OVERVIEW

FPD has been active in mental health since 2012and violence prevention from much earlier. Our work in mental health cuts across all FPDs major priority areas namely:

Providing high-quality affordable education
We offer a wide range of asynchronous online, webinars and in-person training aimed at rapidly addressing the mental health workforce crisis some supported by mentoring. These courses are designed to:

  • Expand and improve MH workforce capacity ranging from community level up to health care professionals.
  • Introduce a new cadre of counsellors trained in Inter-Professional Counselling
  • Promote competency in use of telemedicine
  • Build the mental health resilience of frontline healthcare professionals
  • Create the awareness amongst health managers of the critical role they have in creating a workplace that reduces stress and burnout.
  • Eradicate stigma against MH
  • Integrate mental health into HIV/TB programming
  • Webinars on MH and virtual Grand Rounds for HCPs

Hosting impactful local, regional and local conferences
FPD conferences address major societal challenges where such conferences can create awareness, serve as a call to action, promote inter sectoral collaboration, promote consensus building and stimulate the generation of new knowledge through research. In 2023 we launched the 1st SA Mental Health Conference.

Conducting research
FPD has always had a MH research focus, and this is rapidly expanding around mental including an increasing portfolio of implementation science projects to test service delivery models designed to meet a rapidly increasing need and a rapidly decreasing number of specialized mental health professionals.

Implementing catalytic system strengthening projects to enhance access to health care
FPD system strengthening focus has moved to a more traditional above-site model looking at the challenging areas in the TB/HIV response, the so called “high-hanging fruit”, expanded to include intractable challenges such as GBV, improving access to services for survivors of sexual assault and improving access to mental health services. Since 2021 with PEPFAR funding we have been able to substantially start impacting the policy environment to address barriers to accessing MH care. We have also built muti-sectoral alliances in this process and created a national resource www.masiviwe.org.za to provide access to resources.

Introducing and testing innovative solutions to address service delivery challenges
FPD has recently released the 1st serious app-based game built in Africa for adolescents designed to developing mental resilience skills “The Stepwell Saga” we have also been working with Vula Mobile to use their App to facilitate MH referrals and testing multidisciplinary care models for insured HCWs.

Click here to read more about the game



SITUATIONAL ANALYSIS

South Africa has the third lowest average mental health quotient score of 71 countries surveyed in the 2023 Mental State of the World report, an improvement from being last in the 2021 reports. Only the United Kingdom and Uzbekistan scored lower. The same report shows that South Africa has the joint highest percentage of people in distress/struggling (35%).

15.1% of South Africans were estimated to have encountered mental health challenges in the previous 12 months in 2023, while the South African Depression and Anxiety Group (SADAG) estimates that more than one in three South Africans will develop a mental health condition during their lifetime. A 2017 study that analysed the burden of disease by Carpenter, Nyirenda and Hanass-Hancock, indicated that mental health disorders accounted for 13.8% of the disease burden in South Africa, which was higher than HIV (11.8%) and musculoskeletal disorders (10.4%).

The Mental Health Care Act (No. 17 of 2002) prescribes that mental health should be integrated into general health services including primary, secondary, and tertiary levels to improve access to mental health services and reduce stigma associated with mental illness. Integration also promotes treating patients holistically, which is proven to improve health outcomes. Despite the provisions of the Act, access to MH care is severely limited for uninsured people with MH conditions, and in 2022 it was estimated that 90% of people who require mental health support are unable to do so.

The reasons are multiple and complex and include a severe and rapidly worsening shortage of skilled professionals, especially Psychiatrist and Psychologists, MH maldistribution of professionals between the public and private sector and between provinces, historical professional protectionism that limits the scope of practice of other healthcare professionals in MH, an unwillingness, until recently, to employ mid-level MH workers, (Registered Counsellors-4-year psychology graduates) in the public sector. Antiquated scheduling of all antidepressants as habit forming schedule 5 drugs has prevented primary care nurses, who provide most of the care at primary care clinics, from prescribing them and as such it is estimated that only 1-12% of people who should be on antidepressants are currently on treatment. Despite this need and the high disease burden, only 5% of the national healthcare budget is allocated to MH with 86% thereof redistributed to psychiatric hospitals, leaving virtually no resources for community or primary level care.

Not only does this lead to unnecessary human suffering but the country pays a hefty economic cost in loss of productivity. Just the cost of untreated anxiety and depressions amongst the employed South African population is estimated to range between R170 to 210billion per annum – a devastating cost that our economy can ill afford. Aligned to our vision ‘to build a better society through education and capacity development’, FPD endeavours to be not just a voice in this conversation, but to be a catalyst to address the social, political, and structural barriers to access to mental health services, and to ensuring that everyone will have access to affordable quality mental health care when they need it and much more importantly start building a society where we create mental wellbeing and resilience to reduce this need.

SOLUTION

FPD technical approach (How we do it)

 

The FPD technical approach is delivered through a series of targeted workstreams [WS] and uses South Africa as springboard to test innovative approaches that can be replicated and expanded across the continent and serve as models to support international efforts.

 

WS-1 Technical Assistance: We have established a team of highly skilled local and international experts with extensive experience in all aspects MH health including the interphase between MH and HIV/TB, Gender Based Violence, the World of Work and Climate Change who not only influence our programme design but provide valuable technical assistance to stakeholders including policymakers, organizational management, civil society organizations, researchers, and implementers. Our technical advice targets all relevant stakeholders (NGOs, community organizations, civil society, employers, donor implementing partners and government at all levels) to assist in evidence-based mental health service planning, delivery, supervision, and improved performance.

