UNIVERSITY OF CAPE TOWN
Faculty of Humanities
PSY1004F
Introduction to Psychology I
Assignment Cover Page
“ASSIGNMENT TITLE”
Full name: Nandi Mangeya
Student Number: MNGNAN010
Tutorial Group Number: 39
Tutor's Name: Heshaam Jappie
Due Date: 22 March 2024
Submission Date: 22 March 2024
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____Nandi Mangeya________________ _22 March 2024
________________
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Barriers that Contribute to the Mental Health Treatment Gap
Nandi Mangeya
Department of Psychology, University of Cape Town
PSY1004F: Introduction to Psychology Part 1
Tutor: Heshaam Jappie
Tutorial group: 39
Date: 22 March 2024
Mental health refers to the state in which one’s psychological wellbeing is
(Manwell et al., 2015). The common belief is that once someone receives a
formal diagnosis for their mental illness they would then seek treatment
however that is not necessarily true for everyone. This is called the mental
health treatment gap. The mental health treatment gap explores the
discrepancy between the number of individuals that receive treatment for the
mental health disorder they have been diagnosed with and the total number of
individuals that are diagnosed with mental health disorders (Kohn et al.,
2004). This gap is concerning as many individuals are not getting the help
they need. The obstacles that widen this gap are called barriers. This essay
will consider the different barriers that diagnosed individuals are faced with
namely, stigma, financial inability, and lack of knowledge, and how these
barriers are simultaneously causing and widening the treatment gap.
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It is necessary to discuss mental health illness as it is prevalent in many
societies and affects many individuals. Of the total percentage of the global
disease burden, mental health illness contributes 14% (Rugeme et al., 2015).
Some of the negative effects of delayed treatment are low quality of life,
higher risk of suicide, and further illnesses (Dockery et al., 2015). These
negative effects are part of the reason why the mental health treatment gap is
extremely important to discuss and why to begin bridging the gap, the
different barriers need to be understood.
Stigma is one of the barriers and is one of the main reasons individuals
avoid getting treatment for their mental health disorders (Mackenzie et al.,
2019) Stigma is a characteristic that surrounds one’s social status. It is very
negative and often disparaging (Goffman, 1963). There are various types of
stigmas. When it comes to mental health there is self-stigma and public
stigma. (Cerully et al., 2015). Self-stigma is the stigma one might hold
themselves, this is the discrimination, stereotyping and pessimistic view they
have of mental health treatment (Egebe et al., 2014). A study on individuals
with mental illness in the Kenneth Kaunda district in South Africa
demonstrates self-stigma. In this study, service users were asked what their
thoughts were on their diagnosis and how their diagnosis impacted the way in
which their respective communities regarded them and how they were
treated. The results displayed that self-stigma was a re – occurring factor in
service users’ answers (Egbe et al., 2014). Because individuals tend to be
exposed to the negative beliefs the larger society holds about people with
mental illnesses, they sometimes begin to believe those notions as well. As a
result, when they are diagnosed, they avoid treatment to avoid being treated
or regarded differently by the people around them. Though self – stigma is
the individual’s internalized negative stereotypes, it also involves anticipated
stigma. Anticipated stigma is when the individual expects or ‘anticipates’
negative reactions or consequences because of their mental illness. (Dubreucq
et al., 2021). With anticipated stigma, the expectation of a negative reaction
prevents the individual from seeking out treatment as they are afraid of how
those around them may view them. There are several negative effects of
stigma which include additional emotional and physical challenges in an
individual’s life. One of these challenges is struggles regarding employment.
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Studies have shown that individuals with common mental health disorders are
three times more unlikely to find employment than those without any mental
illnesses (Brouwers, 2020). Obstacles also include finding a place to stay, and
their quality of life in general (Cerully et al., 2015). These challenges appear
when individuals do not receive the proper mental health care and treatment
they may require. Individuals with mental illnesses may be aware of these
different obstacles and be further discouraged to seek treatment. The
unemployment rates for people with mental illnesses further proves the
widespread discrimination society holds and further widens the treatment gap
as individuals need employment to sustain themselves. Public stigma is the
widespread views and opinions within a society. With public stigma, some
have a pessimistic perception on individuals with mental health disorders.
