One of the first studies to look at the association between intake of sugar-sweetened beverages, artificially sweetened beverages, and incidence of liver cancer and chronic liver disease mortality, has found an 85% increase in liver cancer incidence between postmenopausal women who consume one sweetened drink per day and those who consume them rarely. Results from the study, which was led by Brigham and Women’s Hospital, are published in JAMA.
“To our knowledge, this is the first study to report an association between sugar sweetened beverage intake and chronic liver disease mortality,” said first author Longgang Zhao, PhD, of the Brigham’s Channing Division of Network Medicine. Zhao is a postdoctoral researcher who works with senior author Xuehong Zhang, MBBS, ScD, in the Channing Division. “Our findings, if confirmed, may pave the way to a public health strategy to reduce risk of liver disease based on data from a large and geographically diverse cohort.”
This observational study included nearly 100 000 postmenopausal women from the large, prospective Women’s Health Initiative study. Participants reported their usual soft drink, fruit drink (not including fruit juice) consumption, and then reported artificially sweetened beverage consumption after three years. Participants were followed for a median of more than 20 years. Researchers looked at self-reported liver cancer incidence and death due to chronic liver disease such as fibrosis, cirrhosis, or chronic hepatitis, which were further verified by medical records or the National Death Index.
A total of 98 786 postmenopausal women were included in the final analyses. The 6.8% of women who consumed one or more sugar-sweetened beverages daily had an 85% higher risk of liver cancer and 68% higher risk of chronic liver disease mortality compared to those who had fewer than three sugar sweetened beverages per month. No such increase was observed for consumption of artificially-sweetened beverages.
The authors note that the study was observational, and causality cannot be inferred, and relied on self-reported responses about intake, sugar content and outcomes. More studies are needed to validate this risk association and determine why the sugary drinks appeared to increase risk of liver cancer and disease. Furthermore, more research is needed to elucidate the potential mechanisms by integrating genetics, preclinical and experimental studies, and -omics data.
People who take proton pump inhibitors for acid reflux four-and-a-half years or more may have a higher risk of dementia compared to people who do not take these medications, according to new research published in Neurology.
Acid reflux is when stomach acid flows into the oesophagus, usually after a meal or when lying down, resulting in heartburn and ulcers. People with frequent acid reflux may develop gastroesophageal reflux disease, or GERD, which can lead to cancer of the oesophagus. Proton pump inhibitors reduce stomach acid by targeting the enzymes in the stomach lining that produce that acid.
“Proton pump inhibitors are a useful tool to help control acid reflux, however long-term use has been linked in previous studies to a higher risk of stroke, bone fractures and chronic kidney disease,” said study author Kamakshi Lakshminarayan, MBBS, PhD, of the University of Minnesota School of Public Health in Minneapolis, and a member of the American Academy of Neurology. “Still, some people take these drugs regularly, so we examined if they are linked to a higher risk of dementia. While we did not find a link with short-term use, we did find a higher risk of dementia associated with long-term use of these drugs.”
The study included 5712 people, aged 45 and up, without dementia at the start of the study. They had an average age of 75.
Researchers determined if participants took acid reflux drugs by reviewing their medications during study visits and during yearly phone calls. Of the participants, 1490 people, or 26%, had taken the drugs. Participants were then divided into four groups based on whether they had taken the drugs and for how long, as follows: people who did not take the drugs; those who took the drugs for up to 2.8 years; those who took them for 2.8 to 4.4 years; and people who took them for more than 4.4 years.
Participants were then followed for a median duration of 5.5 years. During this time, 585 people, or 10%, developed dementia.
Of the 4222 people who did not take the drugs, 415 people developed dementia, or 19 cases per 1000 person-years. Person-years represent both the number of people in the study and the amount of time each person spends in the study. Of the 497 people who took the drugs for more than 4.4 years, 58 people developed dementia, or 24 cases per 1000 person-years.
After adjusting for factors such as age, sex and race, as well as health-related factors such as high blood pressure and diabetes, researchers found people who had been taking acid reflux drugs for more than 4.4 years had a 33% higher risk of developing dementia than people who never took the drugs.