 

WS-2 Training and capacity development:  FPD, as a registered private higher education institution based in South Africa with a global reach, offer a wide range of accredited courses (online, virtual, and in-person formats) customized to the requirements of all role players. Capacity development programmes cover the spectrum of developing competency from policy and planning, increasing the MH workforce, strengthening the role of civil society, educating the public and building mental health resilience amongst the health and general workforce.

 

WS-3: Technology and innovation: The massive online migration over the past few years and the dramatic growth of artificial intelligence (AI) has created an opportunity to leverage technology to dramatically lower barriers to access to MH care and self-care, Technology allows us to deliver training at low cost, improving MH literacy, developing capacity of HCWs to provide MH care, improve screening, simplify referrals, provide mentoring, and overcome geographic barriers to access. FPD partners with technology and academic partners to introduce innovative technologies to the MH landscape. The FPD research Unit also actively pursues the development of new knowledge through implementation science projects in MH.

 

WS-4: Creating structures to foster cross sectoral collaboration:  FPD leverages more than 25 years of HIV/TB system strengthening and community engagement experience, which has included establishing several national scientific conferences, the 1st health think tank in Africa, local and international NGOs and several extraordinarily successful social media campaigns to build broad coalitions in support of advancing public health goals. This allows for coordination of activities, pooling of resources and focussing advocacy and research activities. 



RESULTS

POLICY DEVELOPMENT AND ADOPTION AT NATIONAL LEVEL

National Strategic Plan (NSP) for HIV, TB and STI  2023 to 2028 where FPD managed to increase the mentions of MH from 12 in the previous NSP to 144 in the new NSP, as well as 35 mentions of the term psychosocial support that did not feature at all in the previous version. We also managed to get PLHIV with MH lived experience designated as a priority population.

 

National Mental Health Policy Framework and Strategic Plan 2023 to 2030 where FPD through TA promoted the inclusion of several game changers including a commitment to rescheduling antidepressant, that are not habit forming, to allow prescription by primary care nurses, formal employment of Registered Counsellors in the Public Sector at primary care clinic level and a general policy shift from a hospicentric to a community model.

 

Medical scheme benefits. Excellent progress has been made with the Government Employee Medical Scheme (GEMS) that covers 90% of HCWs who have made depression one of their prescribed minimum benefits and incorporated mental health into their value-based care team benefit package currently being rolled out across the country that promoted outcome-based care by multidisciplinary teams.

 

INFORMATION EDUCATION & COMMUNICATION

 

Productions of information and education material. The project has produced a variety of IEC and uses all the Masiviwe platforms to distribute the information. To date 15.5 million+ reached through Masiviwe social media channels in March 2024 – lately reaching about a million per month.

 

The Masiviwe website (www.masiviwe.org.za) provides it visitors with a plethora of MH resources, including information on understanding MH, managing emotions, HCW resources, repository of MH content developed, get help features, and so much more. The site has seen more than 18 000 visits to date.

 

The 1st SA Mental Health Conference was launched in April 2023 by FPD and became a joint project with the national Department of Health. This abstract driven scientific conference, under the heading “It is time to talk”, was attended by 673 delegates, with 167 speaker presentations across 37 sessions, 29 poster presentations and 24 exhibition stands. The conference was ably Chaired by Professors Olive Shisana and Dan Stein

 

TECHNOLOGY

 

A potential game changer has been our work with Columbia University Psychiatry Department to validate their electronic mental wellness screening tool (e-MW Tool) algorithm in South Africa, this algorithm allows for rapid screening, diagnosing, and triaging of MH conditions and make it ideal for outreach field based HCWs. Validation of the South African version of the mwTool for use in adults has been completed and the adolescent validation project should be complete in mid-2024.

 

The StepWell Saga is the 1st Serious Game for Mental Health in Africa (launched March 2024) In an innovative leap forward, FPD secured a pioneering grant from Grand Challenges Canada, birthing a landmark achievement in the realm of healthcare: the inception of Africa's first-ever serious game dedicated to mental health, christened 'The StepWell Saga – Stronger Together'.

 

 

GLOBAL ADVOCACY

 

Donor funding for mental health and people living with MH conditions are still extremely limited. As such FPD actively leverages the massive donor investment in HIV/TB in Africa to promote MH activities. We also secured support from the Office of the Global AIDS Coordinator for the integration of MH into HIV/TB programmes in Africa. Leveraging this policy changes are starting to improve access to care for people with MH conditions. See Godfrey, C. and Nkengasong, J., 2023. Prioritizing mental health in the HIV/AIDS response in Africa. New England Journal of Medicine, 389(7), pp.581-583.

 

Key Populations status within the HIV donor programming environment receive dedicated budget allocation and programmes. FPD fully believes that people with severe mental health issues meet all the criteria for being designated as Key Populations. To this end in Freeman, M.C., Wainberg, M.L., Slabbert, J.D., Mabela, S. and Wolvaardt, G., 2023. Persons with severe mental health conditions should be included as a key population in HIV programmes. AIDS, 37(14), pp.2115-2118. We argue this for such status for South Africa but also for other countries too.