Discovery Foundation alumni drive mental healthcare for all

The Discovery Foundation aims to strengthen the South African healthcare system by making sure that more people have access to specialised healthcare services. And this includes mental healthcare.

Each year, the Discovery Foundation gives five different awards to outstanding individual and institutional awardees in the public healthcare sector. To show the ripple effect these awardees have had on their communities, we profiled six mental health heroes who are striving to make our country a better place.

Professor Renata Schoeman drives ADHD awareness

Professor Renata Schoeman – a general psychiatrist based in Bellville, Cape Town – has been instrumental in driving awareness and intervention for attention deficit hyperactivity disorder (ADHD) in South Africa.

She was one of the first researchers in South Africa to:

• Study ADHD
• Publish about adult ADHD
• Write the SA guidelines on the management of adult ADHD
• Establish the SA Society of Psychiatrists Special Interest Group for ADHD.

“This has highlighted the need for mental health interventions in underprivileged areas,” she says.

In 2017, Prof Schoeman co-founded the Goldilocks and the Bear Foundation with entrepreneur Nic de Beer. The Foundation’s mission is to make sure that all children with ADHD and other mental health barriers to education have the necessary support to reach their full potential. It provides screening services for the early identification of children with ADHD, other mental health disorders and learning difficulties. So far, the Foundation has visited 26 schools, brought mental health services to 21 781 children and screened 1 020 children. It has identified 419 children with ADHD and diagnosed 78 children with anxiety disorder and depression.

The Foundation has recently completed a book aimed at children, parents and teachers which addresses ADHD, due to launch on 1 November 2019.

Prof Schoeman says stigma is a major barrier to mental health in South Africa. “In my practice and as a lecturer at the University of Stellenbosch Business School, I’ve become aware of the stigma individuals struggling with mental health disorders face and how it prevents them from seeking support and treatment.” This drives her passion to improve corporate mental health awareness – in which she closely collaborates with Prof Christoffel Grobler (scroll down for more on him).

She hopes that mental healthcare in South Africa will become more accessible and efficient. “I hope for an environment where every child can develop to their full potential, and where adults can flourish into leaders,” she says. “We need to have conversations about mental health as frequently as possible, in as many environments as possible, and on as many platforms as possible.”

In 2006, Prof Schoeman received a Discovery Foundation Academic Fellowship Award to pursue her PhD at the University of Stellenbosch. “The award enabled me to do fulltime research for about 18 months, which launched my PhD, allowed me to receive training abroad, and expand my horizons. It grounded me academically and opened the doors to many other opportunities.”

Professor John Joska helps Discovery Foundation build leaders

Professor John Joska, although not a Discovery Foundation award recipient himself, has been instrumental in supervising our mental health sub-specialists:

• Professor Jackie Hoare (2010/11)
• Dr Carla Freeman (2012/13)
• Dr Engelina Groenewald (2013/14)
• Dr Lindokuhle Thela (2017/18)

“They are all now neuropsychiatrists playing a role in healthcare settings across South Africa,” says the Head of the Neuropsychiatry Division and Director of the HIV Mental Health Research Unit at the University of Cape Town and Groote Schuur Hospital.

As a neuropsychiatrist, Prof Joska works with people suffering from a range of neuropsychiatric disorders, including HIV and traumatic brain injury. He mentions that mental health is chronically underfunded in South Africa. “There is a huge treatment gap for persons suffering with mental disorders in South Africa. We need a lot more evidence on approaches to assessment and treatment. And all of this within a shrinking financial envelope.”

Prof Joska says to improve the mental health of more South Africans, we need to implement a national mental health strategy, reduce mental illness stigma and direct more funds to mental health. “It needs to be afforded the same status as any other discipline,” he asserts.

Prof Joska hopes for “better funding, more resources in primary healthcare and districts, improved access to care, and better engagement between providers and policy makers”.

Professor Jackie Hoare addresses stigma within healthcare services

“Mental health services for adolescents living with HIV are vital to fight the battle against HIV and AIDS,” says Professor Jackie Hoare, who received a Discovery Foundation Academic Fellowship in 2008 and was supervised by Prof Joska.

“This fantastic award provided me with funding and time to be the first MPhil candidate in Neuropsychiatry in South Africa and laid the foundation for all subsequent research,” she says.

Today, Prof Hoare is a neuropsychiatrist consulting at Groote Schuur Hospital and an associate professor at UCT. She’s also the Head of the Division of Consultation Liaison Psychiatry at UCT, a research scientist and co-director of the UCT HIV Mental Health unit. Her clinical work includes treating mental illness, neurocognitive disorders, and adherence (the degree to which a patient correctly follows medical advice) in adolescents and adults with chronic illness.

Prof Hoare says AIDS is the leading cause of adolescent deaths in Africa today. She is passionate about giving adolescents access to better mental healthcare.

“Research has shown that young people who are optimistic about managing their condition had more favourable treatment outcomes and recovery from illness compared to those who did not,” she explains. “Research has also shown that children who viewed themselves as different and less worthy than their peers because of their illness were likely to become withdrawn, socially isolated, have poor self-concept, lowered academic functioning and behavioural problems.”

