Last year we asked for your support in filling in an International Survey on behalf of the Global Alliance of Mental Illness Advocacy Networks (GAMIAN), which we in South Africa are a member of. 40% of you responded.
Despite noticeable improvements in the treatment and management of depression and other psychiatric disorders, the vast majority of people affected by these diseases delay seeking initial treatment for at least two years and often for as long as five years. Figures released by the Global Alliance of Mental Illness Advocacy Networks indicate this to be a world-wide trend, substantiated by results obtained from an international survey conducted in 10 countries. South Africa featured prominently in the survey, with figures indicating dire lack of education and information about mental illness in South Africa and providing a good reflection of the prejudices and uncertainties regarding medical treatment in South African society.
Sponsored by the Bristol-Myers Squibb Company, the GAMIAN study is the first completed survey aimed at assessing on a global level the relationships between patients, health care providers and the public at large in the treatment of anxiety and depression disorders. Conducted through the use of questionnaires, the survey made use of the patient networks established and maintained by advocacy groups in Europe, the USA, South America and South Africa in order to obtained reliable results from sufferers of depression and anxiety. Although the survey made use of responses from over 3 500 men and women from very different walks of life, similarities emerged with regards to how sufferers have dealt with their illnesses and the mental health systems in place in their respective countries. According to Azima Batcha, Bristol-Myers Squibb’s South African Marketing Manager, the GAMIAN survey laid the foundation for future research and is the start of good things to come in the way of destigmatising mental illness and identifying problem areas in the treatment and management of the mental illnesses. Having realised the importance of communicating world-wide trends, Bristol-Myers Squibb became involved in the study as part of the company’s social responsibility to destigmatise mental illness through research and education.
Overall results point to the fact that stigmas, misdiagnoses and the side effects of medication hinder attempts by patients to seek and maintain help for their psychiatric disorders. Another key issue highlighted by the study is the fact that over a third of the respondents never received what they consider to be an appropriate or correct diagnosis of their mental disorder. Of those who are correctly diagnosed and receive treatment, a startling 45% drop out of the treatment at some time due to the medication side effects. The most common side effects cited as reasons for discontinuing treatment based exclusively on psychotherapy recorded a higher drop-out rate than pharmacotherapy treatment, treatments that combine the use of psychotherapy and medication are the most successful and result in the lowest number of drop-outs.
In South Africa, the Depression and Anxiety Support Group facilitated an excellent response from respondents throughout the country. 40% of questionnaires were returned, mostly from the demographically prominent age group of between 35 and 49 years, composed of a high percentage of working individuals. Although questions can be raised about how representative support group members are of the general public, Dr. Dan Stein believes that while extrapolation to the public is not entirely possible, “the feelings of the Depression and Anxiety Support Group members are significantly important to be given very serious consideration by stakeholders.” Results obtained from South African respondents indicate that although global trends in the perception and treatment of mental illnesses filter through to South Africa, we are faced with a particularly difficult task in terms of combating stereotypes and prejudices surrounding mental illness.
Results indicate that a drastic change is needed in the manner in which medical practitioners relate to their patients and approach the treatment of mental illness. In terms of the reasons for delays in seeking help, an alarming 30% if the respondents stated that they could not find an understanding medical professional. This figure is particularly high in comparison to the global trend of not finding an understanding medical professional being stated as a reason for delay in 22% of responses. Further reasons for delays in seeking treatment included feat of using medication and previous incorrect diagnoses. Compared to a global average of 35%, 43% of sufferers only received a correct diagnosis after four or more visits to a doctor. Sadly, ignorance and indifference to mental illness appears to affect both the public at large as well as mental professionals. In spite of high drop-out rates and often unsatisfactory diagnoses, South Africans have faith in mediation and very high expectations that treatment will be successful. Medication has been shown to be very effective in over 62% of treatment programmes, slightly higher that the US average of 61% and substantially higher that the global statistic of only 46$. Figures for psychotherapy as an effective treatment are less encouraging, but rank South Africa very near to the global mean of a 17.6% success rate.
Faith in its various forms and applications appear to affect South African sufferers of Depression and Anxiety both negatively and positively. The most common reason for treatment drop-out in South Africa is the belief among sufferers that they are able to handle mental illnesses on their own, coupled with the belief that seeking treatment is a sign of personal failure. This is very likely a reflection of the stereotypes and stigma’s very much active in our society – that mental illness is not a “real” illness and that is very often an imagined pathology. On the brighter side, Church Ministers and Spiritual Advisors are perceived to be of great importance in assisting South Africans to understand and deal with their illnesses, with figures suggesting that religion and spirituality feature twice as prominently in South African treatment regimes as they do globally. However, Dr. Franco Colin, a prominent Pretoria Psychiatrist and member of the Support Group’s Advisory Board, believes that approaching only a spiritual advisor can be extremely dangerous: “(Spiritual Advisors) generally have no understanding of the real dynamics behind mental illness and always tend to view mental illness as being isolated in a purely religious context.” Dr. Colin also notes that although the Depression and Anxiety Support Group functions very effectively in providing education about mental illness, the education made available is being under utilised, compounding the problem of creating awareness. “Poor knowledge on the side of the doctor can be addressed by more active participation in Doctor’s CME’s, to which the Support Group has made a clear obligation,” says Dr. Colin.
Having long been an area identified to have serious flaws and inadequacies, the South African mental health care system will benefit immensely from the results of the study. According to Prof. Michael Berk, Chairman of the Depression and Anxiety Support Group’s Advisory Board and Psychiatry Professor at Wits University Medical School, “the results obtained from the study have identified particular weaknesses within the system, allowing us to target those areas that are especially weak.” The contribution made by the Support Group to eliminating stigmas and providing education in most notable South Africa produced the third highest sample perceiving support groups as being an important source of information, and aiding with the understanding of depression, anxiety and panic disorders.