Prof. Bonginkosi Chiliza, MD, PhD - Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal

The first case of COVID-19 in South Africa was confirmed at the beginning of March 2020. The government’s response was to institute a nationwide “hard lockdown” before the end of the month (Abdool Karim, 2020). South Africa instituted severe restrictions in order to prepare the health system for the expected onslaught of cases with COVID-19 infections. The government has been lauded for their early robust response to the pandemic; however, the severe restrictions could not be sustained as the deleterious socio-economic consequences became quickly evident. South Africa has one of the lowest COVID-19 mortality rates in the world due, perhaps, to our relatively young population age and the response to the pandemic. 

The mental health response has focused on planning and the rapid generation of policy and protocols. We have comprehensive guidance on mental health interventions that should be implemented during the COVID-19 disaster. However, the effects of the pandemic and the subsequent lockdown had significant negative impact on many mental health care users. Many users with severe mental illnesses became too afraid to utilise our services. Some were impatient with the new regulations for COVID-19 screening, resulting in a number of users defaulting on treatments with subsequent increases in relapses in the last few months. We have also seen some ethical challenges where the triage policies for access to limited resources have excluded people with severe mental illnesses. 

The COVID-19 pandemic and the measures put in place have led to increased rates of loneliness, fear, anxiety and depression. Two rapid general population surveys that have been published point to rising levels of distress and increased utilisation of services. One of our philosophy, so-called UBUNTU, states that, “I am, because we are.” Therefore, the very idea of being human is being connected to other human beings. The necessary social distancing in a country that has low levels of smart phone technology penetration has led to calls to ramp up larger psychosocial responses in order to prevent mental illnesses and promote resilience and mental wellbeing. The pandemic has also put a spotlight on the ‘humaneness’ of doctors and nurses on the frontlines. The multitude of posts on social media prompted the South African Society of Psychiatrists to come together with other organisations to form a HealthCare Workers Care Network. The network offers seminars and workshops to health care leaders in an effort to improve the work place in order to promote mental wellbeing of all front line workers. The network also offers free psychological first aid, by volunteer psychiatrists and psychologists, to any worker in the front lines.

Lastly the monthly webinars organised by the Africa Global Mental Health Institute (AGMHI) have answered the call of many psychiatrists in our country for urgent information on how to deal with the mental health outcomes of the pandemic. The AGMHI is currently fulfilling its vision of equipping mental health professionals in Africa and the diaspora with the tools and agency to effectively care for those suffering from mental illness, by organising the most amazing dialogues. The webinars have ranged from dealing with mental health issues in resource-constrained settings to racism and mental health in the context of the Black Lives Matter at the end of July 2020.

REFERENCES

1. Abdool Karim SS. The South African Response to the Pandemic. N Engl J Med. 2020 Jun 11;382(24):e95. doi: 10.1056/ NEJMc2014960

2. Grillo A, Ghebrehiwet S, Johnson K, Borba CPC, Fricchione GL, Sorel E, Durham M, Chiliza B, Motlana M, Henderson DC. The African Global Mental Health Institute: Increasing capacity, inclusivity and translation of psychiatric research and care. The Journal of Global Health, Oct 2019