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Research on Depression in the Workplace.

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Mental Health Matters Journal for Psychiatrists & GP's

MHM Volume 8 Issue1

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Literacy is a luxury that many of us take for granted. That is why SADAG created SPEAKING BOOKS and revolutionized the way healthcare information is delivered to low literacy communities.

The customizable 16-page book, read by local celebrity audio recordings, ensures that vital health and social messages can be seen, heard, read and understood by everyone across the world.

We started with books on Teen Suicide prevention , HIV, AIDS and Depression, Understanding Mental Health and have developed over 100+ titles, such as TB, Malaria, Polio, Vaccines for over 45 countries.

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The well co-ordinated and active Depression and Anxiety Support Group not only benefits anxiety and depression sufferers in the community, but also decreases the demands made on health-care professionals and increases awareness in the community. Zane Wilson started the South African Anxiety Disorders Support Group in September 1995 as a non-profit, privately funded support group. At the beginning of 2001, its membership has grown to over 14,000, with 150 active regional support groups.

The first obvious benefit of the Support Group is the free information and support that is available for all anxiety and depression sufferers. There is a full-time staff of three headquartered in Sandton, and trained volunteer counsellors to man the phones from 8a.m. to 7p.m. on weekdays, Saturdays from 8a.m. – 5p.m. and Sundays from 9a.m. – 1p.m.. The counsellors provide referrals to expert health-care professionals, send out information packs to members and distribute resource material such as books, audio- and videotapes. Pretoria Psychiatrist, Dr. Anne-Marie Potgieter believes that this service, in itself, is of great value: “[The sufferer] comes into contact with people that are knowledgeable. I have so many people coming to my office because they have been referred to me, not by doctors or psychiatrists, but by the support group. We can never underestimate the role of a support group.”

The counsellors have been trained to deal with a variety of anxiety and depression issues and have an extensive knowledge of self-help suggestions, cognitive behavioural therapy and suicide. In Gauteng, there are also help-lines manned by people who have personally experienced anxiety and recovered significantly enough in order to counsel others.

This easy access to vital information and numbers, and knowing that there is always an understanding voice on the other side of the telephone line, makes a remarkable difference to the lives of sufferers. They are reassured by the fact that there are others experiencing similar symptoms and are empowered by the information they receive. June, one of the group’s longest standing members, suffered for thirty-eight years without a proper diagnosis. Two years ago, she phoned in to speak to a counsellor: “I was so excited [when I phoned in] because I realised that I was speaking to somebody that actually understood...no doctor had ever understood me.”

Self-empowerment has been taken one step further with the establishment of over 150 regional support groups throughout South Africa. These groups are run by regional co-ordinators and generally meet once a month. Members build special friendships and supportive relationships with other people experiencing similar difficulties. The knowledge that another person truly understands and can empathise with the sufferer brings a great sense of relief. Participation in the Support Groups is voluntary, with no commitments or forced disclosures required.

On a practical level, the members of the regional support groups learn goal setting, cognitive relaxation methods and other helpful techniques. They are given full backing by the main support group, which often organises for guest speakers – including psychiatrists, psychologists, doctors, phobic aids and fellow sufferers – to address the meetings from time to time. The main support group also supplies regional groups with written material, video- and audiotapes, and other logistical support.

Research has shown these kinds of smaller self-help groups to be a means of enhanced self-care. Firstly, the social support provided by these groups tends to maximise the immuno-competence of people enduring severe stress. Secondly, the knowledge, skills and attitudes of self-efficacy that they promote tend to make members more effective caregivers. [Reference: Stewart M.J. Expanding Theoretical Conceptualisations of Self-Help Groups. Soc. Sci. Med. 1990; Vol. 31, 9: 1057 – 1066].

The Depression and Anxiety Support Group works closely in conjunction with a number of health care professionals and organisations, and thus forms a complementary network between the self-help group and health professionals. Dr Franco Colin, a member of the advisory board, sees the Support Group as playing an essential role in decreasing the burden on the over-worked health sector by delivering an excellent service to patients and their families.

