measures to promote and improve mental health and well-being as an essential component of Universal Health Coverage.” These measures must be rights-based. This October, mental health academics, advocates and activists worldwide stand together to say everyone, everywhere should be able to access the highest attainable standards of mental health without suffering financial hardship.
Unpacking SAFMH's Theme Integrating mental health into UHC Informed by the Global Mental Health Action Network’s key asks on UHC, when we talk about universal mental health coverage, we mean integrating mental health into UHC. Specifically:
Including mental health in all relevant health services and interventions across the life course and throughout the continuum of care. This includes health promotion, disease prevention, treatment and rehabilitation, and in primary, secondary and tertiary care. Ensuring that mental health conditions are covered by populationwide financial protection measures, like our annual health budget and the proposed national health insurance (NHI). Increasing investment into mental health care so it is on par with, and where relevant accompanying physical health care.
Why have universal mental health coverage? From a human rights perspective: our laws state that every person has the right to access health care, including mental health services. Without including mental health, UHC cannot be a mechanism whereby the right to health is fully realised in our country. From a health perspective: mental and physical health are closely interlinked – improving mental health leads to improved physical health outcomes and vice versa . For example, global HIV and TB infections can be reduced by up to 17% and 20%, respectively if mental health is integrated into HIV and TB programmes. From an economic perspective: It is projected to cost the South African economy more to not invest in mental health, than it does to invest in mental health. Researchers estimate that over a 15 year period, the cost of inaction through lost productivity to be R500 billion, while over the same period, the cost to scale up UHC-informed mental health care would be R326 billion.
Unpacking SAFMH's Theme Realising universal mental health in South Africa Countries need enabling laws and policies to make sure that UHC is realised. The NHI Bill seeks to make this happen in South Africa. There has been much contestation about the NHI Bill. Encouragingly, in the Bill’s preamble, we welcome the reference made to mental health within article 12 of the UN Covenant on Economic, Social and Cultural Rights, as well as Article 16 of the African Charter on Human and People`s Rights. This roots the bill in a human-rights based approach to mental health. We also appreciate that there is specific mention to provide school-based services to promote mental health for young people (pg 49; 4.4.4) and, importantly, that there is a conditional grant provided to invest in improving the mental health services in the country (pg 58; 8.7) ahead of implementing the NHI. On the other hand, as mental health advocates, we so also have concerns with the NHI Bill.
Our concerns about the NHI Bill 1) The conditional grant budget line item for mental health needs to be revisited (pg. 58; 8.7). This amount is not congruent with the proposed recommendations from a 2021 Mental Health Investment Case Report(1) to sufficiently strengthen mental health services and integration. An adequate conditional grant for mental health is necessary to correct the injustices of the past regarding mental health service allocation and invest in scaling up mental health care in the country.
1) Besada D, Docrat S, Lund C. Mental health investment case for South Africa. Final report of the mental health investment case task team. An Independent Initiative commissioned by the National Department of Health of South Africa. Cape Town; 2021.
Unpacking SAFMH's Theme 2) There is no commitment to an explicit priority setting exercise for the NHI packages of care. Currently, the Bill states that the Health Minister will ultimately determine health care benefits that will be reimbursed through the NHI Fund, as well as the service coverage. This is a serious concern. We advocate that the decisions related to the amounts and types of resources to be made available, eligible populations, and specific rules for allocation are informed by an economic analysis to maximise value and achieve social goals. 3) We are unsure what approach will be used to inform priority setting. We advocate that any priority setting should be informed by a needsbased approach rather than a current service use approach. Considerations around burden of disease, our human rights obligations and treatment gaps should drive the prioritisation of health services and associated budgets. These metrics provide good evidence for investing in mental health care. While debates around the NHI will continue and perhaps even intensify in the lead up to the 2024 elections, this should not stunt the immediate implementation of known, uncontroversial, rights-based and evidencebased actions desperately needed to improve health system performance.
What to expect from SAFMH this October 2023? This October, SAFMH wants to see the right to health – including mental health – realised for all in South Africa. This must be from a human rights approach and not only from a biomedical one. Investment into community-based care, rehabilitation, prevention, and promotion is essential. We continue to advocate for evidencebased, cost-effective mental health services, like those outlined in the Mental Health Policy Framework 2023 2030. These can be implemented today to improve the mental wellbeing of all in South Africa.
What to expect from SAFMH this October 2023? ACTIVITIES 10 October 2023 We will be hosting an in-person event at our offices in Johannesburg. The event will see us further unpack our WMHD theme, feature SADAG’s Human Library, and remembering the Life Esidimeni tragedy. Join us as we continue our call for mental health as a universal human right.
Third week of October We will be co-hosting a webinar in collaboration with key Government Departments to discuss our theme of universal mental health coverage and the Mental Health Policy Framework 2023 - 2030.
Throughout October We will be active on social media and targeting organisations to raise awareness about the October 2023 theme.
Want to learn more? Below are a few resources we recommend to supplement some content is covered in this concept document:
Sign up for the WHO QualityRights E-training This online training aims to improve the quality of care in mental health and related services and to promote the rights of people with psychosocial, intellectual and cognitive disabilities.
Know how to use Mental Health Review Boards The Mental Health Care Act established Mental Health Review Boards to look at the care, treatment and rehabilitation services provided to mental health care users. These Boards are there to protect the rights of mental health care users, especially at times when users are unable to protect their own rights (e.g. during involuntary admissions).
Have Your Say On The NHI Bill The National Council of Provinces have issued a call for written submissions and inquiries about the NHI Bill. All submissions must be sent to mawilliams@parliament.gov.za by no later than Friday, 15 September 2023 at 12h00.
We want to hear from you: What will you be doing for WMHD? Email Address
In the lead up to this October, we would love to hear how your organisations and staff will be highlighting the importance of UHC. We invite you to use the information in this concept document to inform your actions, to reflect on your efforts to help raise awareness of the importance of UHC and to identify ways in which SAFMH may support or collaborate with you on these. Looking forward to an engaging and impactful October 2023!
michel'le@safmh.org
SA Federation for Mental Health