Researchers did not find a higher risk of dementia for people who took the drugs for fewer than 4.4 years.
“More research is needed to confirm our findings and explore reasons for the possible link between long-term proton pump inhibitor use and a higher risk of dementia,” said Lakshminarayan. “While there are various ways to treat acid reflux, such as taking antacids, maintaining a healthy weight, and avoiding late meals and certain foods, different approaches may not work for everyone. It is important that people taking these medications speak with their doctor before making any changes, to discuss the best treatment for them, and because stopping these drugs abruptly may result in worse symptoms.”
A limitation of the study was that participants were asked once a year about medication use, so researchers estimated use between annual check-ins. If participants stopped and restarted acid reflux drugs in between check-ins, estimation of their use may have been inaccurate. The authors were also unable to assess if participants took over the counter acid reflux drugs.
Microplastics seem ubiquitous in today’s environment, being found everywhere from rivers to inside the stomach. Now, in a pilot study of patients who underwent heart surgery, researchers in ACS’ Environmental Science & Technology report that they have found microplastics in many heart tissues. They also report evidence suggesting that microplastics were unexpectedly introduced during the procedures.
Microplastics are plastic fragments less than 5mm wide, or about the size of a pencil eraser. Research has shown that they can enter the human body through the mouth, nose and other body cavities with connections to the outside world. Yet many organs and tissues are fully enclosed inside a person’s body, and scientists lack information on their potential exposure to, and effects from, microplastics. So, Kun Hua, Xiubin Yang and colleagues wanted to investigate whether these particles have entered people’s cardiovascular systems through indirect and direct exposures.
In a pilot experiment, the researchers collected heart tissue samples from 15 people during cardiac surgeries, as well as pre- and post-operation blood specimens from half of the participants. Then the team analysed the samples with laser direct infrared imaging and identified 20 to 500 micrometre-wide particles made from eight types of plastic, including polyethylene terephthalate, polyvinyl chloride and poly(methyl methacrylate). This technique detected tens to thousands of individual microplastic pieces in most tissue samples, though the amounts and materials varied between participants. The blood samples also all contained plastic particles, but after surgery their average size decreased, and the particles came from a wider range of plastics.
Although the study had a small number of participants, the researchers say they have provided preliminary evidence that various microplastics can accumulate and persist in the heart and its innermost tissues. They add that the findings show how invasive medical procedures are an overlooked route of microplastics exposure, providing direct access to the bloodstream and internal tissues. More studies are needed to fully understand the effects of microplastics on a person’s cardiovascular system and their prognosis after heart surgery, the researchers conclude.
Altered gait is common in patients with Parkinson’s disease (PD), and the usefulness of treatments is limited. Researchers in Japan have developed a novel transcranial stimulation method using external electrodes, the team demonstrated significant gait improvements in PD patients. The results, which also showed improvements for other neurological disorders, are published in the Journal of Neurology, Neurosurgery & Psychiatry.
Motor function declines characterises PD, particularly in relation to gait disorders, manifesting as decreased step length, reduced arm swing, slow movements, rigidity, and postural instability, which are prevalent among patients with PD. While non-pharmacological approaches like transcranial direct current stimulation show promise in improving motor function, recent research focuses on gait-combined closed-loop stimulation, which synchronises brain stimulation with the individual’s gait rhythm. proposes a novel intervention for gait improvement, thus creating new hope for patients with PD.
“We recently developed a novel neuromodulation approach using gait-combined closed-loop transcranial electrical stimulation (tES) and demonstrated promising gait improvements in patients who are post-stroke. Here, we tested the efficacy of this intervention in patients with Parkinsonian gait disturbances,” explains lead author Ippei Nojima from Shinshu University and Nagoya City University, Japan.
To this end, the clinical researchers from Japan recruited 23 patients with PD or Parkinson’s syndrome. All study participants were randomly assigned to receive either the active treatment or sham treatment.
During the course of the trial, a low-current electrode (up to 2mA) was externally affixed to the occipital region of the head. A reference electrode was then placed in the neck region to establish a stable electrical reference point and to complete the electrical circuit. The treatment included performing tES on the cerebellum in a non-invasive manner. The brain side showing severe impact was specifically targeted during the electrotherapy.
