The President of Chile and the WHO Director-General launch Global Commission to Tackle the Causes behind the Causes of ill-health
Today, the President of the Republic of Chile, His Excellency Mr Ricardo Lagos Escobar and World Health Organization Director-General, Dr LEE Jong-wook launched the Commission on Social Determinants of Health, a new body to spearhead action on the social causes behind ill-health.
The sudden move by medical aid schemes to deny chronic medication benefits for various mental illnesses has been condemned as the biggest disaster to hit psychiatric care in South Africa in the last 10 years. The arbitrary and unilateral move, which could endanger the lives of thousands of sufferers across the country, has drawn widespread criticism from leading groups involved in mental healthcare including the SA Depression and Anxiety Group (SADAG) and the healthcare consumer watchdog, Rights Education and Activism for Consumer Healthcare (REACH). People suffering from (BMD, previously known as manic depression) and depression are particularly at risk, says Zane Wilson, founder of SADAG. Sufferers of bipolar mood disorder ( BMD) and depression can and do function as productive contributors to the economy and highly capable members of society at large. But this is only possible with continued proper medication and monitoring. Otherwise they risk regression with resultant personal setbacks and even hospitalisation, but more dire consequences including suicide and even violent attacks says,Wilson. Outraged patients, many of them successful business leaders and heads of families and whose conditions have stabilised under consistent treatment, have inundated SADAG and REACH with complaints. The decision of the Council for Medical Schemes is based on the lack of published guidelines for the treatment of BMD and lack of registeration gfor most of the medications used. This does not take into account the thousands of patients who are stabilised on current medication, says Khan., the REACH national co-ordinator. It is understandable that treatment guidelines need to be structured on solid evidence-based data. One needs to take into account that, even though certain medications might not be registered in SA, they are however registered abroad. The consequences of the slow registration process for medicines in SA are being borne by patients here. Although BMD has been included in the list of so-called '25 prescribed minimum benefits (PMB)' conditions for chronic medication, individual schemes are refusing to cover costs on the grounds that no treatment protocol exists for BMD. REACH approached the Council of Medical Schemes to assist in drawing up guidelines regarding mental healthcare benefits, only to told that their inputs were not neeed. In a bizarre twist, these illnesses, including BMD, are still recognised as chronic diseases - just not funded any more. Medical schemes are not legally bound to reimburse patients for medications for BMD. There should be very specific guidelines underpinning the lack of a protocol for the treatment of BMD. For example, patients stabilised for a specific period of time should be reimbursed by their medical scheme. Depression is acknowledged as the world's second biggest cause of adult deaths, and BMD causes violent mood swings, ranging from feelings of BMD sufferers may fall into a manic state resulting in extreme violence and even homicide if their condition is untreated. this creates a set back on important advances in bringing mental illness out of the closet for example in addressing the crisis of the growing number of teen suicides and a successful nationwide focus on the mental health issues on 10 October - World Mental Health Day. Hostile environment alienates sufferers In addition to the spectre of having to spend hours in queues at state hospitals, thousands of people on chronic medication now have to thread their way through a veritable labyrinth of different interpretations, conditions and sub-conditions and a host of products within individual medical schemes. We will pursue every means available to get them to reconsider, say Wilson and Kahn. – ( Source: SAPA 27 October 2003).
