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Mental health care in SA needs stronger leadership and increased budgets


Life Esidimeni tragedy, patient abuse, health professionals’ suicides all point to need for better management of public sector psychiatry says incoming South African Society of Psychiatrists president, Prof Bonga Chiliza


The psychiatric profession should play a greater role in advocating for patients’ rights and improving management of mental health in the public sector after a series of recent tragedies that highlighted the neglect of mental health care in South Africa.


Newly-elected president of the South African Society of Psychiatrists (SASOP) Prof Bonga Chiliza said the deaths of 144 patients in the now-notorious Life Esidimeni tragedy; allegations of abuse and human rights violations at the Tower Psychiatric Hospital in the Eastern Cape; and the suicide of UCT Health Sciences Dean Prof Bongani Mayosi following his battle with depression, all pointed to the need for the organisation to “rise and answer the call for advocating on behalf of mental health care users and our profession”.


Prof Chiliza, who heads the Psychiatry Department of the University of KwaZulu-Natal (UKZN) Medical School and will serve as SASOP president to 2020, said the organisation would ramp up its lobbying for mental health care to be allocated an equitable share of the national health budget.


He said SASOP would also be doing more to encourage medical students to specialise in psychiatry, in order to grow the numbers of qualified professionals able to serve public mental health care needs.


“Mental health conditions are often misunderstood, mis-managed and stigmatised, particularly for those who rely on the public health system for treatment. They are extremely vulnerable to abuse and SASOP as the professional body for psychiatrists must take the lead in ensuring better services to our people.

“We will live out the promise we made to society when we engaged in a social contract with our community as practising, professional psychiatrists,” he said.


Prof Chiliza said SASOP was establishing a “robust Public Sector Executive Committee of senior psychiatrists in academia and government services” to guide its efforts to strengthen psychiatric care in the public health sector.


He said SASOP would continue its leading role in the National Mental Health Alliance of NGOs in the mental health care sector as a vehicle for advocacy on policy and budget issues affecting mental health care and the provision of professional psychiatry services in the public sector.


Outlining his vision for SASOP and its contribution to the profession of psychiatry, Prof Chiliza said the organisation would also focus on renewing its leadership transformation efforts, strengthening the relationship between public and private sector psychiatry, and supporting early-career psychiatrists.


“We will re-energise our efforts to transform the leadership of SASOP and psychiatry in general. The leadership of SASOP will continue to transform until is aligned with the demographics of South Africa and is able to fully engage with issues that plague our country such as racism, sexism and other forms of discrimination.


“We will thus embark on a strategic drive towards succession planning for all key positions of leadership in psychiatry,” he said.


Prof Chiliza said that as a scarce resource, psychiatrists in the public and private sectors needed to work together, especially in preparing for the reorganisation of the health care system with implementation of National Health Insurance (NHI).


“We are already piloting value-based care models in the private sector. There is no reason why these pilots cannot be performed in both private and state sectors,” he said.

On early-career psychiatry, he said he aimed to grow SASOP by focusing on young psychiatrists, registrars and medical officers, ensuring that young doctors had ample opportunity to do internships in the discipline and “fall in love with psychiatry”.


“We need to push harder for psychiatry to be truly recognised as a major discipline in undergraduate medical education,” he said.


Prof Chiliza said SASOP would look to increase the support it already offers to medical registrars in order to “facilitate a more equitable training platform for all registrars regardless of the university at which they are training”.


Support for early-career psychiatrists would also extend to assistance in dealing with professional practice issues such as billing, and mentorship for young psychiatrists and future academics.


In addition to his position at UKZN, where he is Associate Professor/Chief Specialist and head of the Department of Psychiatry, Prof Chiliza is a founding director of Harambee Medical Consulting and the African Global Mental Health Institute, and serves on a number of NGO Boards including the SA YMCA and Life Choices.


He has authored over 50 peer reviewed articles and book chapters and won awards including the Hamilton Naki Clinical Research Fellowship and the CINP Rafaelsen Young Investigators Award.


He completed his medical degree and psychiatry specialization at the University of KwaZulu-Natal and his PhD at Stellenbosch University. His research interests include schizophrenia, consultation-liaison psychiatry, health services and medical education.


He is the Deputy Editor of the South African Journal of Psychiatry. 

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