“Gait disturbance lowers activities of daily living in patients with PD and related disorders. However, the effectiveness of pharmacological, surgical, and rehabilitative treatments is limited. Our novel intervention might be able to improve physical function for not just patients with PD but also for those with other disabilities,” comments senior author Yoshino Ueki from the Department of Rehabilitation Medicine at Nagoya City University.
The cerebellum plays a key role in gate control, so electrical stimulation of this region is likely to exert therapeutic benefits. The therapy showed encouraging results after just ten repetitions. The treatment group showed a significant improvement in gait parameters including speed, gait symmetry, and stride length.
Professor Nojima said, “These findings showed that gait-combined closed-loop tES over the cerebellum improved Parkinsonian gait disturbances, possibly through the modulation of brain networks generating gait rhythms.”
Interestingly, no patient dropped out during the study. Moreover, patients from both the groups (treatment and sham) showed good and comparable compliance. Side effects such as skin irritation, vertigo, or odd sensations/perceptions were also not observed in any of the volunteering patients. This study has special significance, considering the fact that Japan is witnessing a sharp rise in its elderly population.
Contrary to previous belief, fewer numbers of daily steps are necessary for health benefits to appear, according to the largest analysis to investigate this. The study, published in theEuropean Journal of Preventive Cardiology, found that walking at least 3967 steps a day started to reduce the risk of dying from any cause, and 2337 steps a day reduced the risk of dying from cardiovascular disease.
The new analysis included 226 889 people from 17 different studies around the world. It showed that the risk of dying from any cause or from cardiovascular disease decreases significantly with every 500 to 1000 extra steps you walk. An increase of 1000 steps a day was associated with a 15% reduction in the risk of dying from any cause, and an increase of 500 steps a day was associated with a 7% reduction in dying from cardiovascular disease.
The researchers, led by Maciej Banach, Professor of Cardiology at the Medical University of Lodz, Poland, and Adjunct Professor at the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, found that even if people walked as many as 20 000 steps a day, the health benefits continued to increase, with no upper limit found yet.
“Our study confirms that the more you walk, the better,” says Prof Banach. “We found that this applied to both men and women, irrespective of age, and irrespective of whether you live in a temperate, sub-tropical or sub-polar region of the world, or a region with a mixture of climates. In addition, our analysis indicates that as little as 4000 steps a day are needed to significantly reduce deaths from any cause, and even fewer to reduce deaths from cardiovascular disease.”
According to World Health Organization data, insufficient physical activity is the fourth most frequent cause of death in the world, with 3.2 million deaths a year related to physical inactivity. The COVID-19 pandemic also resulted in a reduction in physical activity, and activity levels have not recovered two years on from it.
Dr Ibadete Bytyçi from the University Clinical Centre of Kosovo, Pristina, Kosovo, senior author of the paper, says: “Until now, it’s not been clear what is the optimal number of steps, both in terms of the cut-off points over which we can start to see health benefits, and the upper limit, if any, and the role this plays in people’s health. However, I should emphasise that there were limited data available on step counts up to 20 000 a day, and so these results need to be confirmed in larger groups of people.”
This meta-analysis is the first not only to assess the effect of walking up to 20 000 steps a day, but also to look at whether there are any differences depending on age, sex or where in the world people live.
The studies analysed by the researchers followed up participants for a median (average) of seven years. The mean (average) age was 64, and 49% of participants were female.
In people aged 60 years or older, the size of the reduction in risk of death was smaller than that seen in people aged younger than 60 years. In the older adults, there was a 42% reduction in risk seen in those who walked 6000–10 000 steps a day, while there was a 49% reduction in risk in younger adults who walked 7000–13 000 steps a day.
Prof Banach says: “In a world where we have more and more advanced drugs to target specific conditions such as cardiovascular disease, I believe we should always emphasise that lifestyle changes, including diet and exercise, which was a main hero of our analysis, might be at least as, or even more effective in reducing cardiovascular risk and prolonging lives. We still need good studies to investigate whether these benefits may exist for intensive types of exertion, such as marathon running and iron man challenges, and in different populations of different ages, and with different associated health problems. However, it seems that, as with pharmacological treatments, we should always think about personalising lifestyle changes.”