Furthermore Dr Dan Stein of the MRC Research Unit on Anxiety Disorders points out that anxiety and mood disorders are amongst the most common of the mental disorders and together make up a substantial portion of the costs of mental illness. These costs include not only the direct costs of treatment, but also the indirect costs of loss of income and of dysfunction at work. There is growing evidence that organisations such as the Support Group, which promote appropriate treatment of mood and anxiety disorders, are cost-effective interventions.

During 2001, the Support Group carried on expanding into rural areas and making a special effort to reach poorer communities through education and outreach programmes. Regional Support Groups have already been established in Alexandra, Sharpeville, Siyabuswa, Soweto, Tembisa and even at Mogwase Prison in Rustenburg. Dr. Sebo Seape, psychiatrist at Baragwanath Hospital and member of the advisory board, sees these programmes as making help accessible to all people in South Africa. “The group emphasises that there is something people can do on their own even without psychiatric help” she says.

This last year has seen the group expand in some exciting new directions. The group is maintaining a Substance Abuse Helpline with the sponsorship of Sanofi-Synthelabo. The counsellors have received training in handling substance abuse queries and the line is proving to be an important resource for referrals to appropriate treatment centres and professionals. In addition, 2001 saw the implementation of a series of school talks as part of the group’s “Suicide Shouldn’t be a Secret” initiative. The programme has been very well-received and feed-back from teachers and students has been positive.

The Support Group was invited to participate on the WHO “Adherence to Long-Term Therapies” advisory committee which convened in Switzerland this year. In partnership with the Mental Health Information Centre, the group organised a countrywide film festival to create awareness for mental health issues around Mental Health Day this year. In addition, as part of the group’s ongoing initiative to raise awareness and destigmatise mental illness, it is hosting an exciting fundraising event over Christmas. Last year saw the launch of the first Depression and Anxiety Support Group Festival of Christmas Trees which was an incredible success. Funds were raised for the group and awareness raised for mental health amongst the community. This year’s event, to be held at Sandton City, promises to be an even greater success.

Since its inception in 1995, the Support Group has focused on awareness campaigns - encouraging the early identification of anxiety and eliminating the discrimination and prejudices attached to mental illnesses. The Support Group serves as a clear voice for more than 10% of South Africans who suffer from depressive disorders. In 2001, the group held 3 media forums to educate the media on mental health issues and to promote sensitive and responsible reporting.

The group emphasises that, with correct management and follow-up, anxiety and depressive disorders are treatable mental diseases. Dr R Liebenberg believes that media outreach, including publicity in the printed and electronic media, is vital in providing public education: “As soon as The Support Group launches a media campaign, we notice many people phoning in and asking for help - most of them have never asked for help before. They never thought their disorders could be treated.”

A by-product of these campaigns is an increased awareness in the workplace. Studies in America have shown that depression can result in huge financial losses through absenteeism, lost productivity, morale problems, substance abuse and poor work quality. The group is now addressing these potential problems in South African businesses by educating workers and destigmatising mental illness. Dr. Potgieter mentions another interesting development that she has noticed in this regard: “[Sufferers] are now alerted to other people in the workplace who are having similar problems and ask me how they can help these people.”

As a patient advocacy group, the Depression and Anxiety Support Group is committed to representing patients and ensuring that their rights are upheld. During 2001, the group conducted a medical aid survey, looking at the mental health benefits offered by a range of medical aids. The benefits are, in most cases, shocking. The group released the results of this survey to the press at a press conference and plans are underway to lobby these medical aids on behalf of South African mental health service-users.

Dr Potgieter believes that another important area in which the Support Group has the potential to play an active role is that of research. With the correct structure, the group could supply fertile ground for a range of research studies, including epidemiological statistics. At the moment, the group can arrange free drug trials that benefit both the medical industry and sufferers who are battling with the finance for treatment.


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