SAFMH engaged with mental health care users on mental health services in South Africa in the public sector, and gathered input to get a better understanding of the experiences of mental health care users when making use of public mental health services.
The majority (86%) of mental health care users who participated in this engagement exercise indicated that they had visited the clinic or hospital once a month on average. Furthermore, 32% indicated that they had spent between R31-R40 on transport for a return trip to the clinic or hospital, and had therefore spent an average of R420 per year on transport alone to get to the clinic or hospital. Medication stockouts had a direct impact on transport expenses in that mental health care users needed to return on average 2 to 3 times to the clinic to check whether medication was available; they therefore had to spend more than double the cost for transport per month. Considering that most mental health care users were unemployed and only received a disability grant, such a seemingly small amounts for transport are in fact significant for these mental health care users. For mental health care users who rely on the small income from a disability grant, such transport expenses can make a substantial impact on their monthly budgets for living expenses.
Most of the comments made on how mental health care services should be improved revolved around accessibility of services that are inclusive of a range of interventions, additional to consultations with psychiatrists or general practitioners or the collection of medication. Mental health care users indicated that mental health services at clinic level should include mental health and general health education, counselling (that does not limit the number of sessions with a therapist), and recovery programmes that assist the mental health care users in managing their mental health condition more effectively and where the mental health care users can set goals for themselves.
Through informal discussions with mental health care users and during Empowerment Sessions conducted in Kwazulu Natal, mental health care users often indicated that psychologists should be available at clinics to fulfil the needs of mental health care users who required counselling services in addition to just receiving medication and seeing the psychiatrist or general practitioner every few months. mental health care users also indicated that occupational therapists should also be available at clinics, who could play an important role in assisting mental health care users to achieve optimal levels of functioning, with the aim to prepare mental health care users to achieve independence and recovery as far as possible.
Participants also indicated that the system at clinics and hospitals should be improved to decrease the waiting time before being attended to. During site visits to the Northern Cape in the first year of the SAMHAM implementation plan, mental health care users noted that long waiting times at clinics were often the cause of non-compliance. mental health care users from the Northern Cape said that they became despondent just thinking of having to sit at clinics for hours, or at times, for most of the day, waiting to be attended to. They then opted not to go at all. It would be interesting to know whether the long waiting time had the same impact on treatment compliance in other provinces, as was the case in the Northern Cape.
80% of mental health care users noted that they had been treated in a friendly manner by staff when visiting their local clinic or hospital, while 64% noted that they had been treated with dignity and respect. 45% noted that they had been listened to and 45% noted that they had been given the opportunity to participate in their own treatment plans. Only 4% noted that they had been treated with no dignity or respect, while 10% indicated that they had not been given the opportunity to participate in their own treatment plans.
The high ratings of mental health care users who noted a positive experience in terms of staff attitudes (treating them in a friendly manner and with dignity and respect) when visiting the clinic or hospital was encouraging to see. It was however concerning to note that less than half (45%) of the participants said that they were listened to and had been given the opportunity to participate in their own treatment plans. Treatment and management of mental health conditions should always take the views and opinions of mental health care users into consideration when it comes to decision-making related to their treatment plans, and should allow mental health care users to be active participants. Failure or reluctance to listen to mental health care users or allowing them to have a say in their own treatment plans relates to disempowerment and taking away their voices – which is essentially in contradiction with national and international human rights instruments.
The lower ratings which indicated a negative experience in terms of staff attitudes towards mental health care users were from Limpopo (10% not being given the opportunity to participate in their own treatment plan) and from Western Cape (4% not having been treated with dignity or respect). Even though it was positive to note that incidents of negative experiences by mental health care users were low, mental health care users’ rights should be non-negotiable and there should be a no tolerance policy for any form of ill-treatment by clinic and hospital staff. Furthermore, mental health care users' rights to be involved in their own lives and medical affairs should be upheld at all times.