On the brink of World Mental Health Day (10 October), new findings from a research study in South Africa show that people living with mental illness lose substantial income due to the disability and stigma that they face. This has important implications for public health policymakers in low-and middle-income countries, as it reveals that government's investment in mental health care for the public can translate into economic benefits, and reduce the societal costs of mental illness.

It is widely known that people who live with mental illness (such as depression, anxiety and substance use disorders) are less able to earn a living due to their disability. This is made worse by the stigma and discrimination faced by people living with mental illness. Few people know or understand the extent of stigma and discrimination that exists amongst those living with mental illness as the 'victims' fear further harassment by 'speaking up' about it. One brave mental health advocate, Charlene Sunkel, and the South African Federation of Mental Health, share the stigma and discrimination that people with mental illness experience in South Africa [watch the video 4mins 27seconds Source: Mail & Guardian Online].

Based on the first nationally representative sample of mentally ill in South Africa, a recently published research study by Prof Crick Lund and colleagues at the University of Cape Town showed that the total annual cost in lost earnings for South Africans with mental disorders was in the region of R30 billion ($3.6 billion). This is in stark contrast to government's projected total annual expenditure on mental health services of around R500 million ($59.3 million). "The findings support the argument that it costs South African society more to not treat mental illness than to treat it" said Prof Lund. The researchers expect the cost of lost earnings due to mental illness to be higher as their analysis excluded child and adolescent mental disorders, and other severe chronic mental disorders such as schizophrenia and bipolar mood disorder. The researchers suggest that there is a strong economic argument for preventing mental illness and scaling up mental health care and rehabilitation services, as a means for alleviating the economic burden of these diseases.

One research programme (PRogramme for Improving Mental health carE, PRIME) funded by UKAID's Department for International Development (DFID) is developing evidence on the best ways to scale up mental health services. In so doing, PRIME hopes to advise low-and middle-income country governments on the best ways to integrate mental health care into the existing primary health care systems, and how to maximise the use of existing resources through simple ideas such as 'task-shifting' [watch PRIME Research Director Vikram Patel speaking on task-shifting at a TED Talk 12mins 22 seconds Source: TED Global 2012].

However, an important first step towards this goal is for governments to develop the political will, and make more financial resources available for mental health care. And it even makes economic sense. For more information about PRIME, visit their website

Source: [1] Lund, C. Myer, L. Stein, D. Williams, D. Flisher, A (2012). Mental illness and lost income amongst adult South Africans. Social Psychiatry and Psychiatric Epidemiology. Available http://www.ncbi.nlm.nih.gov/pubmed/23007296

Press Release from Division of Public Mental Health regarding World Mental Health Day - 10 October 2012