Strengths of the meta-analysis include its size and that it was not restricted to looking at studies limited to a maximum of 16 000 steps a day. Limitations include the observational nature of the study. The impact of step counts was not tested on people with different diseases; all the participants were generally healthy when they entered the studies analysed. The researchers were not able to account for differences in race and socioeconomic status, and the methods for counting steps were not identical in all the studies included in this meta-analysis.
Artificial sweeteners have once again returned to the headlines with the WHO listing them as a possible carcinogen, Now, a long-term study on artificial sweeteners in diets published in the International Journal of Obesity has shown that, ironically, nearly all of them are linked to increased adiposity.
In the two decade long study, University of Minnesota researchers examined people’s regular dietary intake, with a focus on non-nutritive sweeteners commonly found in artificial sweeteners. They found that long-term consumption of aspartame, saccharin and diet beverages were linked to increased abdominal and intramuscular adiposity. However, the study found no significant association between the artificial sweetener sucralose and these measures of fat volume.
“This study showed that habitual, long-term intake of total and individual artificial sweetener intakes are related to greater volumes of adipose tissue, commonly known as body fat,” said Brian Steffen, PhD, MSCR, a professor in the Department of Surgery at the U of M Medical School and co-investigator on the funded grant. “This was found even after accounting for other factors, including how much a person eats or the quality of one’s diet.”
The study’s findings raise concerns about the recommendations from the American Diabetes Association and the American Heart Association that promote the replacement of added sugars with artificial sweeteners. Based on their results, the researchers recommend considering alternative approaches, as long-term artificial sweetener consumption may have potential health consequences.
“This is an especially timely study, given the World Health Organization’s recent warning of the potential health risks of aspartame,” said Lyn Steffen, PhD, MPH, a professor in the School of Public Health and principal investigator on the study. “These findings underscore the importance of finding alternatives to artificial sweeteners in foods and beverages, especially since these added sweeteners may have negative health consequences.”
The researchers say that more studies are needed to better understand the connection between artificial sweetener intake and increased body fat. Further research is warranted to explore the underlying mechanisms and gain clearer insights into how dietary habits affect metabolic health.
In the recent judgement handed down by the Pretoria High Court in favour of Board of Health Funders (BHF), the Council for Medical Schemes (CMS), Registrar of Medical Schemes and the Minister of Health were ordered to deliver a complete record, which will shed light on the moratorium on granting exemptions to medical schemes to provide LCBO benefits. The order directed the CMS and the Minister of Health to deliver all documents or information requested under Rule 30A within 10 days of the order, but all the respondents failed to meet the deadline.
After the ten-day deadline had passed and noting that the documents were still not produced and there was no appeal to the court order, the BHF was forced to return to court to seek answers. The BHF filed a contempt of court order on an urgent basis. In this application, the BHF highlighted that no complete record had been submitted even though the deadline for the Minister of Health and CMS to do so was on 24 July 2023. In response, the CMS and the Minister of Health opposed the contempt of court action and appealed the rule 30A judgement delivered on 10 July 2023. The Minister of Health, acting through his attorneys, allowed his own team to submit certain documents in terms of rule 30A, and the attorneys have stated that the delivery of the documents demonstrates good faith. This is despite the appealing of the judgement and order delivered in the rule 30A application.
The legal battle against the CMS and Minister of Health not only highlights their failure to comply with the court’s order, but also raises concerns about transparency and accountability within the healthcare system. This delay not only hampers the progress towards implementing affordable healthcare solutions, but also undermines public trust in the decision-making process of these regulatory bodies. This lack of adherence to court orders highlights the urgent need for effective enforcement mechanisms to ensure that court decisions are respected and implemented by the relevant parties.
In a media briefing on Tuesday, 8th August, the Council for Medical Schemes (CMS) sought to clarify its process and recommendations over the approved 5% increase to medical aid scheme contributions, levels above which the medical schemes must motivate for. As for low-cost benefit options (LCBO), the CMS indicated that they would only provide a report to the Health Minister by the end of the month. This could prevent medical schemes from applying for new LCBOs in 2023.
