Enzo Sinisi, a clinical psychologist and practising psychoanalyst in Cape Town shares an in-depth look at how to access public mental health services.
South Africa (16 July 2020) – If you have reached the point where you know you need help, but you cannot access private health care and you aren’t sure where to turn next, then this article is for you. We will look at:
- What brings people to counselling and other mental health services?
- What if you do not want to or are not able or ready to meet with a mental health professional?
- How do mental health services in the public health system work?
- How do you find nearby services?
- In an emergency, what should you do?
- What if a family member or friend needs to go to the hospital but refuses?
Here are a few of the most common reasons a person decides to reach out (your reason might not be listed):
- Feeling overwhelmed, scared, sad, or panicked
- Believing you are inferior or worthless
- Intrusive and upsetting thoughts
- Battling in your relationships
- Working through trauma
- Struggling to function
- Wanting to grow
- Feeling ashamed
- Fearing intimacy
- Wanting to die
- Failing to cope
The first question to ask yourself is what do you need. Are you in a state of intense emotional distress and need to speak to someone right now? Has a doctor or loved one suggested that you see a counsellor or therapist? Do you feel ready (or able) to start meeting with a counsellor or therapist?
Therapy works best in the context of a relationship, such as when you meet with the same therapist over a period of time. But there are times when this is not possible. For example, you might feel too ashamed to start seeing (or be regularly seen by) another person. Or perhaps you need to speak to someone this second. Or maybe you have something you feel is too risky to share in person.
A phone-call away
If this sounds like you then a good first step would be to reach for the phone and to call one of the many valuable crisis lines, helplines, and suicide hotlines.
These lines are enormously helpful and usually offer a free 24/7 service that is entirely confidential. Trained counsellors answer the calls, and while they listen and may advise you, they will accept what you say without judgement and will not tell you what to do. Many also have access to a range of referral resources and so can connect you to other services if necessary.
Make the call; you have nothing to lose.
The South African Depression and Anxiety Group (SADAG) is an excellent choice. You can find their numbers listed here: http://www.sadag.org/.
Other quality services are also available. Click here for a list of suicide lines and hotlines.
I’m ready to see someone, now what?
Telephone, text and email support are all valuable and even lifesaving. However, there are advantages to meeting with and potentially starting an ongoing journey with a mental health professional. Regular meetings with the same professional offers both of you a chance to get to know each other and make it easier for the professional to assess and help you.
Thanks to South Africa’s community service program, it is now far easier to access medical doctors and psychologists than before, especially around cities. However, to maximise your chances, it is essential to understand how the public health system works and to follow the procedures carefully.
The South African health system prioritises community-based care.
Unless you face an emergency, your health care journey starts with a visit to the community clinic nearest to your home. Hospitals do not offer superior care to our clinics; instead, they aim to address more specific problems and then refer to community clinics.
Most people in need of counselling, or other mental health services, are not facing an emergency. They are ordinary people (like you and me) having a difficult time.
Life throws up challenges. Some we manage on our own, others with help from loved ones (if we are lucky enough to have some). Then some problems require expert hands, either because special skills are needed or because they can overburden our relationships.
How to find clinics and services
The internet is an excellent tool when it comes to locating clinics and other services. Unfortunately, many sites (including Google) hold outdated clinic contact details. These two websites are better than most.
- HealthSites is a list of all health facilities in South Africa. The website can be overwhelming, but it is comprehensive.
- TherapyRoute a user-friendly option that automatically displays nearby mental health services like community clinics, hospitals, NGO’s, and private facilities.
What if the phone rings or the number is wrong?
If you can’t get through by phone, visit the clinic and talk to the staff. Prepare by asking yourself the following questions…
- Can you describe the issue that brings you to visit the clinic?
- What do you want to see change?
- When did this all start?
- Why do you think it is happening?
- Do you have troubling symptoms e.g. cannot sleep, no energy, bad dreams?
- Do you want medicine, to talk to someone, or both?
