Second Quarter 2002 Newsletter (Last Updated On: ) Zane Wilson, a consumer advocate from South Africa who has established a large support network there, visited the WFMH Secretariat to discuss her work and learn more about the Federation. The staff asked her questions about the development of her organization in South Africa. She described methods of outreach to remote, poor communities, and the overwhelming impact of HIV/AIDS, which intersects with all other health problems in the country. Q. How did the Depression and Anxiety Support Group get started? A. I suffered from debilitating panic disorder for many years. As I recovered I saw the need for consumer advocates. The Depression and Anxiety Support Group was founded in 1994 and now has a general manager and three paid staff in Johannesburg, 20 volunteers, and has established 100 support groups around South Africa. I am unpaid, and pay my own costs unless sponsored. Q. Do you work across the whole country? A. No to some extent our funding specifies the areas we work in. About half of our work is in urban areas, and half in rural areas, some of which are very remote. Id have to say the need in public health and in rural settings is especially serious. There are only about 320 practicing psychiatrists for the entire country, which is a ratio, roughly, of 150,000 persons per psychiatrist. But some 200 of the psychiatrists work in the private sector, where the ratio is about 33,000 persons per psychiatrist. With only 120 psychiatrists working in the state sector, the ratio there is about 440,000 people per state psychiatrist. There are very few psychologists working in rural areas, and psychiatric nurses are stretched beyond belief. Q. In this situation, how do you go about developing rural outreach? A. We visit the selected location with a standard three-day outreach effort to get a local program set up. Weve decided to do it this way because reaching some of these distant villages is quite time-consuming in itself. Two of our staff members will go out to the village with a psychiatrist, who is with them only for the first day. His goal is to talk to all the general physicians working in the area, to educate them about mental illness and to discuss the problems they see in their practices. On the second day, we target the community leaders church leaders, police, nurses, teachers, youth groups, etc with the aim of finding two people who will work as volunteers to start a support group and keep it going. On the third day we invite interested volunteers to a meeting, and provide them with a start-up pack and as much helpful information as we can. At 1 pm we do a teachers meeting specifically to discuss ways to identify teenagers who might be thinking of suicide. And that evening, we have the first meeting at a local church, school or hospital hall with those seeking to join the support group. Q. How do you make contact with people who might want to join? A. We place notices in hospitals, schools, clinics, community centers. We will ask the local radio station in advance to broadcast information. Sometimes local organizers go through townships in a car broadcasting a message from a megaphone its not what we would do in other areas, but in rural areas it seems to work. Q. Who comes to these meetings? A. The initial number could be 6 or 160. It depends on the size of the community and the degree of stigma locally. A group could include people with HIV/AIDS, cancer, or even heart problems – we dont turn anyone away, because we know that many physical illnesses can involve mental health problems as well. Wherever possible, we try to provide contacts to other organizations that can focus on specific problems for example, there is an excellent outreach organization for schizophrenia. Q. What is the goal of the meetings? A. It’s simply to sustain a presence in a rural area to provide information, and a place where people who feel depressed or anxious can go. We want to create awareness that there is help available, and illnesses are treatable. A lot of people dont realize that. The local volunteer coordinators decide how often to hold meetings, perhaps once every two weeks. Sometimes the meeting is held in English, but often it is conducted in the main local language, and quite often the leader speaks several African languages. We stay in touch with the local organizer by phone, put him or her in touch with the nearest mental health service, and provide a supply of materials (brochures, pamphlets, audiotapes, videos). Q. How serious is stigma and discrimination against the mentally ill? A. Its a problem, but I would say it has been slightly decreasing over the past eight years. Unfortunately, the stigma has been transferred to AIDS it is much worse for those who have AIDS. Q. In what ways does HIV/AIDS impact the mental health field? A. It is pervasive. And the social effects are immense, far beyond those who have the illness. The number of children left without parents is just one example. People with HIV/AIDS often experience emotional problems, rejection by family members and friends, fear, shame, guilt and isolation. Often this is compounded by the loss of employment. Q. How will you develop your programs in the future? A. What we do is not nearly enough. Im trying to raise money to hold a training meeting for our rural coordinators. I would like to develop training that covers the links between AIDS, depression and suicide. There are also many possibilities for telephone conference calls. The fixed telephone lines are unstable, and in many places Internet access isnt good. But cell phones are widely used, and its possible to arrange an educational call for a group of people with a moderator or instructor who uses the local language. Contact: South African Depression & Anxiety Support Group: P.O.Box 652548 Benmore 2010 South Africa Tel: 27 11 783 1474/6 Fax: 27 11 884 7074 Email: [email protected]