(Volume 4) - Mental Health Disorders - Vula - University of Cape Town

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Background to the Burden of Disease ProjectThe burden of bisease is a measure of the impact of disease, in terms ofdisability caused and life lost, in a particular population. Results of the firstGlobal Burden of Disease Study were released by the World HealthOrganisation in 1993 and since this time many countries make use of thismethodology for health priority setting (Murray & Lopez 1996).Following an initiative from the provincial head of the Department of Health, aProject Task Team was appointed to delineate the extent of the burden ofdisease (BoD) in the Western Cape Province in order to identify the maincontributors to the BoD in the Province. Five disease groups were identified asthe largest contributors to the total burden of disease in the Western Cape, asshown in Table 5 below. Five corresponding workgroups were constituted todevelop policies aimed at preventing these diseases from occurring and in sodoing significantly decreasing the burden of disease in the Province.Table 5: The main contributors to the Burden of Diseasein the Western Cape ProvinceDisease group1. Major Infectious diseases2. Mental disorders3. Cardiovascular disease4. Childhood diseases5. InjuryIn order to develop effective preventive policy and programme recommenddations,each of the five workgroups were tasked with identifying the maindeterminants (risk and protective factors) of their disease group. Inrecognition of the strong links between disease and socio-structural factors(such as poverty and the lack of sanitation, for example), the workgroupswere asked to concentrate on developing interventions targeting theupstream 1 determinants of health. This approach is in line with contemporaryhealth-promotion initiatives which aim to address the “causes of the causes”.The Mental Health WorkgroupThe Mental Health Workgroup was established by the Burden of DiseaseProject in May 2006 and consists of a consortium of public-health and mentalhealthexperts drawn from academic institutions, Provincial GovernmentDepartments and Non-Governmental Organisations. The group consists of asmall number of authors and a larger group of peer and expert reviewers (seeAcknowledgements above).1 The term upstream refers to the structural and societal determinants of health that may act bothindirectly or directly to cause disease and/or disability15
The aim of the Mental Health Workgroup is to devise recommendations forinterventions to reduce the burden of mental illness in the Western CapeProvince of South Africa. The main focus is on preventing common mentaldisorders such as depression, substance abuse, childhood behaviouraldisorders and Post-Traumatic Stress Disorder. By implication, the aim is toprovide interventions that promote and sustain mental health.In order to identify the most appropriate interventions, evidence on risk andprotective factors relevant to mental health in the Western Cape was soughtand discussed. A subset of core risk/protective factors was then selected andevidence for quality and utility of interventions targeting these factors furthersought. Once appropriate interventions had been identified, the gaps in suchinterventions were noted. The recommendations presented here are thus theculmination of the analysis of risk factors, evidence for interventions, gaps incurrent programmes, and the policy context in the Western Cape Province, asshown in Figure 3 below on page 17 below. The results of this process arepresented in this report.Economically speaking, the impact of mental illness is vast with annual costsof mental disorders amounting to $147 billion in the United States and 3-4%of the Gross National Product in the European Union (WHO, 2005). In SouthAfrica, data of this kind is not available, but - for alcohol abuse alone - theannual economic costs are estimated at between 0,5 and 1,9 percent