Mr Mondi Govuzela, Senior Manager of Benefits Management, explained that the 5% approved increase is based on the Consumer Price Index (CPI) for 2022, which indicated a 4.9% increase. Schemes therefore may raise contributions by 5%, in line with the Reserve Bank’s inflation prediction for 2024. A prudent percentage markup should be incorporated to take into account cost increases and demographic changes, he advised. Before COVID, contribution increases have typically been 2.4–5% above CPI. The years 2020 to 2022 saw contribution increases dip below CPI.
One of the cost drivers that Mr Govuzela noted in the media briefing was supplier pressure stemming from fewer doctors and specialists, who were pushing for higher remunerations. Increased costs elsewhere in the healthcare industry. On the member side, growing rates of chronic diseases, membership ageing and coverage for medical services also added pressure.
LCBO would appear to be a solution for many individuals to access private healthcare for at least some urgent conditions, but the CMS has yet to comply with a Pretoria High Court ruling ordering that they provide a report on their moratorium on granting exemptions to medical schemes to provide LCBO benefits. The case was brought by the Board of Health Funders (BHF).
As to what the CMS’s response to the LCBO ruling was, CMS Registrar Dr Sipho Kabane said that the CMS was preparing a report that would be delivered to the Health Minister “by the end of the month”, but would not be drawn on what it might say. The deadline for registering new benefit options is September 1.
In their circular explaining the decision increase, the CMS acknowledged the persistent macroeconomic headwinds facing medical schemes and their members, with a meagre 1% increase predicted for SA’s GDP next year. “Against the backdrop of the current adverse macroeconomic conditions characterised by multi-year higher interest rates due to stubbornly higher inflation rate, volatile domestic currency and surging energy prices and overall lacklustre economic growth, it is evident that most household budgets will remain constrained for a foreseeable future, leaving most consumers under a precarious financial position. To cushion members of medical schemes against further financial distress and the probable risk of losing their health insurance cover due to affordability constraints, medical schemes are advised to limit their cost increase assumptions for contribution increases for the 2024 benefit year to 5.0%, in line with CPI.”
Acinetobacter baumannii is a notorious hospital pathogen, and there is great pressure to devise novel therapeutic approaches to combat this growing threat. German researchers have now detected an unexpectedly wide diversity of certain cell appendages known as pili in A. baumannii that are associated with pathogenicity. This finding, published in PLOS Genetics, could lead to treatment strategies that are specifically tailored to a particular pathogen.
Each year, over 670 000 people in Europe fall ill because of antibiotic-resistant pathogens, and 33 000 die from the infections. Especially feared are pathogens with resistances against multiple, or even all, known antibiotics. One of these is the bacterium Acinetobacter baumannii, feared today above all as the “hospital superbug”: According to estimates, up to five percent of all hospital-acquired and one tenth of all bacterial infections resulting in death can be attributed to this pathogen alone. This puts A. baumannii right at the top of WHO’s list of pathogens for which there is an urgent need to develop new therapies.
Understanding which characteristics make A. baumannii a pathogen is one of the prerequisites for this. To this end, bioinformaticians led by Professor Ingo Ebersberger of Goethe University Frankfurt and the LOEWE Center for Translational Biodiversity Genomics (LOEWE-TBG) are comparing the genomes and the proteins encoded therein across a wide range of different Acinetobacter strains. Conclusions about which genes contribute to pathogenicity can be drawn above all from the differences between dangerous and harmless strains.
Due to a lack of suitable methods, corresponding studies have so far concentrated on whether a gene is present in a bacterial strain or not. However, this neglects the fact that bacteria can acquire new characteristics by modifying existing genes and thus also the proteins encoded by them. That is why Ebersberger’s team has developed a bioinformatics method to track the modification of proteins along an evolutionary lineage and has now applied this method for the first time to Acinetobacter in collaboration with microbiologists from the Institute for Molecular Biosciences and the Institute of Medical Microbiology and Infection Control at Goethe University Frankfurt.
