Mental health problems cost SA’s economy billions per year

Depression is a leading cause of disability worldwide, affecting up to 350-million people.

In a 2016 study of eight countries spanning diverse cultures and gross domestic product (GDP) ranges, Dr Sara Evans-Lacko and Prof Martin Knapp from the London School of Economics and Political Science reported that depression was collectively costing the nations of Brazil, Canada, China, Japan, South Korea, Mexico, South Africa and the US more than $246-billion a year.

In that study, nearly twice as many South African employees reported a previous diagnosis of depression (25.6%) in comparison with the average (15.7%) reported across these countries. This is in line with a previous South African study by Prof Crick Lund and others that found mental health problems affected one in four South Africans – with only 15%–25% of affected individuals seeking and receiving help.

According to the World Health Organisation, mental health is defined as a state of well-being in which every individual realises 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.

Stigma – born from ignorance, prejudice and fear – is still a huge problem. In many workplaces, employees (and employers!) suffer or choose to suffer in silence. They are reluctant to seek support and treatment, especially in the current economic climate, out of fear they might jeopardise their jobs. As a result, mental health problems often go unrecognised and untreated, not only damaging an individual's health and career but also directly affecting a workplace through increased absenteeism, reduced productivity and higher costs. 

In many workplaces, employees (and employers!) suffer or choose to suffer in silence

Mental health problems such as depression and substance-use disorders can no longer be “ignored” or “wished away”. But what is the cost to the employer and society? With a loss of earnings due to major depression and anxiety disorders estimated at R54,121 per affected adult per year, the total annual cost to the South African economy amounts to more than R40-billion (2.2% of the country’s GDP).

Furthermore, mental health problems costs the economy two to six times the cost of its treatment – yet the government spends only 5% of its health budget on mental health. Most employers tend to underestimate the financial impact of mental illness on their bottom line. Previously, absenteeism (unscheduled absence from work) was considered a huge problem – which is true – but it is now clear that presenteeism (attending work while unwell) is even more costly.

For example, the South African Association of Social Workers in Private Practice estimates 50% of workplace accidents are related to substance abuse, which can cost the employer 25% of that person’s wages. The cost in lost productivity due to depression was calculated as $17-billion – more than 1.5 times the total South African budget for social protection! Of this lost productivity, presenteeism is more costly: $14.8-billion (more than the total value of South Africa’s tourism industry), while absenteeism costs $2.2-billion. Increasing levels of mental illness drive up disability costs and add to medical-scheme and out-of-pocket expenses.

The cognitive symptoms of depression, such as difficulties in concentrating, decision-making and remembering, are present up to 94% of the time during an episode of depression. Leaders in roles that involve decision-making and responsibility may be more prone to presenteeism than absenteeism, also due to the stigma still surrounding these mental health problems. There are far-reaching consequences: they may struggle to cope with the demands of their jobs  and, because they manage and lead others, interpersonal relationships may be affected too.

This loss can be prevented – or at least greatly reduced. Mental health problems are the result of a complex interplay between biological, psychological, social and environmental factors. The interplay between workplace demands and resources and employees’ resilience is evident. This is exactly where proactive prevention can reduce the prevalence and impact of mental health illnesses.

What can be done to reduce the impact of mental health illnesses?

The onus of mental health lies on both the employer and employee. According to the Institute for Work and Health, prevention includes a range of activities, known as interventions, aimed at reducing risks or threats to health.

1. Primary intervention aims to prevent disease or injury before it occurs by:

• limiting exposure to work-related hazards that contribute to or cause disease (work-place intervention);
• altering unhealthy and unsafe behaviours (improving self-care and healthy lifestyle choices); and
• increasing resistance to illness, should exposure occur.

2. Secondary prevention aims to reduce the impact of disease that has already occurred through:

• early identification and treatment to limit progression and complications;
• prevention of recurrence; and
• the implementation of programmes to return people to health to prevent long-term complications.

3. Tertiary prevention aims to limit the impact of chronic illness or impairment by improving:

• the functional capacity of individuals;
• their quality of life; and
• their life expectancy.

What can employers do?

• Recognise mental health problems as a legitimate concern.
• Aim to create a healthy environment in which job demands and resources are balanced and support for employees is readily available.
• Develop policies and guidelines for alleviating or eradicating possible stressors in the workplace; implement stress management and resilience training programmes and wellness programmes, and ensure access to care.
• Make use of services that aim to increase help-seeking behaviour and identify people in need of care, and provide access to mental and medical health services and crisis management.
• Enable access to support services such as supervision and consultation, counselling or coaching, support groups, and community resources.

What can employees do?

• Address self-care such as ensuring enough sleep, regular exercise, a healthy diet and avoiding substances.
• Seek support and treatment when they struggle, and comply with treatment (both medication and therapy).

The increase in stress brought about by the so-called “VUCA” world – volatile, uncertain, complex and ambiguous – adds to the rise in stress-related diseases, such as depression, in the workplace. Mental health illness has significant personal, organisational and societal costs and we can no longer ignore it.

Unless the government and organisations make mental health issues a strategic priority, these costs will increase. Investing in mental health is imperative. Prevention is the best strategy to avoid the downward spiral into potential disability. South Africa should focus on getting and keeping its current workforce well, which will improve the economy, thereby creating the possibility of more employment and a happier, healthier society.

Dr Renata Schoeman is a psychiatrist and senior lecturer in leadership at the University of Stellenbosch Business School.

This article was paid for by the University of Stellenbosch Business School.