Mental Health Within Schools

Very little is known about the impact of violence on adolescent mental health in South Africa especially in inner city communities with high levels of poverty. Stansfeld et al., (2017) say that the “degree of entrenched severe structural social inequalities, a legacy of the apartheid era, may uniquely normalise and enhance the use of violence as a method of control in South Africa.” For this particular study the sample was taken from seven government co-educational schools in Cape Town, South Africa. Smoking, drinking and drug use inquiries were extracted from other reliable questionnaires previously used in Cape Town school studies. Poverty tends to influence the risk of mental ill health in several ways especially in South Africa. It is showed that “South Africa is one of the most unequal societies in the world. More than 50% of the population live in poverty” (Plagerson, 2021). In the study, it showed that young people with health risk behaviors, those living in poor housing, with financial difficulties and paternal unemployment and high scorers on the mental health outcomes had higher odds of exposure to violence (Stansfeld et al., 2017). In addition it was also found that White and Indian students had lower odds of depressive caseness compared to Black students, and White students and students of color had lower odds of PTSD compared to Black pupils (Stansfeld et al., 2017).

Mental Health Services

Like many low- and middle-income countries there is a significant mental health treatment gap in South Africa. A study showed that about "30% and 17% of adults in South Africa meet diagnostic criteria for a lifetime and past year mental disorder respectively, yet less than a quarter ever receive treatment” (Sorsdahl et al., 2021). Failure to reach adolescents is a major service and treatment gap given this is the peak age of onset for most mental health problems. If left untreated, these problems predict adverse life trajectories. Adolescents who do not seek or access mental health services run the risk of developing more advanced psychopathology in adulthood and are at greater risk for physical health comorbidities and injury (Sorsdahl et al., 2021). South Africa has a 75% treatment gap for common mental disorders, with only 25% of South Africans with common disorders receiving mental health treatment of any kind (Sorsdahl et al., 2021). In order to address the treatment gap in South Africa, mental health services need to increase greatly and are encouraged through integration into the existing primary health care platforms in schools.

Problems with the Health Care System

A major weakness in sub-Saharan African health systems is inadequate human resources. Africa is said to have less than one health worker per 1000 population compared to 10 per 1000 in Europe (Maphumulo & Bhengu 2019). Health problems in South Africa get worse due to the unequal distribution of health professionals between the private and public sectors. Public healthcare facilities also show numerous detriment like long waiting times, poor-quality healthcare delivery, old/poorly maintained infrastructure, and poor disease control and prevention practices . "Work backlog causes extended delay for some patients awaiting treatment, such as cancer patients who are affected by the lack of oncology doctors and of equipment, and long waiting lists for surgery or diagnosis, also because of the lack of equipment" (Maphumulo & Bhengu 2019). Due to this happening mainly to the poorer communities and the fact that the poorer communities are mainly people of color this problem has the biggest impact on people of color.

Improve The Medical System

There was a change in 1994 in the South African government that forced a push for positive transformation in the health care system. The first step to reconstruction was to decentralize the health care system at hand. The health care system in South Africa is organised into three levels: national level, provincial level and local level government. "Decentralization strengthened the capacity of local organisations to negotiate with central government structures for increased resource allocation to previously neglected groups" (Maphumulo & Bhengu 2019). The National Department of Health is head of public health in and is responsible for overall health policy and coordination. Proof of commitment to improvement is the development of the Ten Point Plan Strategic Framework, as outlined in the Hospital Revitalization Program, pursued improvement of hospital infrastructure, health technology, administrative management and quality service (Maphumulo & Bhengu 2019).

Mentally Ill In Incarceration

The study sample consisted of 86% males, who were 96% black Africans followed by coloured participants. Modupi et al. (2020) reported that "Individuals diagnosed with intellectual disabilities were more often accused of rape (28.0%) and assault (15.0%), while those who were suffering from schizophrenia were also more likely to commit violent and aggressive crimes such as assault (33.0%), rape (28.4%) and murder (25.0%).” The generality of mental disorders among the participants in Bizzah Makhate Correctional Service Center is of great worry.