Prof Hoare aims to help reduce the stigma of HIV and mental illness. “Adolescents living with chronic illnesses who internalise, experience and anticipate stigma within healthcare contexts may avoid accessing care and, in turn, experience decreased quality of life,” she asserts.

“We need a stronger understanding of stigma within healthcare contexts among adolescents living with chronic illnesses.”

Professor Rita Thom – mental health is fundamental to general health

Professor Rita Thom, a Johannesburg-based generalist psychiatrist, hopes that “mental healthcare will be recognised as fundamental to general health and wellbeing and that the inequity between the rich and the poor in terms of access to quality care will be addressed”.

Prof Thom received a Rural Distinguished Visitor Award in 2010 to provide mental health support to generalist healthcare providers at the Dr Ruth Segomotsi Mompati District and the Ngaka Modiri Molema District in North West Province and Tintswalo Hospital in Mpumalanga from 2011 to 2014. Her diverse interests include adult psychiatry, child and adolescent psychiatry, neuropsychiatry, and public mental health.

Prof Thom is currently the chairperson of two projects of major significance:

• A consensus study on provider core competencies to address the mental healthcare needs of the nation conducted by the Academy of Science of South Africa
• A public-private partnership task team of the South African Society of Psychiatrists, which is investigating how to make best use of the scarce psychiatric resources in South Africa

Prof Thom says when it comes to mental health in South Africa, we need to address the lack of resources, both human and infrastructure, as well as the inappropriate allocation of resources.

“There is marked inequity in access to mental healthcare across the country, with the poor in rural areas having the least access. There is a lack of understanding and implementation at many levels regarding the most appropriate interventions for improving mental wellbeing and treating mental disorders. There is still a great deal of stigma surrounding mental illness,” she says.

To improve the mental health of more South Africans, all mental health providers at all levels of care need to be involved. “This requires integration of mental healthcare into general healthcare, with appropriate training and mentoring of generalist health providers. We need to use all community-based resources to provide comprehensive care, including rehabilitation and recovery-oriented treatment. We also need to improve in-patient facilities at general hospitals to protect the dignity of people with mental illness.”

Professor Christoffel Grobler supports mental health in the workplace

Professor Christoffel Grobler says to improve the mental health of more South Africans, we need to normalise the conversation in the workplace about mental illness.

Prof Grobler specialises in corporate mental health and psychiatric impairment assessments for the insurance industry. He works closely with Dr Maritha van der Walt from Discovery Life and Prof Renata Schoeman.

The Walter Sisulu University professor and Clinical Head at the Elizabeth Donkin Hospital in Port Elizabeth received a Rural Distinguished Visitor Award in 2014 and 2015. He provided psychiatric outreach services to patients in various Eastern Cape hospitals who were not reviewed regularly or to who had been potentially mismanaged.

Prof Grobler summarises South Africa’s unique health challenges that we need to address:

• Destigmatisation of mental illness through psychoeducation and mental health first-aid training
• Advocating for retaining employees with mental illness through the use of reasonable accommodation
• Disability prevention.

His hopes for the future of mental healthcare in South Africa? “That employers will be much more aware of the extent of mental illness and the numbers of their employees suffering from mental illness statistically. Employers need to become part of the solution – at present they are part of the problem.”

Dr Michele Parker takes care of the elderly’s mental health

In 2016, Dr Michele Tracy Parker received a Discovery Foundation Sub-Specialist Award to study Geriatric Psychiatry through the University of Stellenbosch and the Colleges of Medicines of South Africa. At present, there are no more than five registered sub-specialists in South Africa in psychiatry of the elderly. Dr Parker divides her time between private practice and Stikland Hospital in the Western Cape.

“I am particularly interested in the mental health needs of the elderly. South Africa is one of the most rapidly aging countries in Africa. By 2030 there will be seven million people over the age of 60,” she says. “People are living longer and that makes them increasingly vulnerable to the common mental illnesses associated with old age, such as dementia. Added to this, our social structures are often not geared towards elder care – for example, the children of the elderly are, in many cases, working adults who are unable to care for the day-to-day needs of their parents. Many people are also unaware of the psychiatric services that do exist and the resources that are available.”

Dr Parker believes that all South Africans should know more about mental illness. “People need to be aware of the common symptoms of mental illness, so that they can encourage employees, family members, colleagues and friends to seek the professional help they need. People also need to be aware of the referral pathways so that those affected by mental illness can receive help timeously. Increased knowledge about mental health issues would decrease the stigma that is unfortunately so often associated with mental illness.”

Dr Parker hopes that society will start seeing mental illness as a disease like any other. “My hope is that destigmatising mental illness will encourage people to use the mental healthcare services that already exist in our country,” she says.

“I would love to see an increase in community-based mental healthcare, with more collaboration between the formal mental healthcare sector and the informal sector (NGOs, faith-based organisations, employers, etc). My hope is that mental healthcare in South Africa will receive the necessary attention and finance necessary to meet the ever-increasing need.”