By Dominic Vertue, OAD fellow and Social Worker
The Office of Astronomy for development (OAD) has identified mental health as a need and committed itself to exploring how astronomy can improve the well-being of vulnerable communities1. The broad aim is to empower communities and individuals allowing them to reach their full human potential. We will examine the local South African context and explore the role that astronomy can play in alleviating and promoting mental well-being while also considering possible collaborations and partnerships.
The initial investigation will look at where astronomy fits within mental health and where astronomy fits within the South African mental health landscape.
Governments legislative support for mental health care users
Health is defined by the World Health Organization (WHO) as “a state of complete physical, mental and social well-being” while mental health can be defined as the “the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity; from early childhood until later life, mental health is the springboard of thinking and communication skills, learning, emotional growth, resilience, and self-esteem” 2.
The South African government has acknowledged the need for mental health care services and various initiatives and legislative processes have shown governments commitment to improving the mental health of its citizens.
In South Africa neuropsychiatric disorders are ranked 3rd in their contribution to the overall burden of disease, with anxiety and mood disorders being most prevalent among adults at 8.1% and 4.9% respectively and generalized anxiety at 11% for children and adolescents2.
To examine governments response to dealing with mental health it is useful to consider legislation and policy on the topic.
The Mental Health care act no 17 of 2002 (MHCA) strives to regulate mental health care aiming to ensure equitable and efficient services, coordinate services, and integrate mental health care into general health services3.
The aim is to ensure mental health care services at primary, secondary and tertiary levels.
Under the MHCA, health establishments must provide any person requiring mental health care the appropriate level of care or refer the person to a health establishment that can provide the adequate level of care3.
South Africa’s mental health care challenges
South Africa is a society that has stark inequality with barriers that include poor patient literacy, transport difficulties, inequality and distrust in state system. The relationship between poverty and mental ill-health has been described as a “vicious cycle”2. Those in poverty find themselves at high risk of developing mental illness and mental illness increases the risk of becoming/staying impoverished.
Docrat et. al. identified a mental health service gap of 91% with only 2% and 7.5% of the uninsured South African population requiring care receiving some form of inpatient and outpatient care respectively4.
Ongoing challenges include: no officially endorsed mental health care policy, lack of mental health funding and resources, inequity between provinces, lack of awareness and stigma, lack of accurate routinely collected data, heavy reliance on psychiatric hospitals and the fact that despite integration into public health care mental health care is usually focused on managing the medication of those with severe disorders and not detection and treatment of other mental disorders such as depression and anxiety2
Response from government
In May 2022 the Ministerial Advisory Committee (MAC) on COVID-19 released The Mental Health Impact of COVID-19 On South African Society: How to Build Back Better. The advisory examines the increased psychosocial distress experienced by people throughout the COVID-19pandemic and in so doing highlights South Africa’s unmet human rights needs among those living with psychosocial disabilities5.
It is clear that the impact COVID-19 has had on mental health will remain with us for a long time and that the impact thereof will be even greater for vulnerable and disadvantaged groups as COVID-19 adds to already strenuous living conditions5.
The MAC recommends building back a better mental health system with increased capacity and investment and an emphasis on community-oriented mental health services. The MAC recommends a framework of psychological first-aid, inclusive telemental services and a toll-free national mental health helpline5.
The MAC highlights the need for interventions to target economically disadvantaged people, those with pre-existing mental illness, children, adolescents and youth, health care workers and students5.
In the Western Cape, the newly established Assertive Community Treatment (ACT) teams have shown a reduction in inpatient admissions and length of stay among people with severe mental illness, as well as improved user, family, and staff satisfaction2.
Sustainable Development Goals
The clearest target sustainable development goal is goal 3. Goal 3 “Good health and well-being” is a broad goal looking at ensuring healthy lives and promoting well-being for all people at all ages6.
Role of Nature
Berto performed a literature review examining the role nature can play in coping with psycho-physiological stress. Berto found natural environments produced positive mood change, mediate negative effects of stress and enhance positive emotions 7. Natural settings were shown to have restorative influences on three dimensions namely: positive affect, anger/aggression and fear7.
Nature provides effective “distraction” from the psycho-physiological stress that people experience7. Kaplan’s Attention Restoration Theory (ART) originated from observations that exposure to natural environments had profound restorative effect on people’s ability to focus. ART states a person can engage attention involuntarily and voluntarily7,8.
