Using evidence in the time of COVID-19 to reduce health inequalities for Persons with Psychosocial Disability in South Africa

Author: Linda Ajemba

LLD candidate, Centre for Human Rights, Faculty of Law, University of Pretoria

The ongoing coronavirus (COVID-19) pandemic has had an unparalleled impact on all spheres of life globally. As with other disasters, evidence shows that while the impact of the COVID-19 pandemic threatens all members of the society, it disproportionately affects persons with psychosocial disabilities. Persons with psychosocial disability refers to individuals suffering from a spectrum of mental conditions that influence their feelings, perceptions and behaviors. A psychosocial disability arises when someone with a mental health condition interacts with a social environment that presents barriers to their equality with others. Persons with psychosocial disabilities are greatly impacted by diverse response measures employed by governments across the globe to curb the pandemic.

Despite the fact that universal inclusion is a basic principle of the Sustainable Development Goals (SDGs), inclusion of persons with psychosocial disabilities in humanitarian interventions and development policies during disasters remains obscure. In March 2020, the government of South Africa declared the outbreak of the coronavirus a national disaster, effectively implementing stringent and militarized measures to curtail the spread of the virus. Imposed measures which include nationwide lockdown, social distancing and limited access to social and health services, failed to include vital health services for people with psychosocial disabilities as they were not regarded as ‘essential services’. Evidence shows that these rigid response actions markedly increase emotional distress and cause extreme threats to survival, thereby substantially increasing the risk for psychosocial disability as well as exacerbating the severity and duration of psychiatric morbidity in people with psychosocial disabilities. They pose huge threats to South Africa’s public mental health in a society where one in three individuals develop a psychiatric disorder during their lifetime, and in a country defined by its preexisting racial and economic inequity.

The limiting responses to the COVID-19 pandemic in South Africa stem from inequalities that were established during the apartheid regime. In addition to widespread prejudice related to race, gender and socio-economic factors, people with psychosocial disabilities experience stigma and discrimination based on their disabilities. This includes lack of access to healthcare, lack of access to education or appropriate support within schools, lack of access to employment opportunities, and social seclusion. Amidst the high rates of mental illness in South Africa, only 27% of patients with severe mental illness receive treatment. The barriers to accessing care despite the high prevalence of mental illness in South Africa suggests that mental healthcare must be a priority in emergency response plans.

Stigma plays a major role in persistent and prolonged suffering of people with psychosocial disabilities. In the context of the coronavirus pandemic, the gross undermining of the human rights protection and mental health needs of vulnerable populations in South Africa’s emergency response policy and management further fortified the already existent attitudinal, environmental and institutional barriers. Response efforts to contain the spread of the virus through restricting movements and limiting social interactions posed unintended consequences which additionally restrict access to social support structures, treatment, and medications for people with preexisting mental health challenges. Previous global studies on the consequences of these measures report elevated risk for mental illness and suicide. Thus, for millions of South Africans with psychosocial disability, the impact of stigma mediates the association between psychosocial disability and poorer health outcomes attributable to heightened risk of developing comorbid illnesses and poor treatment compliance. In a statement mad by the Mental Health Portfolio Manager at Pharma Dynamics in South Africa, he noted that:

We are likely to see much higher rates of mental illness among South Africans post the pandemic and need to increase psychosocial support efforts to avoid a COVID-19 related mental health crisis. He also stated that those with pre-existing mental health conditions have reported their symptoms getting worse as a result of the pandemic.

While the lockdown measures imposed by the government of South Africa effectively curtailed the rapid spread of COVID-19 infections and associated morbidity and mortality risk, the mental health implications intensified by these measures cannot be overlooked in a country with significant psychiatric morbidity and inequity in accessing the limited mental health care infrastructure. The multiple levels of inequality which stem from stigma towards persons with psychosocial disability invariably depicts that COVID-19 responses have unequal impacts within diverse contexts and amongst a varied range of South Africans. It exposes disparities in inclusion of the needs of persons with psychosocial disabilities, particularly in emergency policy responses.

Regarding vulnerable and at-risk populations, the issues arising in South Africa may be broadly applicable to other countries, particularly low and medium-income countries. These issues emphasize ethical discourse on ameliorating the conditions that produce vulnerability, offering unique opportunities to prioritize the expansion and improvement of mental health services and support to ensure a rights-based approach in such services so the rights of persons with psychosocial disabilities are adequately respected.

The Bill of Rights, which forms part of the Constitution of the Republic of South Africa (1996), states that all persons, including persons with disabilities are equal; that everyone has the right to access healthcare services; that everyone has inherent dignity and the right to have their dignity respected and protected; and that everyone has the right to life. In order to achieve these, measures that consider the reality of persons with psychosocial disabilities and allow for reasonable accommodation of their needs must be developed with their involvement and implemented.

There is need for the government of South Africa to rethink priorities and revisit structural discrimination in mental healthcare policies to move towards human rights compliant and sustainable mental health systems that encompass the whole community. Comprehensive long-term strategies to mitigate the health and socio-economic consequences of the current crisis on people with psychosocial disabilities urgently need to be developed and implemented. This includes consistent mass media psycho-educational interventions and continued eased access to psychosocial support and care for people with psychosocial disabilities and people experiencing mental distress. This means providing measures that allow for flexible service provision, peer support, helplines and online psychosocial support.

About the Author

Linda Ajemba is an LLD candidate at the Centre for Human Rights, Faculty of Law, University of Pretoria. She is involved in research, monitoring and evaluation at the Centre for Human Rights, University of Pretoria. She is also pursuing her Master’s in Public and Development Sector, Monitoring and Evaluation at the University of Witwatersrand.