South African President Cyril Ramaphosa, in his COVID-19 update to the nation on 30 March 2020, reminded citizens why the government deemed a drastic 21 days lockdown on the country necessary. The South African Federation for Mental Health(SAFMH), like many organisations, fully support President Ramaphosa’s call for South Africans to practice social distancing by staying home to avoid getting infected with and spreading COVID-19, which has already infected some 740,000 people worldwide and resulted in more than 35,000 people losing their lives.
The president stressed that the lockdown is absolutely necessary to save the lives of thousands, even tens of thousands, of our people from the virus that in South Africa has already infected 1353 people, with the death toll standing at five on the 1st of April 2020. While it is important that people avoid going out at all cost, health care workers, security and emergency personnel, food suppliers, providers of medicine and basic goods, and other providers of essential services, as defined in the regulations, can go continue to go out to work. This means that people in urgent need of these services, including mental health care users seeking essential medical services, are allowed to go out to get the services they need.
During the next 16 days, we are all challenged to consider alternative options to managing our concerns, and in doing so, continue to ensure healthy and safe lifestyles for ourselves and our families. People with mental illness are some of the most vulnerable in our society, and more care is needed to ensure that they are not exposed to the COVID-19 virus. It is important for these people to continue taking and getting access to medication to ensure adherence to treatment, which is necessary to prevent relapses and maintain a balanced lifestyle, while at the same time ensuring minimum exposure to the virus.
Being consistent with regular routines will help people with mental health illness to maintain their mental health. This could include using phone technology through voice and video calls to keep psychologists or psychiatrists’ appointments, where possible. According to a study published in Conflict and Health (2013), mental health problems, especially anxiety and mood disorders, are common in humanitarian emergencies, both natural and man-made disasters. This study which looked at four programs by Médecins Sans Frontières, an organisation that provide mental health services during emergencies, found that mental health care services should be part of the standard response to humanitarian emergencies.
An international group of organisations representing people who are living with psychosocial disabilities who includes “users and ex-users of psychiatry, victims-survivors of psychiatric violence, mad people, voice-hearers, and people with psychosocial diversity” says people with mental illness may be at increased risk of contracting COVID-19. The group made of organisations such as the Pan African Network of Persons with Psychosocial Disabilities, Redesfera Latinoamericana de la Diversidad Psicosocial - LOcura Latina, Transforming communities for Inclusion of persons with psychosocial disabilities- Asia Pacific and European Network of (Ex-) Users among others, say people with mental illness could be at risk as a result of:
● Living in social care institutions, shelters, psychiatric wards, correctional facilities and other settings that deprive them of their will to exercise social distance.
● The conditions in such environments usually increase risks of infections because of overcrowding, sharing amenities and being ill-equipped.
● Inability to access relevant health information in languages they can understand.
● Socio-economic challenges that preventing them from in following recommended preventative hygiene measures where they live.
● “Mistreatment and abuse”.
● Inadequate social support and inclusive communities.
● The systemic discrimination against people with mental illness.
People with psychosocial and intellectual disabilities must be empowered to participate at all levels of their lives, so sharing important information on COVID-19 on a regular basis will reduce mental anxiety according to the World Health Organisation. In a media statement on 27 March 2020 the Deputy Minister of Social Development, Hendrietta Bogopane-Zulu, acknowledged that persons with disabilities are among those who are particularly vulnerable to the negative impact of COVID-19.
Ms Bogopane-Zulu stressed that during this period of national disaster and lockdown, people with disabilities should not be left behind. The Deputy Minister called for measures to ensure that persons with disabilities and their families continue to receive services during the lockdown, through residential facilities, including centre and community-based respite facilities, which will remain operational as they form part of the essential services.
