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July Psychosocial Disability Awareness Month


Every year July is commemorated as Psychosocial Disability Awareness Month, and this year the South African Federation for Mental Health is focusing on the need for upscaling and integration of community mental health care services.

The death of 94 mentally ill patients who were transferred from the Life Healthcare Esidimeni facilities to unlicensed NGO’s by the Gauteng Department of Health has placed the spotlight on the many problems existing within the current mental health system in South Africa. South Africa has good policies and legislation for mental health care, such as the Mental Health Care Act and the Mental Health Policy Framework and Action Plan 2013-2020, but the implementation of these policies remain a challenge. Mental health services have in many cases not been integrated effectively into other primary health services, and as a result mental health remains largely marginalised and underfunded. It is important to recognise that the Life Esidimeni tragedy is an example of a symptom of a mental health care system that does not provide adequate treatment or services to the many South African’s who need mental healthcare, along with a poorly-implemented deinstitutionalisation policy.     

Community-based mental health organisations provided crucial services, and without them thousands of Mental Health Care Users (MHCUs) would not receive the treatment and care they need. These community-based organisations are however largely dependent on the support of Government, the private sector and their communities in order to be able to provide effective services. It is necessary for primary health services such as Clinics and Hospitals, as well as social services such as social workers, community care workers, District Health Teams, private sector organisations such as medical schemes, pharmaceutical companies and private sector psychologists and psychiatrist to collaborate more effectively with community-based mental health organisations to provide the services that MHCU need.

Integration of these various services can help to improve access and facilitate the use of services, as well as preventing duplication of services. This collaboration and integration of services can also help to facilitate effective deinstitutionalisation. Deinstitutionalisation is a process of replacing psychiatric hospitals with community-based mental health services for people diagnosed with a mental disorder or intellectual disability.

Throughout the month of July, SAFMH and our Mental Health Societies and partners will be advocating for increased support and funding for community based mental health services, as well as for the integration of mental health services into primary health care on a community level. 

The following are recommendations regarding the increased support, and upscaling of resources for community based mental health organisations, as well as for the improved integration of mental health services:

  • Mental health services must be prioritised and developed with an equal level of high importance across all provinces in South Africa, and across rural and urban areas
  • Existing human and infrastructure resources need to be utilised as efficiently as possible and additional resources need to be developed and or prioritised
  • Services and resources at community level should be developed in consultation with MHCU, their families, NGO’s and other key partners/stakeholders/decision makers/service providers to ensure the development of such services is done in an informed and collaborative way
  • The prioritisation, implementation and monitoring of the MHPF at provincial level is essential, and provincial Departments of Health need to be held accountable for failure to do so
  • Savings generated through budget cuts in tertiary Psychiatric Care Facilities need to be used to support community-based care and to ensure that MHCU have access to high-quality care
  • Government needs to address the pervasive shortfalls in resources needed to adequately facilitate deinstitutionalisation policy requirements
  • South Africa needs to see the development of a range of comprehensive community-based mental health services to ensure that MHCU are provided with a range of community-based services
  • South Africa requires more consistent and more comprehensive subsidisation of community-based services, with adequate increases and timely payments of subsidies to ensure continuity in community-based mental health service delivery
  • Government also needs to look at the types of subsidies/funding opportunities that are made available to NGOs; what is required, in addition to post-funding, is more programmes funding for community-based organisation to aid in the development of more concerted service project development for MHCU
  • Treatment and rehabilitation of MHCU should be integrated into a system of Psychosocial Rehabilitation (PSR). These PSR systems should focus on areas such as skills training, peer support, vocational services and community resource development, to ensure that MHCU receive support and services enabling them to reintegrate into their communities


Marthé Kotze

Programme Manager: Information & Awareness

SA Federation for Mental Health

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28 June 2017

In light of recent reports of dramatic, sudden cuts in NGO subsidies in Gauteng, the SA Federation for Mental Health condemns such ill treatment of NGO’s by the Gauteng Department of Health.

Media reports and complaints to our offices have brought to light the fact that the Gauteng Department of Health has failed to pay the monthly subsidies of a number of NGO’s caring for vulnerable mental health care users (MHCU) in the province for the past few months, possibly due to revised licensing guidelines that the Department has hastily put in place in response to the Ombudsman’s damning report on the Gauteng Marathon Project, which saw approximately 100 MHCUs lose their lives due to poor planning and execution by the Gauteng Department of Health.

These NGO’s now face possible closure, and the MHCU face being left destitute, as a result of the Departments actions. It is important to recognise that ultimately any ill treatment of NGO’s by the Department translates into ill treatment of MHCU, as they are dependent on the care and services that they receive from the NGO’s.

