Mental health care must go beyond treating symptoms and take into account the poverty, unemployment and difficult living conditions that can make recovery harder, a University of Pretoria (UP) professor says
Prof Nontembeko Bila, head of UP’s department of social work and criminology, made the argument during her inaugural address, where she introduced the Isiduli Framework, an African-centred approach to mental health social work grounded in the philosophy of Ubuntu
Bila said medication and therapy remained essential, but their effectiveness could be undermined when people returned to environments marked by poverty, unemployment, stigma, unsafe housing and inadequate support
“Coping skills cannot, by themselves, create a job, make a home safe or remove a barrier to care,” she said
She developed the framework to help social workers consider the wider circumstances affecting a person’s mental wellbeing, including:
- family relationships;
- community support;
- cultural beliefs; and
- socioeconomic conditions.
One in three South Africans will experience a mental health issue at some point in their lives, while only one in 10 people with a mental illness has access to mental health care or treatment
— Cassey Chambers, Sadag operations director
The framework takes its name from the isiXhosa word for a termite mound. Bila uses the structure, which is built and maintained through the collective efforts of thousands of termites, as a comparison for how people’s wellbeing depends on interconnected relationships and the social structures around them. It is built on four pillars:
- The first, Ubudlelwano, refers to relationships and connections with family, friends and communities that can link people to care and support.
- The second, Umoya oyiBambano, focuses on collective resilience and how communities share the burden of adversity through structures such as stokvels, burial societies, women’s groups and faith-based organisations.
- The third, Isisekelo, considers the role of spirituality, religious beliefs, cultural practices and other sources of meaning in how people understand mental illness and recovery.
- The fourth, Ukwelapha, focuses on addressing structural conditions such as poverty, inadequate housing, unemployment and barriers to health care.
Bila said the framework offered social workers a way to assess people’s lives beyond their symptoms
“A good assessment asks who feeds this person, who checks on them, and who they could call at two in the morning. Connection is never purely personal. It is also structural,” she said
Her research draws on studies involving people living with mental illness, caregivers, social workers and communities. This includes research in rural Limpopo examining how cultural and spiritual beliefs influence people’s understanding of mental health and decisions about seeking treatment
Bila also challenged the way African knowledge systems have been treated in academic research and professional practice, arguing that they should be recognised as ods, rather than simply being added as cultural examples to theories developed elsewhere
She said the framework did not reject international scholarship or clinical science but called for African concepts to contribute to the development of knowledge
Gap between need and access: Sadag
The challenges highlighted by Bila are also reflected in the experiences of people seeking mental health support operations director at the South African Depression and Anxiety Group (Sadag)
Chambers said the organisation hears daily from people whose mental health is affected by financial pressure, unemployment and difficult living conditions. For someone struggling to afford food, pay rent or support their children, the pressure can affect their sleep, relationships, self-esteem and sense of purpose
Long-term unemployment can also leave people feeling they are failing their families or becoming a burden, contributing to hopelessness, anxiety, depression and social isolation. Overcrowding, unsafe communities, exposure to violence and limited access to basic services such as electricity and water could add to the strain, Chambers told TimesLIVE
“These challenges don’t necessarily cause a mental health condition in every individual, but they can increase the risk of developing a mental health issue. They could also worsen existing symptoms and make recovery more difficult,” she said
The human mind does not walk alone. Our wellness is bound up in the wellness of our neighbour, our family and our institutions
— Prof Nontembeko Bila, University of Pretoria
She said people receiving treatment for depression or anxiety could return home to unemployment, financial pressure, family conflict or unsafe surroundings. Those circumstances did not disappear when a counselling appointment ended or because someone was taking medication
Chambers said South Africa faced a significant gap between the need for mental health support and access to treatment. She said one in three South Africans will experience a mental health issue at some point in their lives, while only one in 10 people with a mental illness has access to mental health care or treatment
She called for closer collaboration between health, social development, education and employment services, as well as non-governmental organisations. For example, she said, “someone experiencing depression while unemployed may need counselling alongside help finding work, developing skills or accessing social support such as a grant, feeding scheme or shelter”
Bila also called for stronger partnerships between health-care services and community institutions, including churches, mosques and other places of worship. These could provide mental health education, peer support and referrals to professional services, provided appropriate safeguards are in place
Chambers said families and communities could help by creating spaces where people felt safe to speak about their mental health without fear of judgement or stigma. She encouraged people to look out for changes such as:
- withdrawal from social activities;
- persistent sadness;
- irritability;
- changes in sleeping patterns; and
- losing interest in things they previously enjoyed.
However, she cautioned against placing the responsibility for someone’s recovery entirely on their family, as relatives and friends may also be dealing with financial and personal difficulties
Bila stressed that community-based support should not replace professional care. The government and formal health-care providers must remain responsible for ensuring people can access adequately re
“The human mind does not walk alone. Our wellness is bound up in the wellness of our neighbour, our family and our institutions,” she said
TimesLIVE