Coldiron, M.E., Llosa, A.E., Roederer, T. et al (2013). Brief mental health interventions in conflict and emergency settings: an overview of four Médecins Sans Frontières – France programs. Accessed at https://conflictandhealth.biomedcentral.com/articles/10.1186/1752-1505-7-23#citeas
Pan African Network of Persons with Psychosocial Disabilities, Redesfera Latinoamericana de la Diversidad Psicosocial, Transforming communities for Inclusion of persons with psychosocial disabilities, Asia Pacific. et al (2020). COVID-19 and persons with psychosocial disabilities
Social Development (2020). Deputy Minister Hendrietta Bogopane-Zulu on measures and services available to persons with disabilities during Coronavirus COVID-19 lockdown. Accessed at https://www.gov.za/speeches/deputy-minister-bogopane-zulu-measures-and-services-available-persons-disabilities-during
The Daily Maverick (2020).Covid-19: Giving meaning to ‘social solidarity’ through mental health support. Accessed at https://www.dailymaverick.co.za/article/2020-03-26-covid-19-giving-meaning-to-social-solidarity-through-mental-health-support
The Presidency (2020). Message by President Cyril Ramaphosa on COVID-19 pandemic. Accessed at http://www.thepresidency.gov.za/speeches/message-president-cyril-ramaphosa-covid-19-pandemic
World Health Organisation (2020). Mental health and psychosocial considerations during COVID-19 outbreak.Retrieved from https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf
(Project Leader – Info & Awareness, SAFMH)
011 781 1852
Please note that, until further notice, SAFMH will only be available for phone interviews and email enquiries
During the stressful time we are going through as a nation due to the COVID-19 virus pandemic, the following are some useful tips for people to consider while spending long amounts of time at home as part of disaster management protocols:
Source: Masimanyane Women’s Rights International (2020). Staff contingency mental health protocol. Accessed at https://d3367578-f3ce-4c71-aaf0-dc484080cfc8.filesusr.com/ugd/15949a_5c3ec6d02ba54347a73652e1a9e6b741.pdf
Staff at the South African Federation for Mental Health (SAFMH) used the annual Intellectual Disability Awareness Month commemorations to show society that people with intellectual disabilities can rise above demeaning labels attributed to them with support.
Persons with intellectual disabilities (ID) are recognised as the one group that has consistently been denied dignity and the value attached to the status of being “normal”, emphasising the destructive view that lives of persons with ID are perhaps of less value. This year, SAFMH is using Intellectual Disability Awareness Month (IDAM) in March to draw attention to contributions individuals with ID can make to society, despite the challenges they face on a daily basis. For 2020 the organisation is focusing on the theme “I am able, not a label” to discourage the negative labelling and stigma directed at persons with ID.
To kick off the IDAM celebrations, the SAFMH programmes team visited Little Eden Society and took part in the organisation’s launch of the 3rd annual Little Eden CEO Wheelchair Campaign. The campaign had attracted growing corporate participation since its inception three years ago. SAFMH’s Deputy Director, Leon de Beer, joined Little Eden Society CEO, Xelda Rohrbeck, by spending part of the day in a wheelchair in order to highlight mobility challenges faced by people with severe and profound intellectual disabilities. SA Paralympic boat rower, Sandra Khumalo, who is also a patron of Little Eden and an ambassador for the campaign and herself a wheelchair user, also participated in the launch.
ID generally starts before the age of 18, affecting a person’s development, which continues through the person’s life. According to the Western Cape Forum for Persons with Intellectual Disability, children with ID develop and learn slower than other children their age in two specific areas:
1. Adaptive functioning - the ability to acquire skills and behaviours that help them to navigate the demands of everyday living to the same degree as other children their age.
2. Intellectual functioning - the ability to learn, think, engage in problem-solving, use reasoning and make sense of the world to the same degree as their peers.