SAFMH National Director, Bharti Patel, says the Gauteng Department of Health is not showing its commitment to mental healthcare. “NGO’s have communicated their challenges – which range from not being issued with licenses to non-communication about subsidies - to the Gauteng Portfolio Committee on Health. The Department of Health promised to issue licenses to all of the affected NGO’s two weeks ago, and yet today we hear that licensing is still a problem and this is affecting subsidies. The Department of Health does not seem to be serious about improving mental health services despite the increased budget allocations which were announced after the Health Ombudsman’s report on the Life Esidimeni tragedy.” 

In the wake of the Life Healthcare Esidimeni crisis, the Gauteng Department of Health should be mindful not to again jeopardise lives through carelessness or poor, rushed administrative procedures. While SAFMH recognises the need for new and stricter licensing requirements for NGO’s to be implemented, these procedures should be implemented in such a way that the care of MHCU is not affected and that NGOs are given sufficient time to bring themselves in-line with new licensing demands placed on them by the Department of Health so that service standards may be raised realistically whilst ensuring that the process is managed effectively and is not to the detriment of MHCUs.

SAFMH calls on the Department to pay all of the subsidies owing to the various affected NGO’s, and going forward to manage the licensing process in a more consultative and realistic manner. Whilst we recognise the need for more stringent licensing procedures, such new measures should be implemented with the wellbeing of MHCUs in mind at all times. We call on all parties involved to remember that the most important aspect of this case is the wellbeing of the MHCUs, and we urge all stakeholders to place their interests first.



Marthé Kotze

Programme Manager: Information & Awareness

SA Federation for Mental Health

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Bharti Patel

National Director

SA Federation for Mental Health

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26 June 2017 

Every year 26 June is commemorated as International Day Against Drug Abuse and Illicit Trafficking. This year the SA Federation for Mental Health wants to draw specific focus to the issue of youth and substance abuse. Substance abuse often affects people during the years when they should be completing school or finding employment, and the entrapment of youth in drug and alcohol abuse, as opposed to engagement in legitimate employment and educational opportunities, poses distinct barriers to the development of individuals and communities.

Substance abuse among youth has severe effects on our communities and families, and has many potential physical and mental health effects for the users, such as increased risk of injury and death due to either violence or accidents; increased probability of engaging in sexual behaviour with high risk of teen pregnancy and transmittable diseases; and increased risk for suicidal behaviour and psychosocial disorders. Abuse of different substances is furthermore also often the reason for declining grades, high absenteeism and school dropouts as well as involvement in crime and gang-related activities.

Substance abuse can be common among people suffering from mental health conditions. People experiencing anxiety, depression, or other mental illnesses often turn to drugs or alcohol to find temporary comfort. These substances are also sometimes used as a coping mechanism for those enduring a great deal of stress or hardship, such as experiencing troubles at home or at school, or losing a loved one.

Using drugs or alcohol to deal with difficult feelings or symptoms of mental illness is sometimes called ‘self-medication.’ But it can make existing mental health problems worse. Studies have for example shown that people who consume high amounts of alcohol are vulnerable to higher levels of mental ill health.

According to reports published in the Journal of the American Medical Association:

  • Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse
  • 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness
  • Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs

It is vitally important that we educate our youth about the dangers of drugs and alcohol abuse, and that we provide them with the emotional and they need so that they do not develop the need to turn to substance use for comfort. It is also essential that parents, teachers and the youth themselves are educated about the signs and symptoms of substance abuse, so that they can identify it early on and get the affected person help as soon as possible.

SAFMH calls on all sectors of society to prioritise the support, education and protection of our youth against substance abuse, and to work together to safeguard their physical and mental health.

Signs of substance abuse -  

Behavioural changes:

  • Drop in attendance and performance at work or school
  • Frequently getting into trouble (fights, accidents, illegal activities)
  • Using substances in dangerous situations such as while driving or operating a machine
  • Engaging in secretive or suspicious behaviour
  • Changes in eating or sleeping patterns
  • Changes in personality or attitude
  • Sudden mood swings, irritability, or angry outbursts
  • Periods of unusual hyperactivity, agitation, or giddiness
  • Lacking motivation
  • Appearing fearful, anxious, or paranoid, with no reason

Physical changes:

  • Bloodshot eyes and abnormally sized pupils
  • Sudden weight loss or weight gain
  • Deterioration of physical appearance
  • Unusual smells on breath, body, or clothing
  • Tremors, slurred speech, or impaired coordination

Social changes:

  • Sudden change in friends, favourite hangouts, and hobbies
  • Legal problems related to substance use
  • Unexplained need for money or financial problems
  • Using substances even though it causes problems in relationships


Marthé Kotze

Programme Manager: Information & Awareness

SA Federation for Mental Health

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Every year the 7th of April is commemorated as World Health Day, to mark the anniversary of the founding of the World Health Organization. This year the theme selected by the WHO is Depression: Let’s Talk.

