Mental Health Conference Day 1

[00:00] mental well-being at learning institutions. If Professor Mary Maloleka or Professor Solomon is in the audience, if you can please come forward, that would help us. And Dr. memory Muturiki as well. If you could please come forward.

[00:20] is a seat assigned to you. We just going to we just had a bit of a technical problem with the first two presentations. So we're just going to start this afternoon with Suzanne. So Suzanne is a registered counselor with experience working for community keepers within

[00:40] schools in South Africa to improve the psychosocial well-being of children and young people. She's a part-time psychology lecturer and for her PhD she aims to develop a cognitive behavior therapy-based, parent-delivered psycho-educational intervention.

[01:00] for children in grades 5 to 7. Thanks Susan. So you just press this for next. Good afternoon everyone. Yes, I'm here on behalf of a team of researchers.

[01:20] from Stalambas University, the University of Bath, and then South African NGO community keepers, and we received funding for this body of research from the Wellcome Trust. Just also to say, Dr. Bronwyn Kudzia from Stalambas was the lead investigator.

[01:40] So we at this conference we all know that many children and young people in South Africa suffer from anxiety and depression. So therefore intervening early really is an urgent public health objective and how

[02:00] can we do that? We can do that by building resilience in the lives of children and young people. And seeing as though many children spend many of their time at schools, schools could be a place to implement universal or psycho-educational interventions and what we

[02:20] mean by that is an intervention for everyone, not just for kids who already have mental health problems. So how did we develop our intervention? We conducted a systematic review to see what's been done in terms of universal school-based interventions in other

[02:40] low and middle income countries. We found only 11 studies, none done in South Africa. All the interventions had some sort of manual for the facilitators and they were mostly delivered by outside people, mental health care professionals, sometimes teachers.

[03:00] and generally parents weren't involved. We also interviewed a total of 66 children, their parents or caregivers, community keeper staff and educators from two primary schools to ask them do you think doing

[03:20] a programme like this is worth it and if so, what should we focus on? Who should deliver it? In November 2019, we came together and workshoped the intervention. I facilitated it and my colleague will measure so that in future we can...

[03:40] determine how big a sample size we need to assess effectiveness in a future RCT. So we would have implemented four steps to my future in 2020, but then COVID and then we weren't allowed in schools.

[04:00] So we implemented four steps to my future in 2021. Term one, consent, assent pre-intervention measures at both schools. School one was a immediate intervention group. School two, the late intervention group. Term two,

[04:20] We implemented the intervention at school 1, also the post-intervention measures and exit focus groups with children. School 2 then had another round of pre-intervention screening and school 2 received the intervention in term 3. Not allowed to do

[04:40] any research in schools in term 4. So feasibility, can it be done? We wanted to see how many parents or caregivers refused consent, how many children refused to take part, how many participating kids completed all the

[05:00] measures at all time points, how many groups of kids received all eight sessions, how many children attended each session and then how many of the sessions were delivered fully and as attended or intended. How did we assess acceptability? We had semistrechauns.

[05:20] structured interviews with children after the delivery of the intervention. We had independent observers attend each session and complete fidelity checklists and at the end of implementation we invited teachers for feedback, rating the facilitators, the content of the program.

[05:40] program and also how engaged the children seem to be. Our secondary object of the exploratory psychological measures, each kid received their own booklet of measures. We looked at a few demographics things. We used the RCATS study item.

[06:00] version to assess feelings of anxiety and depression. We also had the emotion regulation questionnaire, a two-item obvious bullying scale, the Lewis and Bar self-esteem scale and a goal-setting scale.

[06:20] So some findings about feasibility, were we able to do it? Yes we were. So we delivered all eight sessions at school one over eight weeks. So that was one lesson per day per group. We had a one-month gap in delivery when we had a surge of COVID-19.

[06:40] cases in the country and schools closed down again. Then due to all of that, term 3 was much shorter at our second school and there we also delivered all eight sessions but in a much shorter time. So all eight lessons over only two weeks. What did that look like?