While SAFMH recognises that research and information goes a long way in helping to make a case for the importance of eradicating stigma, the organisation also believes in the immense value of listening to the voices of those who are directly affected or are persons with ID themselves. Through the assistance of Cape Mental Health, a constituent body of SAFMH that provides a wide range of services to persons with both psychosocial and intellectual disabilities, SAFMH was able to share some insights from individuals with ID at the beginning of the campaign. Their stories reflected the daily experiences of persons with ID and also highlighted the crucial role played by community-based mental health service providers.
One mental health care user who shared her story was Samantha*, who had a difficult upbringing, with people often calling her derogatory names because she had ID. According to Samantha, such words left her broken inside and hurt her deeply. However, she refused to allow the severe sadness this caused to discourage her from doing things she set her mind on doing.
“I had to tell myself that I could do things and that everyone is special. I started at the Training Workshops Unlimited and worked on contracts. I worked a couple of shops in contract positions afterwards. I also participated in the Hygiene and Cleaning Learnership. I started believing in myself with every opportunity,” said Samantha.
In 2018, Samantha was selected for a German exchange programme when she came across and took interest in the “Easy-to-Read’’ programme. Upon her return, she worked with the Cape Mental Health to develop the “Easy-to-Read” programme which to date has resulted in a 500-word “Easy-to-Read” dictionary.
Another mental health care user who had become accustomed to demeaning labelling while growing up with an ID is Bongani*. Bongani turned 18 years old when he was doing grade 8 and therefore was the oldest person in his class. He was called names because he had a learning disability. “Some people call you by funny names, “mad, crazy, stupid” but they don’t know how these words can hurt you and even if you try to explain to them they will never understand,” he explained.
Bongani now goes around educating the public about ID. “People applaud me, I feel very proud because I have shown them that I am not a label,” he concluded.
Stories such as these show that when offered support and opportunities, persons with ID are able to rise above labels and become productive members of the society.
*Names have been changed to protect the identities of the interviewees.
We apologise for the inconvenience.
In March 2020, the South African government declared the outbreak of the COVID-19 disease as a national disaster, following in the steps of various countries around the world that have announced strict measures to contain the virus. According to public health officials, the coronavirus is highly contagious and has been spreading across the world at a fast rate. When South Africa announced the measures to curb the spread of the virus, the presidency announced that the country had seen an increase from 1 case to 51 cases in 10 days. Citizens have been advised to minimise social contact and to wash their hands regularly for 20 seconds at a time.
Some of the preventative measures in place announced by the president are:
● Closure of schools from 18 March 2020 until after the Easter holidays
● Suspending visits to correctional services for 30 days
● A ban on gatherings of more than 100 people, and cancelling of large government events
● A travel ban to high-risk destinations
● Mandatory testing and self-isolation or quarantine for South African citizens returning from high-risk countries
While these measures have been reassuring, it also means that the country is now officially in a national state of disaster in terms of the Disaster Management Act, which has caused panic among many citizens. Kumar, Math, Moirangthem & Nirmala (2015) state that developing countries have a high-risk level in terms of proneness to disasters, while also facing challenges related to insufficient resources, poverty, poor infrastructure, illiteracy, corruption, a lack of trained human resources and poor knowledge of managing mental health in disaster situations. The latter is important as disasters have been shown to have a profound effect on both the physical and mental health of the populations that are affected, with the World Health Organisation (WHO) (2020) stating that virtually all people affected by large-scale emergencies will experience psychological distress.
In the face of a global virus pandemic, the fear of contracting COVID-19 is thus now also impacting on the mental well-being of people, and social stigma attached to the coronavirus has started rearing its head (CIFRC, UNICEF & WHO, 2020). Social stigma related to health refers to the negative association between a person or group of people who share characteristics and a specific disease. During a situation such as the COVID-19 outbreak, this could lead to people being stereotyped and discriminated against, treated differently and a loss of status because of the perception of being linked to the illness. This can, in turn, affect those with the illness adversely, along with also impacting on their friends, families, communities and their caregivers. COVID-19 has brought about stigma and discrimination against certain groups of people, based on their ethnicities, along with prejudice against people who have supposedly been in contact with the virus (CIFRC, UNICEF & WHO, 2020).
