In June this year the Department of Health launched its new National Strategic Plan for the prevention and control of non-communicable diseases [2022-2027]. We were delighted to see mental health firmly embedded within the plan, receiving the much-needed focus it deserves within the wider non-communicable disease [NCD] discussion.
To ensure that mental health found its rightful place in the South African NCD space, the Department made the proactive move to update the previously-utilised “4 x 4” approach from the Global NCD Action Plan [focusing on cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers], to a new “5 x 5” approach, which now also includes mental health as the fifth priority.
So why are we so thrilled to see mental health becoming a permanent fixture of the NCD landscape in South Africa? For starters, mental health, as a core component of overall health and a field that is highly relevant to the preservation of human rights, is chronically neglected in SA in terms of investment and policy implementation. Furthermore, the Mental Health Innovation Network states that “mental health conditions are one of the major groups of NCDs with crucial relevance in efforts to control and prevent NCDs. Mental health also has links to cancer, diabetes, cardiovascular and respiratory diseases and other NCDs. By considering mental ill health and other NCDs together, we can improve the lives of people affected by NCDs worldwide…”. Benjet et al [2019] tells us that “mental health and wellbeing are central to reducing the global burden of NCDs” while also stating that “risk factors for NCDs such as tobacco use, unhealthy diet, physical inactivity, and harmful alcohol use commonly cluster in people with mental disorders”.
The Mental Health Innovation Network explain that mental health conditions are often caused by an interplay of biological, environmental and social factors related to where people live, along with their exposure to certain risk factors. Many modifiable factors [e.g. diet, exercise, and use of alcohol and drugs] that increase the likelihood of someone being affected by a serious NCD [e.g. diabetes or cardiovascular disease] also impact their mental health . Additionally, mental health conditions often occur together with other NCDs. This means persons with chronic physical conditions have higher rates of mental health conditions, especially depression and anxiety and vice versa. The reality is that physical health outcomes are also worse if people have mental health conditions, which may lead to a drastically reduced lifespan. At the same time, mental health outcomes tend to be worse for people who have comorbid, chronic conditions like other NCDs.
So the case for mental health being included is solid, and we applaud government for taking this on board during the drafting of the NCD plan. However… as elated as we are with mental health being included in the NCD plan, there are a few issues that need to be considered:
- As it stands, the South African Mental Health Policy Framework and Strategic Action Plan 2013-2020 [MHPF&SA] has lapsed, with no apparent sense of urgency from the Department of Health to review, update or launch a new policy. With mental health now also being included in government’s NCD plan, while the mental health sector waits for a new stand-alone policy with bated breath, we are concerned that mental health might eventually fall through the cracks and/or become diluted. As much as mental health should be a key part of the NCD conversation, it also requires its own stand-alone policy, complemented by resources and clear implementation strategies to guarantee that policy objectives may translate into reality
- Because South Africa generally has a poor track record of policy implementation, we naturally have concerns about whether and/or how the NCD plan will be implemented effectively. If the MHPF&SA taught us anything, it was that South Africa is really good at writing policy, but very poor at implementing it. We wouldn’t want to see the NCP plan suffer the same fate as the MHPF&SA
- As was the case with the MHPF&SA, the NCD plan is firmly grounded in a respect for human rights as one of its guiding principles. However, the Life Esidimeni tragedy taught us that merely stating a commitment to human rights means nothing when those implementing policies do not take this commitment to heart. If the NCD plan is to be truly grounded in a respect for human rights, we would like to see this in the practices of those turning the paper-based policy objectives into real-world outcomes while working to bring about meaningful change for persons affected by NCDs
We wish to congratulate government and the NCD Alliance on all their hard work in terms of drafting the NCD plan. But now it’s time to knuckle down and turn policy into practice. And we look forward to playing our part in this journey.
By Leon de Beer – Deputy Director, SA Federation for Mental Health