of thecountry's Gross Domestic Product. This translates to about R8,7-billion ayear, and – when the costs of drug abuse are added – rises to at least R10-billion a year (Benjamin, 2006). It is noteworthy that across the globe, themajority of financial costs incurred are due to absenteeism and decreasedproductivity rather than costs of mental health care.In terms of population health, mental illness results in significantly greaterdisability than most physical illness and as such accounts for a largeproportion of the Burden of Disease. According to the World HealthOrganization, 25% of people will develop a mental or behavioural disorder intheir life-time and – at any point in time - 10% of the adult populationworldwide will have a mental disorder (WHO, 2004). Five of the ten leadingcauses of disability, moreover, are classifiable as psychiatric conditions(including depression and alcohol abuse) (WHO, 2004). Depression is furtherpredicted to become the second leading cause of disability worldwide in 2020(WHO, 2004).In the Western Cape Province, more than 22% of all disabilityhas an emotional or cognitive origin (Statistics South Africa 2001).The impact of mental health will be grossly underestimated, however, if oneexcludes the impact it has on physical illness, since mental disorders areassociated with substance abuse, smoking, and unsafe sex, and as suchmental illness results in a higher risk for injuries, cardiovascular disorders,and HIV (Herman & Jané-Lopis, 2005) - all of which are major contributors tothe Burden of Disease in the Western Cape Province. Considered in this light,mental health is itself an ‘upstream’ determinant of multiple health outcomes.16
Page 1 and 2: Western Cape Burden of DiseaseReduc
Page 3 and 4: AcknowledgementsAuthorsDr Joanne Co
Page 5 and 6: illion a year. When the further cos
Page 7 and 8: Table 2: Percentage contribution of
Page 9 and 10: I Multiple Deprivation1. Improve ac
Page 11 and 12: 11.Evaluate and support Non-Governm
Page 13 and 14: interventions. More broadly, the su
Page 15: Figure 2: An example of how interve
Page 19 and 20: Why mental health is necessary: the
Page 21 and 22: Medical Research Council/ UNISA. (2
Page 23 and 24: FindingsWhile the findings of the r
Page 25 and 26: The literature review also identifi
Page 27 and 28: Table 7: Selection criteria with re
Page 29 and 30: Cape Province. Furthermore, such an
Page 31 and 32: On the other hand, the Provincial G
Page 33 and 34: the quality of building materials,
Page 35 and 36: Conclusion‣ The Western Cape can
Page 37 and 38: association and the evidence on the
Page 39 and 40: Figure 7: The relationship between
Page 41 and 42: The Michigan Prevention Research Ce
Page 43 and 44: y 11-34% (Ficano et al, 2006). This
Page 45 and 46: through the stresses associated wit
Page 47 and 48: ‣ an insufficient recognition of
Page 49 and 50: ‣ Community buy-in and participat
Page 51 and 52: understand the relationship between
Page 53 and 54: ‣ Ensure ongoing training and sup
Page 55 and 56: Evans, G.W., Wells, N.M., Moch, A.
Page 57 and 58: Vic Health.(2007).www.health.vic.go
Page 59 and 60: 1999; Stenius & Veysey, 2005) — a
Page 61 and 62: Collaborating Centre for Mental Hea
Page 63 and 64: Conclusion‣ Some types of early i
Page 65 and 66: ‣ Self-awareness training should
Page 67 and 68:
‣ Non-Governmental Organisations
Page 69 and 70:
g) Any disaster plans for the Weste
Page 71 and 72:
National Institute of Mental Health
Page 73 and 74:
The legal regulation of substances
Page 75 and 76:
‣ Media campaigns are shown to be
Page 77 and 78:
3.1. Social-influence model‣ Emph
Page 79 and 80:
Conclusion‣ Reducing the availabi
Page 81 and 82:
‣ Marital and family therapy has
Page 83 and 84:
emphasis on broader environmental f
Page 85 and 86:
Table 10: Governmental intervention
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D. RecommendationsThe recommendatio
Page 89 and 90:
Ferri, M., L. Amato, et al. (2006).