Social stigma related to COVID-19 is based on three factors – 1) it is a new disease, which still has many unknowns, 2) people are often afraid of the unknown, and 3) fear is easily associated with “others” (CIFRC, UNICEF & WHO, 2020). While public confusion, fear and anxiety is understandable in these times, it is important to recognise that these factors are worsening harmful stereotypes. The reality is that stigma can undermine social cohesion and bring about the isolation of certain groups, leading to situations where the virus is more, not less, likely to spread, leading to more severe health problems and challenges in terms of controlling the disease (CIFRC, UNICEF & WHO, 2020).
• Push people to hide their illness to avoid facing discrimination
• Prevent people from seeking urgent health care
• Discourage them from adhering to health behaviours
A few useful do’s and don’t’s on how to communicate (CIFRC, UNICEF & WHO, 2020) to help address social stigma:
Don’t attach locations or ethnicities to the disease (it is not a “Chinese Virus” or an “Asian Virus”). The correct name was deliberately chosen to avoid stigma: the “co” stands for “Corona”, the “vi” for “virus” and “19” because it emerged in the year 2019. Instead, talk about the “Corona Virus” or “COVID-19”
Don’t refer to people with COVID-19 as “COVID-19 cases” or “victims”. Instead, talk about “people who have COVID-19”, “people who are being treated for COVID-19”, “people who are recovering from COVID-19” or “people who died after contracting COVID-19”
Don’t talk about “COVID-19 suspects” or “suspected cases”. Instead, talk about “people who may have COVID-19” or “people who are presumptive for COVID-19” Don’t talk about people “transmitting COVID-19”, “infecting others” or “spreading the virus” as this implies intentional transmission and assigns blame. The use of criminalising or dehumanising terms creates the impression that persons with COVID-19 have done something wrong or are less human than the rest of us. This perpetuates stigma, undermines empathy and has the potential to fuel a reluctance to seek treatment and attend screening, testing and adhering to quarantine. Instead, talk about people “acquiring” or “contracting” COVID-19
Don’t share unconfirmed rumours, and avoid hyperbolic terms that perpetuate fear, including “plague” and “apocalypse”. Instead, talk accurately about the risks related to COVID-19, based on scientific data and the latest official health information
Don’t dwell on negative issues, messages or threats. We all need to work together to help keep those who are most vulnerable safe. Instead, talk positively and emphasise the effectiveness of prevention and treatment measures because, for most people, this is a disease they will overcome. There are simple steps we can follow to keep ourselves, our families and vulnerable people safe
Continue to emphasise the effectiveness of sticking to protective measures to prevent acquiring COVID-19, along with early screening, testing and treatment
To help counter the stigma associated with COVID-19, people can 1) spread the facts through using simple terminology, not clinical terms, 2) engage social influencers to help amplify messages about curbing stigma, 3) promote the stories of people who have experienced COVID-19 and have recovered, 4) promote diversity and respect for different ethnicities by showing how all people are working together during this time, 5) encourage and engage in ethical journalism by reporting positively and not stigmatising people, and 6) linking up to existing anti-stigma efforts and promoting/creating an ethical environment based on care and empathy (CIFRC, UNICEF & WHO, 2020).
But why focus on stigma? And what (if any) is the link to mental health?
The SA Federation for Mental Health is particularly concerned about stigma and would like to highlight its impact on mental health and well-being. Stigma, as a major cause of discrimination and exclusion, affects people’s self-esteem, disrupts relationships and limits people’s ability to socialise and access housing and employment (WHO, 2020). It also obstructs the prevention of mental health problems, the promotion of mental well-being and the provision of effective modes of care and treatment. Stigma also contributes directly to human rights abuses. Recognising the need for mental well-being during this period of mass panic, WHO (2020) has developed guidelines for mental and psychological well-being of adults and children during the COVID-10 outbreak. Because the disease is likely to affect people from all walks of life, these considerations aim to assist people to cope, from ordinary members of the public to health care workers, as well as children and elderly persons In order to reduce anxiety.
