During the launch of the UN policy brief, COVID-19 And The Need for Action on Mental Health, the United Nations highlighted the need for governments to put measures in place to protect their citizens’ mental health. Sadly, as the world frantically fights COVID-19, other conditions requiring routine medical care, such as HIV, TB and mental illness have taken the back burner, and the repercussions will be felt. The World Health Organisation estimates that over 800 000 people commit suicide every year. The organisation’s director for the Department of Mental Health and Substance Use, Devora Kestel, says past economic crises increased the number of people with mental health issues, resulting in higher suicide rates.
Recently a search was launched for a Durban couple who had allegedly made a suicide pact precipitated by their financial difficulties. The comments that came are a stark reminder for the urgent need to raise awareness on suicide ideation and how to respond to it. The husband and wife were dragged on social media and were accused of cowardice and selfishness for wanting to kill themselves, leaving their children without carers. Fortunately, they found their way back home alive.
In most indigenous African communities, there is a huge stigma attached to mental health problems, and this is primarily because of poor understanding of the psychiatric conditions, and not much being done by relevant authorities to raise awareness. In Zimbabwe, and I presume other societies on the continent as well, psychiatric conditions are usually attributed to witchcraft and vengeful spirits or angry ancestors haunting the family. As a result, many people who are aware of their mental illness chose to suffer in silence than get a proper diagnosis and treatment, which they are well aware will be accompanied by stigma. Not many families seek medical attention for mental illness, choosing instead to visit traditional healers and prophets. Untreated mental illness can spiral to suicides, which is also blamed on evil spirits.
Back in the day, when a person hanged himself in the forest, a grave would be dug directly beneath the body. The rope would then be cut, and whichever way the body fell, that’s how it would be buried. Although people who die of self-harm now get considerably better burials, the stigma and contempt is still very much evident. While normally there are night vigils following a death in the family, a person who dies from suicide is not accorded one. The wailing that is a typical feature of African funerals is even forbidden, and loved ones are forced to sob quietly. At funerals of people who die of acceptable causes, a cow is slaughtered to feed mourners, but in the case of suicide, that is never done. No celebration of life. No after-tears. The person is buried in an isolated area, far from other family members, and his worldly possessions, especially clothes, are buried with him to avoid the spirit that motivated him to take his life lurching to potential recipients. There needs to be a shift in society to view suicide as something not to just be feared, but confronted and actively prevented.
The COVID-19 crisis has led to high levels of distress for various reasons. Governments around the world imposed lockdowns to put a lid on the fast-spreading pandemic, and people with certain levels of mental health problems, who could have benefited from socialising or keeping busy found themselves imprisoned in their homes, with nothing but their dark thoughts to keep them company. The fear of contracting the virus itself drove many into panic mode. The pandemic has many tentacles that have affected people in various ways. Those who lost loved ones had to contend with mourning in solitude to obey lockdown regulations, and also to minimise the risk of transmitting the virus to other people, if they had been in contact with the deceased family member. With borders closed, a number of migrants had to watch funerals of their parents or other loved ones online, as travelling home would have meant being quarantined, if they had the means to go home. Talk about company closures leading to massive job losses and salary cuts, at a time when not much hiring is being done, the impact of COVID-19 is driving people over the edge there couldn’t be a better time like the present to raise awareness on suicide.
The disdain psychiatric patients endure from society starts from the top, and that’s where the redress must also come from. Way before the pandemic, people with mental illness in South Africa were already suffering as a result of poor policies. A case in point is the Life Esidimeni scandal, where about 1300 psychiatric patients were transferred from a private healthcare provider to their families, non-governmental organisations (some of them unregistered and ill-equipped), and other hospitals. As a result of this move, at least 143 of the patients died from causes that included neglect and starvation, while others could not be accounted for. Against this background, if cases of mental illness escalate, it could easily turn into a crisis of monumental proportion. The South African Depression and Anxiety Group said calls to their helpline had more than doubled during the lockdown. Bearing in mind that not everyone has access to helplines, or the capacity to seek help, it is clear that another calamity is brewing. Experts say most suicides are preventable, but some work has to be put in for that to happen. Governments, civic society, and ordinary citizens should do more to look out for the vulnerable.