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The rapidly rising tide of mental illness in the workplace is a serious risk to business sustainability, writes Dr Fundile Nyati

In 1948, the World Health Organisation (WHO), who are the custodians of all matters health from a global context, defined health as “a state of complete physical, mental, and social well-being, and not just the absence of disease and infirmity”. Since then, this bio-psycho-social (BPS) definition of health by the WHO has not been officially revised, even though many leading thoughtleaders in healthcare led by American philosopher, scholar, and medical ethicist at the Kennedy School of Ethics, Dr Daniel P. Sulmasy, has in the past two decades been advocating for an expanded health definition that includes spiritual health as the fourth pillar, thereby forming an unofficial broader definition of health being Bio-Psycho-Social-Spiritual (BPSS).

Looking at the original and official WHO holistic definition of health, one of the key pillars of BPS holistic health is #MentalHealth. So, if we then zoom into this key pillar of mental health, we further need to define it, to ensure that we have a common point of departure or understanding, before we delve deeper into it. So, what is #MentalHealth? The answer is that it is “a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to his or her community”.

Therefore, looking at the definition of #MentalHealth, the optimal levels of #MentalHealth for everyone demands good performance on four key abilities; firstly, being to realise one’s own potential; secondly, the ability to cope with normal day-to-day life stresses; thirdly, to be productive or fruitful in one’s endeavours; and, fourthly, the ability to add value to one’s community or society. So, to fulfil the above definition of mental health, one ideally must score well in all the four key requirements of optimal mental health.

Now that we have dispensed with the foundational definition issues of health broadly, and #MentalHealth specifically, we can now proceed with our topic of discussion for this latest instalment of my #HealthMatters article, that being the ‘rapidly rising or burgeoning prevalence of #MentalIllness or #MentalDisorder locally here in South Africa, and globally’. As you can see from this previous sentence, I have just introduced two key concepts of #MentalIllness or #MentalDisorder, and it is important that I clarify these as well.

What is #MentalIlness or #MentalDisorder? A person with a #MentalDisorder or #MentalIllness is a person whose mental health is not in an optimal state, meaning they do not completely fulfil the broad definition of #MentalHealth as defined herein above, in that the underlying disturbance in their state of #MentalHealth makes them to have a mental dysfunction, which negatively affects their abilities at home; or at work; or in society in general; or on two or all three levels.

Because of the #WorldMentalHealthDay on the 10th of October of every year for the last 31 years, the month of October has now been designated #MentalHealthMonth in the annual health calendars of most countries, including by our own National Department of Health (NDoH), here in South Africa. So, the theme of #WorldMentalHealthDay2023 was “#MentalHealth is a universal human right”. This theme resonates a lot with us here in South Africa because, generally, there is a big problem of inequity of access to affordable, quality healthcare for most of our people.

The problem of health inequity with regards to access to affordable, quality #MentalHealth care is even worse, both in the public health sector and the private health sector, the latter largely funded by private medical schemes and out of pocket self-funding. When one looks at the public health sector, or private health sectors, there is a clear and severe bias in favour of physical healthcare, at the detriment of #MentalHealth care, when it comes to strategic and operational prioritisation, which is then reflected in the resourcing allocations, for example, budgeting for necessary facilities, necessary supporting infrastructure, staffing etc.

In the private health sector, generally, the medical schemes have a disproportionate allocation of benefits in favour of physical health challenges, as opposed to allocations for #MentalHealth challenges, yet the latter group is now arguably a top five driver for people to seek health professional help at all levels of healthcare services.

In recognition of the fact that healthcare is a basic human right, Section 27 (1) of our national Constitution here in SA says everyone has a right to have access to healthcare services, including reproductive healthcare, and no one can be refused emergency medical treatment. On the ground, the reality is however different, especially when it comes to #MentalHealth care, hence the relevance of this year’s theme for the overwhelming majority of South Africans, of all levels of the social strata.

#MentalHealth challenges are very democratic or non-discriminatory because none amongst us is immune to suffering from them; they affect people of all walks of life/social strata; they affect people of all races or ethnic group; they affect people of all genders or sexual orientation; and they affect people of all income levels. Prevalence wise, the situation was already very worrying before the COVID-19 pandemic, now as we negotiate the post-COVID-19 era, the situation has gone from bad to worse.

To illustrate the magnitude of the #MentalHealth tsunami that we are facing here in South Africa, at a recent #WorldMentalHealthDay event that was hosted by Discovery Group at their head office in Sandton, various speakers or experts in the field shared some very worrying statistics and trends.

Ms Cassey Chambers, who is the Operations Director of the South African Depression and Anxiety Group (SADAG), shared some worrying statistics from their operations. She shared that in South Africa today, 1 in 3 people experience a mental health issue, yet of those people only 1 in 10 of them (10% of them) access the necessary treatment and support. Further, Ms Chambers shared that before COVID-19, their toll-free helpline used to handle 600 calls per day, and now it handles 3 000 calls per day, a five-fold increase in the helpline utilisation. In addition to the calls made to the helpline, they also handled hundreds of SMS messages, e-mails, and social media interaction requiring help with #MentalHealth issues.