In addition to what was listed earlier in terms of combatting stigma and discrimination, here is what members of the public can do to ensure their mental well-being and of people around them (WHO, 2020):
1. Protect yourself and be supportive to others. Assisting others in their time of need can benefit the person receiving support, as well as the helper.
2. Seek information updates at specific times during the day, once or twice. The sudden and near-constant stream of news reports about an outbreak can cause anyone to feel worried. Get the facts! Gather information at regular intervals, from the WHO website and local health authorities, in order to help you distinguish facts from rumours.
3. Honour caretakers and health care workers supporting people affected by the disease in your community. Acknowledge the role they play to save lives and keep your loved ones safe.
1. Avoid watching, reading or listening to news that cause you to feel anxious or distressed; seek information mainly to take practical steps to prepare your plans and protect yourself and loved ones.
Support for health professionals
According to a new study (Cheung et al, 2020) mental health care for patients and health professionals directly affected by the global COVID-19 epidemic has been under-addressed. Using data from mental health problems and interventions observed during the 2003 SARS outbreak as reference, the researchers state that health care workers in hospitals caring for people with confirmed or who may have COVID-19 are vulnerable to both high risk of infection and mental health problems. On Thursday the 19th of March 2020, the confirmed cases of COVID-19 in South Africa stood at 150 (News24, 2020), and locally health care workers may thus also be experiencing fear of contagion and transmitting the virus to their families, friends, or colleagues. It is also important to note that many NGOs will continue their work in caring for children, mental health care users and the elderly by managing residential and day care facilities. Social services caring for these groups can also benefit from WHO guidelines on caring for one’s mental health during this period.
For health workers, the WHO (2020) says feeling stressed is a normal experience that most will likely go through. Here are some considerations for those tasked with ensuring the well-being of people who are being treated for COVID-19:
1. Managing your stress and psychosocial well-being during this time is as important as managing your physical health.
2. Take care of your basic needs and employ helpful coping strategies. Make sure you rest and get respite during work or between shifts, eat sufficient and healthy food, engage in physical activity, and stay in contact with family and friends.
3. Some health care workers may, unfortunately, experience being avoided by their family or community due to stigma or fear. This can make an already challenging situation even more difficult. If possible, stay connected with your loved ones including through digital methods as a way to maintain contact.
4. Turn to your colleagues, your manager or other trusted persons for social support - your colleagues may be having similar experiences to you. 5. Use understandable ways to share messages with people with intellectual, cognitive and psychosocial disabilities.
1. Avoid using unhelpful coping strategies such as tobacco, alcohol or other drugs to cope. In the long term, these can worsen your mental and physical well-being.
Caring for children
The national state of disaster has also resulted in the prolonging school holidays. During periods such as these WHO (2020) notes that children feel relieved if they can express and communicate their feelings in a safe and supportive environment. Here is how to assist children:
1. Help children find positive ways to express disturbing feelings such as fear and sadness. Every child has their own way of expressing emotions. Sometimes engaging in a creative activity, such as playing and drawing, can facilitate this process.
2. Keep children close to their parents and family, if considered safe for the child. If a child needs to be separated from their primary caregiver, ensure that appropriate alternative care is available and that a social worker or equivalent will regularly follow up on the child’s situation.
3. In the event of separation, ensure that, during periods of separation, regular contact with parents and caregivers is maintained, such as twice-daily scheduled phone or video calls or other age-appropriate communication.
4. Maintain familiar routines in daily life as much as possible, especially if children are confined to home. Provide engaging, age-appropriate activities for children. As far as possible, encourage children to continue to play and socialise with others, even if only within the family, when advised to restrict social contract.