Globally it is estimated that 300 million people of all ages experience depression, and depression is currently the leading cause of disability worldwide. It is therefore crucial that people are educated about depression, and that all sectors of society are encouraged to speak openly and honestly about their experiences and struggles. Depression can affect anyone regardless of age, race, gender or socioeconomic status. The disorder can greatly impact a person’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends as well as the ability to function at school or work.

Although all aspects of society may be affected by depression, the South African Federation for Mental Health is appealing to Government, teachers, parents, social workers, and all members of society to place specific emphasis on the mental health of South African youth.  

The 2008 National Youth at Risk Survey which focused on children and adolescents between grade 8 and 11 found that one in four youth (24.7%) reported feeling sad or hopeless, and just under 18% had made at least one suicide attempt. Only 37.2% of youth who reported feelings of sadness had sought treatment from a counsellor or doctor.  World-wide suicide is now listed as the second leading cause of death among 15-29-year olds according to the WHO. Depression is associated with increased risks of substance abuse, unemployment, early pregnancy, and educational underachievement. It is crucial that young people experiencing depression feel safe and comfortable to open up about their struggles, and to seek the correct help and treatment they need.

Research has shown that there are a number of factors that make a person more likely to develop depression, these include environmental factors such as adverse childhood experiences like abuse or poverty, stressful life events such as the loss of a job, death of a loved one or exposure to physical violence. There is also a genetic and physiological component as first degree relatives of someone with major depressive disorder are two to four times more likely to develop the disorder. Depression often remains largely underreported by teens with studies finding that it often takes several years before depressed adolescents and children receive appropriate treatment. This treatment gap is in part due to stigma and fear of discrimination.

On World Health Day SAFMH calls on all South Africans to begin talking openly about depression, and to thereby combat the stigma and misinformation surrounding mental health. Young people struggling with feelings of depression, or any other mental health problems, are encouraged to seek professional help so that they can access the correct forms of treatment.


Symptoms of Depression to look out for:

•        Sad, low, or irritable mood or feeling nothing

•        Decreased interest or pleasure in activities

•        Change in appetite or weight

•        Sleeping more or less than usual

•        Feeling restless or slowed down

•        Fatigue or loss of energy

•        Feelings of guilt or worthlessness

•        Decreased concentration

•        Sense of hopelessness

•        Substance abuse

•        Recurrent thoughts of death or suicide


Marthé Viljoen

Programme Manager: Information & Awareness

SA Federation for Mental Health

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31 March 2017

Every year March is commemorated as Intellectual Disability Awareness Month, and this year the South African Federation for Mental Health focused on creating awareness around the right that persons with intellectual disabilities have to access employment opportunities. As the month draws to an end, SAFMH would like to call on Government, partners, mental health care users and the public to continue working to ensure that the rights of persons with intellectual disability are protected and upheld.

The right of persons with disabilities to access employment opportunities is enshrined in various pieces of national and international legislation, and it is our collective responsibility to empower and assist persons with intellectual disability to access these rights.   

SAFMH would like to encourage persons with intellectual disabilities and prospective employers to make use of the SAFMH Right to Employment video materials and other informational resources, and to look for ways in which our workplaces and economy can become more inclusive and accessible.  

The DVD and videos are divided into two sections:

Section 1 is focused on persons with mental disabilities who want to find employment. The video includes information such as practical tips on how to create a CV, how to prepare for a job interview, what reasonable accommodation is and what labour laws exist in South Africa that protect the rights of persons with disabilities.

Section 1 for employees can be accessed here:

Section 2 is focused on prospective employers of persons with mental disabilities. It aims to educate companies and organisations about what is meant by mental disability, what the various benefits are of employing persons with disabilities, what can be expected of companies with regards to reasonable accommodation, and what labour laws protect persons with disabilities in South Africa.

Section 2 for employers can be accessed here:

Thank you to all partners and stakeholders for their efforts throughout the month to raise awareness around this important topic. We hope that the hard work will continue to ensure that persons with intellectual disability are given the chance to access all the opportunities that other South Africans enjoy.


