CAPE TOWN — As mental health threatens to take over from HIV/Aids as the leading cause of illness in South Africa and medical aid claims for it soared by 80% over the past five years, the state continues to neglect hundreds of thousands of patients reliant on the public sector. With depression and associated illnesses estimated to cost the economy R12-R16bn annually in absenteeism and disability, thousands of public-sector in-patients are being abandoned as a decentralisation/decanting policy turfs them into a facility void. For those remaining, proper oversight of mental health hospitals is farcical with the only viable statutory provincial Mental Health Review Board existing in the Western Cape. A review board member in KwaZulu-Natal says “thousands” of mental health care patients are being “illegally detained”. By not complying with the Mental Health Care Act (of 2002), in appointing functional review boards, his provincial MEC was causing patients to be admitted to mental health care facilities without their applications being reviewed. The province does not have a single legally-constituted Mental Health Review Board. Seven other provinces are little better or as bad. KZN has 20 of its 45 public sector psychiatry posts filled, a situation described by the SA Society of Psychiatrists as ‘critical’. Roll on an NHI? – Chris Bateman
By Adiel Ismail, Fin24
Cape Town – Mental health spend has increased by more than 80% in the past five years, reaching R2bn in 2016 with hospitalisation claims amounting to R32m more than predicted, according to Discovery Health CEO Dr Jonathan Broomberg.
“Mental health spend increased by 87% over the past five years (from 2011 to 2016),” said Broomberg.
Discovery Health’s data shows that depression contributed over 40% of the overall mental health disease burden. Other conditions include attention deficit and hyperactivity disorder, parasomnia (sleep disorder), anxiety disorder, non-specific neuroses and bipolar mood disorder.
In-hospital mental costs totalled R773m over the five years compared to R1.283m for out of hospital mental costs.
But in-hospital expenditure, as a proportion of total mental health spend, increased by 113% from 2011 to 2016. This increase in admissions is also attributed to an increase in the number of psychiatric beds available in hospitals.
Tip of the mental health iceberg
Prof Crick Lund, director of the Centre for Public Mental Health (CPMH), told Fin24 the increase in mental health service spending is reflective of a global trend which is seeing increased demand for mental healthcare services over time.
However, he pointed out that the spending figures reported by Discovery Health represent only the tip of the iceberg.
“They reflect mental healthcare spending by those who can afford private medical aid. We know from epidemiological studies that the prevalence of mental illness is much higher among poorer populations, who have the least access to mental healthcare and cannot afford medical aid.”
Lund said it is, therefore, vital that SA moves towards a National Health Insurance (NHI) system that facilitates more access to mental health care and does not exclude those who cannot afford private mental health care.
The prevalence of mental illness among medical scheme beneficiaries is rising, according to the latest Council for Medical Schemes (CMS) report.
The 2013-14 report shows that the total benefits per average beneficiary per month paid to psychiatrists increased by nearly 35% from 2011 to 2013. The total benefits paid to psychologists increased by 26%, while the total benefits paid to mental health institutions increased by 58%.
Despite the surge in mental healthcare claims, Shouqat Mugjenker, mental health portfolio manager for Pharma Dynamics, pointed out that members still face challenges from their medical schemes.
“People with mental illness continue to face prejudice and discrimination by medical schemes that are not obligated to reimburse patients for medications related to depression and anxiety, since these are not included in the list of prescribed minimum benefits (PMBs) for chronic medications,” said Mugjenker.
As a result, he said, those living with depression and anxiety wait much longer to get treatment than they should. Mugjenker warned that without the right treatment, sufferers not only risk serious regression and hospitalisation, but they face a greater risk of suicide.
About 30% of adult South Africans are likely to suffer from a mental disorder over the course of their lifetime, based on a South African Stress and Health (SASH) study. However, this figure is likely to have risen substantially since the SASH – the first and only nationally representative study of mental disorders in the country – was conducted 13 years ago.
Overtake HIV/AIDS as the leading cause of illness?
Mental illness is indeed rising, said Dr Ali Hamdulay, who is the general manager of the policy unit at Metropolitan Health. “Soon it could overtake HIV/Aids as the leading cause of illness in South Africa.”
He noted that despite the significant financial loss to employers and the broad economy, many mental disorders fly below the radar in the workplace.
“Mental illness in the workplace leads to decreased productivity, increased sick-related absenteeism, poor work quality, wasted materials and even compromised workplace safety,” Hamdulay said.
“Most employers tend to completely underestimate the financial impact of mental illness on their bottom-line. Increasing levels of mental illness drive up disability costs and demand more medical scheme spend.”
Hamdulay said a more proactive approach for managing mental illness in the workplace is a strategic imperative for South African employers.