Violence, Alcohol Misuse and Mental Health: Gaps in the health system's response

Violence, alcohol misuse and mental disorders are inextricably linked and are leading contributors to the burden of disease in South Africa, each in their own right but particularly where they overlap to produce a perpetuating cycle of harmful outcomes. South African homicide rates are estimated at more than eight times the global average among males and five times the global average among females. Similarly, South African drinkers rank in the top five riskiest drinkers in the world, with approximately 33% to 40% of drinkers consuming alcohol at risky levels. The South African Stress and Health Survey estimates the lifetime prevalence of mental illness amongst adults to be at 30.3%. This chapter outlines the evidence linking alcohol misuse, mental illness and violence. Access to mental health and substance misuse services in South Africa is low, with evidence suggesting extremely poor rates of detection and a major gap between demand for and supply of treatment services, particularly for substance misuse. Surveillance data, which is necessary to inform and monitor outcomes of relevant evidence-based policies and interventions, is sorely lacking for mental illness and substance abuse. In terms of violence, only mortality data are available, which will likely underestimate violence against women and also carry a significant time lag. Owing to the intersectoral nature of many of the risk factors for violence, alcohol abuse and common mental disorders, many of the related policies, legislation and interventions rely on government departments other than health. This gives rise to numerous opportunities but also to many challenges, which impact on policy development and service delivery.