Healthcare facilities are now free for people with disabilities. According to a statement released by the health ministry on Tuesday, the move forms part of the government's efforts to expand services to people in need of social support. People with the following disabilities would benefit: people with permanent, moderate or severe disability. This includes people who move with difficulty and cannot walk on their own; those who cannot dress or eat on their own; and those with communication problems and vision and hearing difficulties; those diagnosed with chronic irreversible psychiatric disability. These patients will qualify irrespective of the fluctuation in their mental status; and, frail, older people and long-term institutionalised state-subsidised patients. A standardised assessment tool had been developed that would be used in all provinces to classify beneficiaries, the statement said. The free services, however, would not be available to people with temporary disabilities or chronic illness. The free healthcare services would allow qualifying people to access free in-patient and outpatient hospital services. Tshabalala-Msimang said the care would include specialist medical attention, prosthetics, wheelchairs, and hearing aids. (Source: Jillian Green: The Star, 2 July 2003)
Health Systems Trust
Mental health has over many decades acquired the unwelcome reputation of being a pariah or stepchild of the health services. This was partly because it was narrowly understood as psychiatric illness, an area of concern for only psychiatrists, psychiatric nurses, patients and their families. However, the past three to four years have seen mental health care steadily moving out of this quarantine, towards mainstream health care. Also, mental health care has begun to address issues that distress South Africans on a day to day basis such as crime, violence and HIV/AIDS. This is starting to change peoples perceptions of mental health as an abstract, mysterious set of interventions, to an understanding that this is a component of health that addresses issues of general psychological well being and problems of day-to-day living. This transformation of mental health has been made possible by a diversity of developments, pioneered by the Mental Health Directorate in the National Department of Health, working in conjunction with provincial departments of health, non-governmental organisations and other interest groups. Some of these developments deserve special mention: * The Draft Mental Health Bill of 1999 which was published for public comment in the Government Gazette on the 4th February 2000. This draft Bill provides the legislative framework for the provision of mental health care in a humane manner, based on the individual rights espoused by our Constitution, and resonant with the times in which we live. Should this Bill be passed in the year 2000, as it is intended, this will be an important milestone. The new challenge that will obviously arise from this is the formulation of pragmatic implementation strategies. * Violence Surveillance Project, undertaken by the Mental Health Directorate in conjunction with the Institute for Health and Social Sciences, as part of the National Crime Prevention Strategy * Training of Primary Health Care Workers in Victim Empowerment * Development of Secondary level studies for Victims of Violence * Development, together with the Centre for the Study of Violence, of the Violence Prevention Project in Schools * Collaboration between the Mental Health and HIV/AIDS directorates to develop policies for pre-and-post test counselling of individuals * Development, together with Columbia University in New York, of interventions to prevent the spread of HIV/AIDS in institutions for people with intellectual disabilities The above areas of focus do not imply that people with psychiatric illness have been neglected. The Mental Health Directorate has also paid attention to: Development of Norms for Severe Psychiatric Care and Standards for monitoring Quality of Care in institutions providing mental health care. This was done together with the University of Cape Town. De-institutionalisation of people with mental health problems, to provide care in a milieu as close to the family of the patients as possible. This project was done together with the Centre for Health Policy (CHP) (see Research hot off the Press). Identification of barriers to the implementation of findings of mental health research. Areas of focus where more attention is needed include: Integration of mental health care into Primary Health Care (PHC) based on the District Health System. A lot of effort has been dedicated to this, for instance, by the Community-based Mental Health Project (CMHP), attached to the University of Durban-Westville. A scientific evaluation by an external team that could help to identify factors that facilitate and those that inhibit integration would be useful. Identification of barriers to the implementation of mental health research findings, most of which have been hailed as breaking new ground. Strengthening the capacity of provincial departments of health (and welfare) to translate the mental health policies of the national department into workable strategies. Focusing on the issues that affect us a nation on a daily basis such as crime and violence will almost certainly enhance peoples understanding of mental health as an integral aspect of daily living and not as a far-off illness that only affects some people who are hidden away in institutions. Of course, results speak louder than aspirations, and I have begun to see some of the interventions, for instance, the training of health workers in victim empowerment, beginning to enhance confidence and change attitudes. The formulation of the legislation is another important development. The partnership between the Mental Health Directorate and various NGOs, academic institutions and other interest groups, in enhancing the mental health care of the people of South Africa, as already been highlighted, is commendable. So although there is still a long way to go before the mental health system in South Africa approaches the ideal for this country, some important steps forward have been taken and the future looks promising.