The World Health Organization defines mental health as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to her or his community (WHO, 2014). This article will reflect on data collected through using narrative interviews of a research project about alcohol use in pregnancy. The aim of the research project was to understand alcohol use in pregnancy and the social context within which drinking during pregnancy takes place from women and their partners or family member’s perspective. The main purpose of this article is to highlight how mental health is shaped by the social, economic, and physical environments in which people liveand the need for access to psychological services in previously disadvantaged communities.
My research partner and I interviewed 25 participants from previous disadvantaged community in the Eastern Cape. Many of our participants are trapped in a cycle of poverty characterised by lack of formal education, unemployment and are dependent on social grants and causal work for living. The relationship between poverty and mental health is complex and has been associated with social marginalisation, lack of housing, malnutrition, violence, lack of adequate healthcare and the HIV/AIDS pandemic (van Wyk & Nadioo, 2006). The themes that emerged from our data include the following; HIV, sexual violence, unemployment, intimate partner violence, and poverty. This shows that mental well-being is shaped by many social inequalities (including inequalities) of the social, economic and physical environments in which people live.
Yet, mental health provision in South Africa is still characterised by unequal allocation of mental services and resources. Because, most psychologists tend to practice in areas and among clients who can afford their services (Vogelman, 1990). For example, listening to the stories of our participants about their living conditions, how they make sense of their alcohol use and traumatic events they went through in pregnancy highlighted the need to address the lack of availability of psychological services in disadvantage communities. This is not to say disadvantaged communities deserve mental health services more than other communities, but they should be equal access to psychological services for all.
The legacy of apartheid left a racially biased distribution of mental health care resources (Meyer et al., 2008). As a result, the minority of the country (white, middle class people in urban settings) receive volume of mental health services while the majority are left disproportionately underserviced (Chipps & Ramlall, 2012). We tried referring the participants in need of counselling to Non-Profit Organisations that offer counselling services for free but all of them were situated in Town and the participants could not afford taking taxicab for counselling session in Town. This shows that mental health care services remain centralised in large urban areas.
Consequently, people with mental health problems in socioeconomically communities use self-destructive behaviour as a coping strategy. Self-destructive behaviour includes personal habits and behaviour patterns which are harmful to health such as tobacco smoking, the excessive use of alcohol and drugs, violent and aggressive behaviour, suicide and cutting yourself (Haan, Dennill and Vasuthevan, 2005). For example, all our participants said that they drink alcohol to forget their problems and cheer themselves up. In addition, heavy drinking has been robustly linked to a variety of stressors, including relational problems such as marital disruption, intimate partner violence, poverty and involuntary unemployment (Choi et al., 2014).
In conclusion, the provision of access to mental health services to previously disadvantaged group is not given the priority it deserves in South Africa. Many disadvantaged communities still do not have access to psychological services despite a clear demand. To rectify the situation where most South Africans do not have access to basic mental health care, a costly development and extension of community mental health centres and staff is necessary (Vogelman, 1990). Also, there is a need to bring the mental health services to the previously disadvantaged communities and educate people about mental health.
References
Choi, K. W., Watt, M. H., MacFarlane, J. C., Sikkema, K. J., Skinner, D., Pieterse, D., & Kalichman, S. C. (2014). Drinking in the context of life stressors: a multidimensional coping strategy among South African women. Substance use & misuse, 49(1-2), 66-76.
De Haan, M., Dennill, K., & Vasuthevan, S. (2005). The health of southern Africa. Juta and Company Ltd.
World Health Organisation. 2014. May 13, 2018, from http://www.who.int/features/factfiles/mental_health/en/
van Wyk, S., & Naidoo, A. V. (2006). Broadening mental health services to disadvantaged communities in South Africa: Reflections on establishing a community based internship. Journal of Psychology in Africa, 16(2), 273-281.
Vogelman, L. (1990). Psychology, Mental Health Care and the Future: Is appropriate transformation in a future South Africa possible? In Social Science and Medicine, Vol. 31, No. 4.