From a workplace perspective in South Africa, pre-COVID-19, a research study that was led by Professor C. Lundt from the University of Stellenbosch found that on average, at least 1 in 4 employees (25%) experienced #MentalHealth challenges. What was even more worrying as a finding in that study was that only 25% (a quarter) of the employees who were struggling with #MentalHealth challenges, sought professional help and disclosed their #MentalHealth challenges in their workplaces.

What the Stellenbosch University-conducted study finding meant therefore was that 75% (three quarters) of the employees who have #MentalHealth challenges were most likely untreated, and obviously their situation was worsening with time, thereby negatively affecting their work productivity due to sick absenteeism and presenteeism (being present at work, yet with sub optimal levels of productivity). In trying to explain the possible reasons why three quarters of the affected employees opted not to seek professional help or disclose to their employers, the issue of fear of stigmatisation and possible discrimination or victimisation played a big role. So, the workplace culture and climate, as well as levels of knowledge and awareness, are important determinants with regards to whether employees seek professional help, and disclosure to employers.

Discovery Health Medical Scheme (DHMS), which constitutes 57.8% (2.8 million members) of open medical scheme members in South Africa, revealed that in their scheme the prevalence of #MentalHealth conditions as a proportion of claims has increased from 11.3% in 2018 to 13.5% in 2022. Further, DHMS shared that as a proportion of medical scheme claims, the prevalence of the major psychiatric mental condition of depression increased from 6.3% in 2018 to 8.1% in 2022. It was further shared that depression as a major psychiatric diagnosis accounted for 60% of all claims with a psychiatric diagnosis, and it was mainly amongst young adult female members. So, the increasing prevalence of mental health conditions as seen by SADAG as reported above, is also being seen by the market leader in the medical scheme industry.

Discovery Life, which is a sister company to DHMS, also shared their current experiences regarding #MentalHealth trends on their life insurance business. They shared information that anxiety and depression, which are the most common major mental disorders/illnesses in South Africa can reduce longevity by as much as 7.9 years. They shared that in their environment, #MentalHealth impact is reflected in their claims experience on two levels, their Income Continuation Benefit for Temporary or Permanent Disability, as well as Death Claims due to suicide incidences.

With regards to suicide claims, they shared that these had increased by 13% in 2022 in comparison with 2019 to 2022 period, and 24% increase in comparison to the 2016 to 2018 period. Further, they shared that they had observed a 149% increase in suicide claims amongst the younger age groups under 30 years of age, when they compared the current year 2023 to similar period in 2019-2021. From a gender perspective, they revealed that suicide claims were 2.2 time more likely to be made for male members as opposed to female members, whilst for the Income Continuation Benefit, it was 1.8 times more likely to be made by female members than male members.

So, it should not be a surprise that South African workplaces are having a high prevalence of employees with #MentalHealth challenges, because they draw their staff complement from a South African society that is experiencing a significantly high prevalence (33% prevalence) of #MentalHealth conditions.

This high prevalence of #MentalHealth conditions amongst staff in South African workplaces, reveals itself with increasing trends of sick-related absenteeism (short and long), presenteeism, increasing frequency of injuries on duty, increasing staff conflicts, toxic management and leadership, disempowering toxic workplace climate, increasing turnover of staff moving away from toxicity, increasing rate of occupational temporary disability, and premature exits due to permanent occupational disability and deaths (suicides).

In her address at the #WorldMentalHealthDay event, Ms Chambers also shared the drivers of the increasing prevalence of #MentalHealth challenges, citing high levels of trauma, loss and grief, gender-based violence, crime, domestic abuse, divorce and separation, financial stressors, and day to day stressors. I would like to add long COVID (Post Covid Syndrome), a relatively new and still poorly understood clinical phenomenon, wherein those who contracted the COVID-19 disease (even those who had a mild illness) present with a wide variety of physical and mental health challenges, some of which are occupationally disabling. With regards to #MentalHealth, in the prestigious Lancet Psychiatry journal of April 2021, it was reported that at least a third of survivors of COVID-19 presented with a Major Neuro-Psychiatric diagnosis within six months of surviving the SARS-Cov-2 infectious disease.

So, managers and leaders of companies must identify #MentalHealth of employees as a major risk to the functioning and sustainability of their businesses, as such they MUST formulate effective forward-looking strategies, well-researched policies, and fund effective programmes to mitigate the negative impact of rising #MentalHealth prevalence in their workplaces. Lessons can be learnt from how in the early 2000s, companies effectively responded to the HIV and AIDS pandemic. Failure to plan and respond appropriately and effectively to this silent #MentalHealth epidemic will be tantamount to planning for failure to managing its downstream impact on the business operations, with disastrous results on the bottom line.

Dr Fundile Nyati is the Chairman and CEO at Proactive Health Solutions.