- Has this happened before? What helped?
If you do get to see someone, it will most likely be a medical officer or a nurse. They will assess your situation and most likely either give an appointment, put you on a waiting list, or refer you to another clinic or hospital.
Clinics are medical spaces – Mental Health
The person assessing you will likely prioritise ruling out medical conditions. It is possible that counselling is not on top of their mind. If you are aware of an emotional need and would like to see a counsellor, you should ask to see one. Be polite and direct, for example: “I would like a chance to speak with a psychologist or counsellor. Please can you refer me to one?”
If possible, it can help to arrive with a letter from a private GP supporting the need for counselling.
Treating professionals will use their expertise to decide how best to proceed. They might decide that counselling is unnecessary, or that they do not have access to enough resources to provide it. Still, there is no harm in asking. It is also worth asking if another clinic (or NGO) could help.
How to get the most from counselling:
- Be open and honest. There is no sense in pretending things are better than they are.
- Focus on how you can change rather than on what others are doing wrong.
- Commit to the process. You will probably need to go more than once.
- Keep working between sessions by applying what was discussed, and taking note of what to talk about the next time.
- Feel proud of yourself.
How to access a hospital
Public mental health hospitals are considered secondary level facilities, which means one needs to be referred to them by a primary level facility.
New patients are required to bring a referral letter. Your community clinic, local GP or psychiatrist, will assist with this.
If you are a known patient of the facility, you may call your treating team and they will explain the steps to take.
Remember: Hospitals do not provide better care than clinics, they address specialised problems. There is no need to attend a hospital unless your situation requires it.
What if it is an emergency?
Emergencies are situations that require immediate intervention to reduce imminent harm or risk. In mental health terms, risk can include risk to someone’s personal or professional reputation.
If you (or someone) are experiencing an emergency, visit a nearby casualty/emergency department (preferably near your home). Ask a friend or family member to accompany you.
Answering yes to the following questions suggests risk.
- Are you experiencing overwhelming and incapacitating sadness or anxiety that prevents you from functioning?
- Are you struggling to control an impulse to kill or seriously harm yourself or another person?
- Have you started hearing and seeing things other people cannot hear or see?
- Have you started believing things that others say are delusional?
- Have your thoughts and movements slowed down dramatically?
- Are your thoughts racing faster than other people’s and are you unable to sleep?
- Has your behaviour become risky or hypersexual and are you acting out of character?
- Is this a new state (not a chronic diagnosed condition) and is it getting worse?
- Are you unable to function?
Answering yes to the following implies a lower risk.
- Are you confident that you can and will keep yourself and others safe?
- Are others confident that you are not a risk to yourself or society?
- Are you able to function in a productive way from day to day?
What to do if someone needs to go to the hospital refuses?
I am sorry if it applies to you since this is an experience that can be upsetting, difficult and scary. Fortunately, there are systems in place, and help is available.
If someone has a mental illness or suspected mental illness, they are a risk to themselves or others, and they refuse to go to the hospital – you can call the South African Police Services (SAPS). The Mental Healthcare Act 2002 (Section 40) obliges SAPS to assist in bringing the person to a nearby hospital or clinic that offers emergency services.
It is sometimes necessary to call the local station commander and remind them of their responsibility. Be polite; they do not do this every day.
What else can you do to help? Mental Health
Does the person have a psychologist or a doctor? If so, an accompanying referral letter from them can help improve the chances of being seen quickly. If necessary, TherapyRoute.com can help you find a private mental healthcare professional.
Ask the psychologist or doctor to call the emergency room, ahead of the patient, to discuss the case with the on-call doctor. If they do this, ask them to address the referral letter directly to that doctor.
Sometimes it helps to complete the paperwork beforehand. A family member or associate is required to complete a Form 4 (download here) before involuntarily admitting a patient. You can download the form here:.
The admitting doctor is required to complete a Form 5 (download here).
For more advice, contact the Mental Health Help Line on 0800 12 13 14.