Improvements Needed In the Prisons

A number of mental health professionals have stated that the impossibility of conducting truly ethical mental health practice due to the fact that they're in such an oppressive social context. “It has been more than 20 years since the advent of democracy in South Africa and, while some advances have been made towards greater equality and justice, there are still considerable structural, economic and socio-political factors which hamper the delivery of mental health care and provide less than optimal conditions for psychological well-being” (Bantjes et al., 2017). Multiple social workers have said that the Department of Correctional Services has fallen woefully short of its responsibilities to protect the rights of prisoners and create a safe environment. Overcrowding and resource constraints are major concerns and are associated with high levels of psychological stress, psychiatric illness, interpersonal violence, physical assault and sexual abuse within South African prisons (Bantjes et al., 2017). Most Black South Africans continue to live in poverty and in circumstances which are far from optimal in terms of health and human development and this puts them on a more narrow path leading to imprisonment which then leads to them being the main population in the prisons.

References

Bantjes, J., Swartz, L., & Niewoudt, P. (2017, October 12). Human rights and mental health in post-apartheid South Africa: lessons from health care professionals working with suicidal inmates in the prison system - BMC International Health and Human Rights. BMC International Health and Human Rights. Retrieved June 16, 2022, from https://doi.org/10.1186/s12914-017-0136-0

Grant, M., Luvuno, Z., Bhana, A., Mntambo, N., Gigaba, S., Ntswe, E., & Petersen, I. (2021, December). The development of a Community Mental Health Education and Detection (CMED) tool in South Africa. SCienceDirect. https://www.sciencedirect.com/science/article/pii/S2666560321000232?via%3Dihub

Plagerson, S. (2021, January 14). South African policies go some way to tackling poverty and inequality. But more is needed. The Conversation. Retrieved June 11, 2022, from https://theconversation.com/south-african-policies-go-some-way-to-tackling-poverty-and-inequality-but-more-is-needed-151696

Modupi, M. B., Mosotho, N. L., & le Roux, H. E. (2020). The prevalence of mental disorders among offenders admitted at health facilities in Bizzah Makhate Correctional Service Centre, Kroonstand, South Africa. Psychiatry, psychology, and law : an interdisciplinary journal of the Australian and New Zealand Association of Psychiatry, Psychology and Law, 27(6), 963–972. https://doi.org/10.1080/13218719.2020.1751742

Maphumulo, W. T., & Bhengu, B. R. (2019). Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis, 42(1), e1–e9. https://doi.org/10.4102/curationis.v42i1.1901

Republic of South Africa. (n.d.). How does the criminal justice system work? South African Government. Retrieved June 12, 2022, from https://www.gov.za/faq/justice-and-crime-prevention/how-does-criminal-justice-system-work

Scholaro Pro. (n.d.). South Africa Education System. Scholaro. Retrieved June 9, 2022, from https://www.scholaro.com/pro/Countries/South-Africa/Education-System

Sorsdahl, K., van der Westhuizen, C., & Neuman, M. (2021, March 16). Addressing the mental health needs of adolescents in South African communities: a protocol for a feasibility randomized controlled trial - Pilot and Feasibility Studies. Pilot and Feasibility Studies. Retrieved June 11, 2022, from https://doi.org/10.1186/s40814-021-00803-5

Stansfeld, S., Rothon, C., Das-Munshi, J., Mathews, C., Adams, A., Clark, C., & Lund, C. (2017). Exposure to violence and mental health of adolescents: South African Health and Well-being Study. BJPsych Open, 3(5), 257-264. doi:10.1192/bjpo.bp.117.004861

Van Hout, M. C., & Wessels, J. (2021, November). Navigating the complexities of the mentally ill and mentally incapacitated in the criminal justice system in South Africa. orensic Science International: Mind and Law, Vol 2(100068), 1-5. https://doi.org/10.1016/j.fsiml.2021.100068