Page 91 and 92:
IV. MENTAL HEALTH SERVICES(return t
Page 93 and 94:
Table 12: Categories of mental-heal
Page 95 and 96:
opportunities and rewards for bully
Page 97 and 98:
‣ Culturally appropriate interven
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Some health services in schools are
Page 101 and 102:
2.1. Core features of workplace-bas
Page 103 and 104:
2.3. Existing interventionsWhile th
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to be representative of the general
Page 107 and 108:
• Trauma units and surgery casual
Page 109 and 110:
Similar models may be generated for
Page 111 and 112:
Table 15:. Estimated needs for ment
Page 113 and 114:
D. Recommendations1. School-based m
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Invest in media campaigns that aim
Page 117 and 118:
Browne, G., Gafni, A., Roberts, J.,
Page 119 and 120:
McLoone, J., Hudson, J. L., & Rapee
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for Economic Sciences, economist Ja
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employment, which is protective aga
Page 125 and 126:
turnover, positive and committed at
Page 127 and 128:
only one quarter of the community-b
Page 129 and 130:
Ou, S. & Reynolds, A.J. (2006). "Ea
Page 131 and 132:
leisure significantly predicts posi
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Conclusion‣ There is evidence tha
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Petticrew, 2003). South (2004) repo
Page 137 and 138:
4. Environmental factorsHealthy nei
Page 139 and 140:
• Include non-competitive sports
Page 141 and 142:
Table 17: Recreational activities t
Page 143 and 144:
ReferencesArgyle, E., & Bolton, G.
Page 145 and 146:
Marine, A., Ruotsalainen, J., Serra
Page 147 and 148:
educing falls among elderly people:
Page 149 and 150:
economic opportunities and assets.
Page 151 and 152:
Table 19: The impact of recommended
Page 153 and 154:
V. Implementationi. Integrating int
Page 155 and 156:
programme is first implemented) wit
Page 157 and 158:
Appendix 1Literature review of the
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Conclusion: There is strong evidenc
Page 161 and 162:
achievements and successes in the s
Page 163 and 164:
• The built environment influence
Page 165 and 166:
Evidence from cross-sectional surve
Page 167 and 168:
and substance abuse disorders among
Page 169 and 170:
isk for physical ill-health, which
Page 171 and 172:
Conclusion: The evidence demonstrat
Page 173 and 174:
has shown that the most poor are un
Page 175 and 176:
1.9. Transport Back to IndexNo arti
Page 177 and 178:
nine provinces ranging from 0.20-0.
Page 179 and 180:
(Bhugra, 2004). Furthermore, the li
Page 181 and 182:
1.12. Spatial segregation Back to I
Page 183 and 184:
conversely, substance abusers were
Page 185 and 186:
Conclusion: The evidence for urban
Page 187 and 188:
Again, the likelihood is that this
Page 189 and 190:
this instance are (Kaliebe & Sondhe
Page 191 and 192:
2.4. Race Back to IndexA review of
Page 193 and 194:
females 3.8 times as likely to have
Page 195 and 196:
teacher burnout (Hastings & Bham, 2
Page 197 and 198:
2.7. Personal experience of abuse o
Page 199 and 200:
A review of literature in the devel
Page 201 and 202:
studies: one (Dalgard & Tambs, 1997
Page 203 and 204:
Section 10. Human dignitySection 12
Page 205 and 206:
punishment, which explains the effe
Page 207 and 208:
health or social harm (a pattern co
Page 209 and 210:
McKee, Karasz, & Weber (2004) descr
Page 211 and 212:
abuse, HIV related stressors and Ai
Page 213 and 214:
methodological problem of recall bi
Page 215 and 216:
• Maternal substance using during
Page 217 and 218:
childhood to adulthood. While these
Page 219 and 220:
American Psychiatric Association (1
Page 221 and 222:
Bursik, R. (1988). Social disorgani
Page 223 and 224:
De Vries, M. W. & Wilkerson, B. (20
Page 225 and 226:
Funk, M., Saraceno, B., Drew, N., L
Page 227 and 228:
Jin, R., Shah, C., & Svoboda, T. (1
Page 229 and 230:
Leatt, A., Rosa, S., & Hall, K. (20
Page 231 and 232:
Mulvihill, D. (2005). The health im
Page 233 and 234:
Patel, V. & Kleinman, A. (2003). Po
Page 235 and 236:
Rosenheck, R., Dausey, D., Frisman,
Page 237 and 238:
Stukas, A., Dew, M., Switzer, G., D
Page 239 and 240:
Whitaker, R., Phillips, S., & Orzol
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(Volume 4) - Mental Health Disorders - Vula - University of Cape Town

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