Marthé Viljoen

Programme Manager: Information & Awareness 

SA Federation for Mental Health

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30 March 2017 

World Bipolar Day is celebrated every year on the 30th of March, the birthday of Vincent Van Gogh, who was posthumously diagnosed as possibly having bipolar disorder.

Bipolar disorder is the 6th leading cause of disability in the world, with an estimated 60 million people worldwide living with the disorder, according to the World Health Organisation. Despite its prevalence, bipolar disorder is still surrounded by stigma and misinformation. The reality is however that despite the severe and often debilitating symptoms, with the correct treatment and support many people with bipolar disorder are able to live functional and healthy lives as part of their communities. In order to fight the stigma surrounding the disorder, and to try and encourage understanding and support, the South African Federation for Mental Health is encouraging persons living with bipolar disorder to share their stories.   

Sifiso Mkhasibe Life Story - Living with Bipolar Mood Disorder

"I am a survivor of Bipolar Mood Disorder type 2. I can remember when I was told that I had this mental condition, I was confused and had no idea what it was and how to manage it. It was all new to me. I remember the doctor telling me that I had to take medication for the rest of my life, and it seemed like a death sentence. I didn’t understand why I had to be on medication and even worse why I was taken away from my family to stay in a hospital, I felt like my freedom was taken away from me. I didn’t see myself as a person who was chronically ill with a mental disorder. I knew I did not belong in hospital, it wasn’t a place for me. And so my journey began.

I remember I was extremely violent and aggressive. And when I was down I was so depressed I tried to kill myself. I didn’t know what to do with this mental disorder that had crippled my life. I was young in my late 20’s, doing well in college and working part time. I was excelling at everything I touched or did. So when I was admitted to hospital, I felt like my life had just ended. I never saw myself living in a lock up ward in hospital. I was always sedated, because of my violent outbursts and my manic and depressive episodes. I had given up on life and any chance of recovering from my mental illness.

My family’s response was that I was bewitched and would never be normal again, unless I went to the traditional healer. My family took me there but I was not healed, so back to hospital I went. I was written off by my family because they didn’t understand what was happening to me or how to help me. It affected them badly, my father even suffered a heart attack from thinking too much about my illness and what went wrong in his life. He blamed himself for my illness and that resulted in the heart attack, but he recovered from it. The rest of my family members kept their distance. I think it was due to a lack of education on how to support me during this time and confusion about my disorder.

Days, weeks, months went by, until I realised enough was enough. I had to take ownership of my bipolar mood disorder. I educated myself about the symptoms I had experienced when I was diagnosed. I went through depressive symptoms which included sadness and hopelessness, with no drive to live. I also went through hypomanic symptoms that included irritability and over excitement, I was also a compulsive spender, and at some point gave away all my belongings to strangers. Once I had learned how to manage my bipolar mood disorder, life started to become clearer, I knew what I had to do and how to do it. I was no longer a victim of my disorder. I stopped defining myself as a person with bipolar mood disorder, now I just say that I had those symptoms when I was diagnosed. I am on medical treatment and I do not present those symptoms any longer.

I am now a healthy and functioning member of society, and I work and study. I live life with a purpose to empower and educate people all over the world about bipolar disorder. I love to take part in outdoor activities. I’ve joined a gym in my community and play for the local soccer team, which consists of friends with bipolar and other mental disorders. I am a highly active South African Mental Health Advocacy Movement (SAMHAM) advocacy leader in my community, helping those who are struggling with their mental condition to understand and manage it, like I have done, and to fight against stigma and discrimination in our society. I work to help others live with dignity and respect, for them to know their rights as mental health care users, and to be responsible for their own mental well-being. 

The treatment I am currently taking has worked well for me over the years. I have come to terms with having to take my medication for the rest of my life, because it brings stability to my life. I am taking Epilim and Seroquel on a daily basis, and been for many years. I have had to make some lifestyle changes in order to manage my disorder, and this has helped me to be healthy.

I am Sifiso Mkhasibe… I am not my illness. My bipolar mood disorder does not define who I am. I used to present symptoms of bipolar disorder but not anymore. I am a survivor of bipolar disorder and I live a normal life. Remember to look after your mental wellbeing." 

By telling their stories in their own words, mental health care users living with bipolar disorder can help to combat the shame and silence that often surrounds mental illness, and they can become empowered through sharing their struggles, experiences and victories with the world. SAFMH encourages anyone living with bipolar disorder to send us their story to help and encourage conversation and education around bipolar disorder. SAFMH would also like to encourage all South Africans to educate themselves about bipolar disorder, in order to create a society that treats mental health care users with dignity and respect.


Marthé Viljoen

Programme Manager: Information & Awareness 

SA Federation for Mental Health

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