This leads to alienation which results in an ‘us’ and ‘them’ divide (Dockery et
al., 2015). Individuals that are not diagnosed with mental illness being the
‘us’ and separating themselves from those who do have mental illnesses. This
alienation can add onto the emotional distress individuals already face and
can further encourage the individual to avoid seeking out professional
treatment. The various types of stigma these individuals face ultimately
result in the same problem. It results in the avoidance of seeking out the
treatment the individual needs which in turn, contributes to widening the
treatment gap. Stigma is especially important to understand as a barrier to
mental health, as it often causes delayed and even non-existent treatment
seeking which further harms individuals.
Another barrier that prevents individuals from access to mental health care
is their financial status. The treatment for individuals with mental illnesses
are often developed in top tier, specialized institutions and are then
distributed (Singla et al., 2017). They then require professional mental health
care service providers who are both in short supply and expensive, to deliver
the treatments (Singla et al., 2017). These service providers are more
expensive because they have received training in these specialised institutions
which leads to added costs and expenses to acquire them which many
individuals may not be able to afford especially in low-and-middle-income
countries such as South Africa according to the Organization for Economic
Co-Operation and Development. A number of individuals may avoid seeking
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treatment because they cannot afford it and want to avoid further financial
burdens. Additionally, South Africa’s history with Apartheid has resulted in
economic and financial strains which led to South Africa having one of the
highest Gini index ratings around the world (Jack et al., 2014). The Gini
index was created as a means of measuring the unequal distribution of
income and wealth that a country may experience (Giorgi, Gigliarano, 2016).
Because of South Africa’s unequal income distribution, many individuals are
not earning enough to sustain themselves and/or their family and at the same
time, afford treatment. Because individuals do not have the financial
resources, it may lead to delayed treatment seeking or not receiving treatment
at all. Individuals also stop treatment before the treatment is complete
because they can no longer afford the full treatment costs (Andrade et al.,
2014). This also contributes to the treatment gap as individuals are still
suffering from their mental illnesses as they cannot afford to complete
treatment. Mental health care is very expensive, and many people cannot
afford it which results in them not getting treated which widens the treatment
gap.
There is a widespread lack of knowledge about mental health and mental
illnesses and disorders, and this lack of knowledge also acts as a major barrier
to access to mental health care. (Kohn et al., 2004). Having some sort of
knowledge of mental illnesses correlates with treatment compliance (Dockery
et al., 2015). The more knowledgeable individuals are about mental illnesses
the more likely they are to seek out treatment and complete the treatment
Having this knowledge may remove some of the fears and doubts that
individuals experience that make them less willing to receive treatment.
However, if they do not have this knowledge, they are less likely to receive
treatment and in turn, contribute to the treatment gap. Health professionals
are also capable of not recognizing mental illnesses in cultures and societies
they are not familiar with (Andrade et al., 2014). Because of various social
and cultural barriers, professionals may be unable to correctly identify and
diagnose mental illnesses which may lead to individuals being under the
impression that they do not need treatment. This especially relates to South
Africa as it has an abundance of different cultures and languages which also
act as a barrier between service providers and service users. Individuals also
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experience “low perceived need” (Andrade et al., 2014). Low perceived need
is when an individual is under the impression that there is little to no
requirement for professional intervention (Andrade et al., 2014). This low
perceived need is one of the consequences of not having enough knowledge
surrounding mental illness. Individuals assume that their symptoms are not as
serious as they might be, and that professional mental health care is not
necessary. In turn, these individuals contribute to the treatment gap
Conclusively, the mental health treatment gap is a major problem. The
main barriers contributing to this gap are stigma, financial inabilities, and a
lack of awareness of mental illnesses. These barriers contribute to the
treatment gap as they present a multitude of obstacles and challenges to
individuals which ultimately encourage them not to seek treatment and avoid
it completely. As shown above in this essay, the mental health treatment gap
can be bridged by addressing and trying to eliminate these barriers
individuals face when it comes to access to mental health care. If these
barriers are addressed, the treatment gap can begin to be bridged.
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Word count: 1500 words
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