5. Discuss the COVID-19 with your children in an honest way and with age-appropriate information. If your children have concerns, addressing those together may ease their anxiety. Children will observe adults’ behaviours and emotions for cues on how to manage their own emotions during difficult times.
1. Avoid separating children and their caregivers as much as possible.
Elderly persons, especially in isolation and those with cognitive decline or dementia, may become more anxious, angry, stressed, agitated, and withdrawn during the outbreak or while in quarantine. Those who are caring for elderly persons should note the following:
1. Provide practical and emotional support through informal networks (families) and health professionals.
2. Share simple facts about what is going on and give clear information about how to reduce the risk of infection in words that they can understand. Repeat the information whenever necessary.
3. Instructions need to be communicated in a clear, concise, respectful and patient way. It may also be helpful for information to be displayed in writing or in pictures. Engage their family and other support networks in providing information and helping them practice prevention measures e.g. handwashing.
4. Encourage older adults with expertise, experiences and strengths to volunteer in community efforts to respond to the COVID-19 outbreak. For example, the healthy, retired, older population can provide peer support, neighbour checking, and childcare for medical personnel restricted in hospitals fighting against COVID-19.
In March 2020, South Africa (and much of the world) finds itself headfirst in frightening and uncertain territory. But while COVID-19 is placing pressure on and testing the resilience of individuals, communities, entire nations and continents, and ultimately that of the whole human race, it is also giving us the opportunity to show that, despite our perceived differences in terms of ethnicity, culture, class, social standings, income and educational levels, we are able to collectively stand together to fight the virus. Over the past few days we’ve seen unprecedented scenes of cross-political party cooperation and a sense of local and global unity in the face of COVID-19, with nations uniting, all in the name of survival.
But while so much of the focus is currently on washing our hands, coughing into our elbows and maintaining adequate social distance, the SA Federation for Mental Health would also like to remind people to be kind to their minds during this time and to take care of and support the mental and emotional needs of those around us.
Someone once said “If it were not for hopes, the heart would break”. Let us maintain hope, positivity and a fighting spirit during this time. So that we may prosper not only physically, but also mentally.
Cheung, T., H Ng, C., Li, W., Xiang, Y, T., Yang, Y., Zhang L., & Zhang Q. (2020). Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet (7), 228-229.
CIFRC, UNICEF & World Health Organisation (2020). Social stigma associated with COVID-19. Retrieved from https://www.epi-win.com/sites/epiwin/files/content/attachments/2020-02-24/COVID19%20Stigma%20Guide%2024022020_1.pdf
Kumar, N. C., Math, S. B., Moirangthem, S., & Nirmala, M. C. (2015). Disaster management: Mental health perspective. Indian Journal of Psychological Medicine, 37 (3), 261-271.
News24 (2020). Coronavirus: There is no negotiation, says Cele and cases jump to 150. Accessed at https://www.news24.com/SouthAfrica/News/coronavirus-all-the-latest-news-about-covid-19-in-south-africa-and-the-world-20200312
The Presidency (2020). The Statement by President Cyril Ramaphosa on measures to combat COVID-19 epidemic. Accessed at http://www.thepresidency.gov.za/press-statements/statement-president-cyril-ramaphosa- measures-combat-covid-19-epidemic
World Health Organisation (2020). Mental health and psychosocial considerations during COVID-19 outbreak.Retrieved from https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf
World Health Organisation (2020). Mental health in emergencies. Accessed at https://www.who.int/news-room/fact-sheets/detail/mental-health-in-emergencies
World Health Organisation (2020). Stigma and discrimination. Accessed at http://www.euro.who.int/en/health-topics/noncommunicable-diseases/mental-health/priority-areas/stigma-and-discrimination
Project Leader – Info & Awareness
011 781 1852
Please note that, until further notice, SAFMH will only be available for phone interviews and email enquiries.