In the process, the researchers concentrated on hair-like cell appendages, known as type IVa (T4A) pili, which are prevalent in bacteria and that they use to interact with their environment. The fact that they are present in harmless bacteria on the one hand and have even been identified as a key factor for the virulence of some pathogens on the other suggests that the T4A pili have repeatedly acquired new characteristics associated with pathogenicity during evolution.
The research team could show that the protein ComC, which sits on the tip of the T4A pili and is essential for their function, shows conspicuous changes within the group of pathogenic Acinetobacter strains. Even different strains of A. baumannii have different variants of this protein. This leads bioinformatician Ebersberger to compare the T4A pili to a multifunctional garden tool, where the handle is always the same, but the attachments are interchangeable. “In this way, drastic functional modifications can be achieved over short evolutionary time spans,” Ebersberger is convinced. “We assume that bacterial strains that differ in terms of their T4A pili also interact differently with their environment. This might determine, for example, in which corner of the human body the pathogen settles.”
The aim is to use this knowledge of the unexpectedly high diversity within the pathogen to improve the treatment of A. baumannii infections, as Ebersberger explains: “Building on our results, it might be possible to develop personalised therapies that are tailored to a specific strain of the pathogen.” However, the study by Ebersberger and his colleagues also reveals something else: Previous studies on the comparative genomics of A. baumannii have presumably only unveiled the tip of the iceberg. “Our approach has gone a long way towards resolving the search for possible components that characterize pathogens,” says Ebersberger.
Before being diagnosed with bipolar disorder Type 1, Sifiso Mkhasibe says he was often labelled as the “black sheep” of the family and he did not know where to go for help. He was often dismissed as crazy and told that this is a white man’s illness.
“My immediate family did not know how to help or support me,” he says. “I was always labelled the black sheep of my family. I was told that I was crazy, bewitched and that I was just pretending to be sick. I was told to be strong and to get over myself and that this disease is a white man’s illness and black people do not have such things.”
Mkhasibe says his family thought it was a cultural thing and that he had an ancestral calling to become a traditional healer. He did not agree.
The South African Federation of Mental Health (SAFMH) defines stigma as “an attribute, quality, or condition that severely restricts or diminishes a person’s sense of self, damaging their self-worth, social connections, and sense of belonging”.
The challenge of getting help
“It was extremely challenging to get help and support from my family. They played a big role in stigmatising me,” Mkhasibe tells Spotlight.
A delay in accessing mental healthcare services led to Mkhasibe’s condition deteriorating. He says some of his symptoms were racing thoughts, impulsive spending, hearing voices, and insomnia. “I was always high on life with extreme energy levels. Things became worse, whereby I became violent and aggressive. I was eventually admitted to Chris Hani Baragwanath Hospital in 2007 and later transferred to Sterkfontein Psychiatric Hospital in Krugersdorp.”
“I was never informed about my diagnosis. What it was and how to manage it. I had no idea what to do when I was diagnosed. The challenge was that I was not educated about my mental illness,” he says.
Mkhasibe says he was in Sterkfontein Hospital until 2011. By then, he was estranged from his family and moved around a lot staying with cousins, aunts, and his late grandmother.
“I was at Sterkfontein for four years. My family did not want me back home. I moved from one ward to the other during that time. Now I’m close to my sister and mother again but it took a while to mend those bridges.”
He says his experience with the illness prompted him in 2011 after he was discharged from hospital, to start volunteering and creating awareness on mental health conditions. Mkhasibe is now 39 years old and was until recently a project leader for mental health at the SAFMH. He started at the organisation in 2017. On leaving the organisation, he says he has learned a lot but now has a newborn son and wants to spend time with him. Mkhasibe describes himself as a family man. He is married and has two children.
Stigma and seeking care
Ashleigh Craig, a clinical psychologist who runs a Johannesburg-based private practice and has also worked in the public sector, says beliefs around mental health contribute to stigma because there are negative connotations surrounding mental illness.
“People seeking care are often called names such as bewitched or crazy. This prevents people from seeking out care,” says Craig. “This results in people seeking care when their condition is acute and recovery will take much longer. Stigma can often lead to people completely stopping to take treatment.”