Voluntary attention creates mental fatigue. “Mental fatigue manifests itself in negative emotions, irritability, impulsiveness, impatience, reduced tolerance for frustration, insensitivity to interpersonal cues, decrease altruistic behaviours, reduced performance, increased likelihood of taking risks”7. Nature serves to both directly assist with stress recovery and mental fatigue restoration and to serve as a buffer against stressful experiences7.
Berto examined mental health services who provide nature-orientated programs to foster social inclusion, constructive inter-personal relationships and de-stigmatization of mental illness. They found that the participants experienced positive emotions, healthy relationships, physical activity, involvement and familiarity within the community, exhibition of skills that enable acceptance in the community and perceived inclusion within the community7.
Ability to access nature need not prevent individuals from experiencing the restorative effects thereof. For those unable to enter nature, virtual nature can simulate similar positive effects. Immersion in virtual nature settings have been found to be “a valid therapeutic aid in the treatment of anxiety disorders and an effective tool in stress management and relaxation”7.
The restorative effect of nature has been measured and confirmed both through self-report and neuro-physiological tests. Common neuro-physiological tests include measuring cortisol, electromyography, skin conductance response, pulse transit time, cardiac response, partial thromboplastin time and electroencephalogram (EEG)7. As for self-reporting, majority of studies utilize the Perceived Restorativeness Scale (PRS)7.
The PRS is a scale aimed at measuring the presence of the four theoretical restorative factors namely: being-away, fascination, extent, compatibility7. It has been widely used to measure the restorative value of both natural and urban settings as well as the “perceived restorativeness of outdoor activities, vacation destinations, zoo and small public parks”7.
Role of astronomy
Astronomy is uniquely situated in that it is inherently nature focused, accessible to all and deeply rooted in culture, history and tradition.
In the South African context, resources and access are always major stumbling blocks. With Astronomy it could be possible to facilitate a restorative mental health experience using very little resources. As mentioned, both nature and virtual nature can be utilized to reach this end and this opens up the possibility of utilizing imagery captured of the stars and cosmos within the restorative activities.
These astronomy activities can easily be tailored to be presented as individual or group activities. They also allow for the possibility of rich narratives to be incorporated. Narratives can be utilized as a means to preserve heritage, build upon the local community’s history or encourage personal reflection.
Role-players and stake-holders within the South African Context
South Africa’s healthcare system is structured in 5 layers9:
- Primary Healthcare (Clinics)
- District hospitals; Regional hospitals
- Tertiary (Academic) hospitals and
- Central (Academic) hospitals.
When looking at non-governmental role players there are the private practices, non-profit organizations and non-governmental-organizations.
The initial process will involve identifying specialists and collaborators (both governmental and non-governmental) for a pilot project. This will be a consultative process.
- Mental Health for Development and Astronomy’s Potential. Accessed June 6, 2022. https://www.astro4dev.org/flagship-themes/celebrating-our-common-humanity-astronomy/astronomy-mental-health/mental-health-for-development-and-astronomys-potential/
- South African Department of Health. National Mental Health Policy Framework and Strategic Plan 2013-2020.; 2012.
- Mental Health Care Act 2002 (Act No. 17 of 2002). Government Gazette; 2004.
- Sumaiyah Docrat, Crick Lund, Donela Besada. An Evaluation of the Health System Costs of Mental Health Services and Programmes in South Africa.; 2019. Accessed June 6, 2022. https://doi.org/10.25375/UCT.9929141
- Ministerial Advisory Committee (MAC) on COVID-19. THE MENTAL HEALTH IMPACT OF COVID-19 ON SOUTH AFRICAN SOCIETY: HOW TO BUILD BACK BETTER.
- Goal 3 | Department of Economic and Social Affairs. Accessed June 6, 2022. https://sdgs.un.org/goals/goal3
- Berto R. The role of nature in coping with psycho-physiological stress: A literature review on restorativeness. Behavioral Sciences. 2014;4(4):394-409. doi:10.3390/bs4040394
- What is Kaplan’s Attention Restoration Theory (ART)? Accessed June 3, 2022. https://positivepsychology.com/attention-restoration-theory/
- South Africa’s Healthcare Structure. Accessed June 6, 2022. https://www.sbah.org.za/index.php/15-main-page/27-south-africa-s-healthcare-structure