Claire Hart, a post-doctoral fellow at Wits University’s Developmental Pathways for Health Research Unit (DPHRU), says the label of any mental illness is often also associated with a mark of social disgrace or stigma. This has been shown in South African communities, where studies revealed high levels of stigmatisation towards individuals with mental disorders. The label of having a “mental illness” is socially stigmatised and constitutes negative external perceptions, which may, in turn, be internalised and negatively impact an individual’s internal sense of self.
“As a result, these individuals may avoid using existing mental health care services in fear of being labelled even when experiencing severe psychological distress. Thus, both having a mental illness and seeking help may be viewed as undesirable,” says Hart.
Under-funded, under-resourced
Hart says fighting stigma requires a two-fold approach that involves education and providing adequate resources. “People with a lived experience can help in terms of fighting mental health stigma and raising awareness. However, mental health is underfunded and there is a shortage of psychologists in the country. To become a registered psychologist, you need a Masters degree and most universities only take six to 12 Masters candidates per year,” says Hart.
Craig says people in the public sector can wait up to four months just to see a psychologist. She says private psychologists are very expensive and in the public sector most mental health services are only available at tertiary hospitals.
According to South Africa’s new National Mental Health Policy Framework and Strategic Plan 2023 – 2030 (the mental health framework,) the country has less than one psychologist for every 100 000 people. This is among the reasons why there are limited mental health services in the public health sector, especially in rural areas.
“At present, mental healthcare in rural areas, preventive and promotive aspects of mental health, and the provision of services to children, adolescents and those with anxiety, mood, and other non-psychotic disorders remain under-resourced and underdeveloped. Furthermore, primary healthcare workers are under considerable strain due to high caseloads and have minimal training in mental health, resulting in patients receiving inadequate mental health care,” says Hart.
The social and economic costs
Data in the mental health framework indicates that about 5% of the total public health budget was allocated to public mental health expenditure in 2016/2017. Provincial public health budget allocations towards mental health showed marked inequality, ranging from 2.1 to 7.7% across provinces.
According to the mental health framework, social costs of mental illness can include disrupted families and social networks, stigma, discrimination, loss of future opportunities, marginalisation, and decreased quality of life.
Mental illnesses such as depression and anxiety have been estimated to cost the economy more than R61.2 billion in lost earnings, according to the mental health framework. It states that at a societal level, lost income associated with mental illness far exceeds public sector expenditure on mental health care. In other words, it costs South Africa more to not treat mental illness than to treat it.
What to do?
Although the mental health framework goes to great lengths to stress the impact of stigma on mental health, its plans to address this are relatively low in detail. According to the framework, all health staff working in health settings will receive basic mental health training, inclusive of anti-stigma training, and ongoing routine supervision and mentoring. Provincial departments of health are meant to look at expanding their mental health workforce.
The framework also sets out to strengthen mental health promotion, prevention and advocacy. “Currently, however, no concerted national programme exists,” the framework states. “In 2024, a national public education programme for mental health will be established, including knowledge of mental health and illness; stigma and discrimination against people with lived experience of mental illness.” This, according to the policy framework, will be steered by the national health department and provincial health departments. Other relevant government departments, including Employment and Labour, Education, and Social Development will, among others, introduce mental health literacy programmes into curriculums or workplace policies and decrease stigma.
But according to Michel’le Donnelly, a project leader for advocacy and awareness at the SAFMH, there is no clear outline for any anti-stigma programming in the mental health policy framework. “As the SAFMH we hold the view that the South African government needs to actively ensure that there is sufficient funding targeted for anti-stigma programming. Monitoring, evaluation, and implementation of these programmes should be done in collaboration with people with lived experience of mental health conditions and NGOs working in the sector. These programmes should include contact-based education as part of governments intended activities because, through evidence and research, this has proven to be a way of ending stigma.”
Mkhasibe agrees that we need more support to make people aware of mental health services and how to fight stigma. ”We need more community engagement in terms of mental health education and awareness. People all over South Africa need to know that mental health is more prevalent than we think. Businesses and organisations need to instil mental health training as a culture in the office,” he says.
“Schools, colleges, and universities should make mental health a priority within education. Awareness campaigns should be done at churches, malls, taxi ranks, airports, and bus stations. Basically, everywhere where people gather,” he says.