[07:00] organized chaos, so two lessons per day, twice a week. Some findings, the children at both schools were in grade 5, around 10 and a half years of age, mostly male and Afrikaans. Many more learners at school

[07:20] reported that they've repeated a grade and then most kids lived with both biological parents. Feasibility, school one had 114 grade 5 kids, school 238. Only two parents refused or offered

[07:40] opted out at school one. In the end we had a sample of 222 children and yes number of grade 5 classes who received all 8 sessions, all of them. There were 6 classes at school one and 8 at school two and they all received all the lessons.

[08:00] Some more about feasibility. You can see, I hope you can, school one, generally better school attendance and therefore better session attendance because this was built into the curriculum of the day. Program fidelity, we stick to the content of seven out of...

[08:20] of eight of the sessions. With one we deviated slightly. Some acceptability results, hoping a paper about this is currently under review. So as facilitators, we rated high on being confident, prepared.

[08:40] enthusiastic and that we managed the classroom well learners were rated as engaged that they took part and that they seemed to grasp the content quite easily at school too interestingly less teachers male or female chose to attend the sessions

[09:00] and we also had more disruptions and disciplinary actions there. This is what some of the kids had to say in the exit focus groups. It was nice. She helped me with some of the things that I struggled with. I think it would be better if the teacher is not in the class.

[09:20] Then you make yourself feel comfortable at your desk and you think of a place where you feel safe. Let's read one more. I can deliver the programme to my parents myself because I think it would give them a good life. So the kitchen we interviewed seemed to like it.

[09:40] Some findings from our secondary objective, no significant results, but also the sample size wasn't powered as such. But school one, the children showed improvement in terms of self-esteem and emotional regulation and school two, improvement in emotional regulation.

[10:00] So where to next? What do these findings mean going forward? Four Steps to my Future seemed to be a good fit for these two schools and the context. The programme could be flexible. We had to make some adjustments to adhere to COVID-19 protocols and we were able to.

[10:20] do it. The programme can also be delivered over a longer time or a shorter time depending on what the school would choose. Learners and teachers definitely bought into the programme, so that's very encouraging. And myself and other

[10:40] Most graduate students were able to implement this program with very little training and supervision, and then the crucial role of NGO community keepers and in the future community keeper staff members can be trained to implement this program.

[11:00] at all the schools where they have offices. Thank you so much.

[11:20] Susanne at this point. So maybe I could just ask Susanne, you mentioned that, oh, sorry. Okay, maybe while Sima is getting there, what aspects of the intervention were adapted during COVID? Were you able to do things virtually?

[11:40] instead of in person.

[12:00] we moved to either whole group discussions in the whole class where you could raise your hand where you were sitting or individual things. So we did away with the paid tasks or the small group tasks. Good afternoon. Two questions, one relating to the.

[12:20] schools that you selected. Were those private or public schools? And then you're saying the class populations were mostly male and off-recaunts. So does that mean that culturally, rationally, there were homogenous groups? And how might that then compare to a different setting? Thank you. Two good questions. So both schools

[12:40] were public primary schools and the reason why we chose them is because the NGO community keepers have offices there. So research has shown that if mental health researchers link with already established service providers there's a better chance of success. So the schools, the prints

[13:00] principles already trust community keepers and community keepers vouched for us and also should we during the course of the implementation of the intervention identify care to maybe need individual therapy we could refer them to community keepers who's at the school.

[13:20] We had a place of a pathway of referral. In terms of what the groups looked like, yes. School one, only Afrikaans. In terms of what the sample looked like, a lower socioeconomic class.

[13:40] kids. Urban community but definitely poorer community, so very much homogenous. School two, sorry, school, I mixed them up now, that was school two. Only Africans, very much homogenous.

[14:00] juniors in terms of ethnicity and so on. School one had English children as well but other than that ethnicity also the same slightly higher income group but in terms of cultural context lots of similarities and that's again where community keeper

[14:20] was so valuable because they work in those schools. So they could help us make the stories and the characters and the examples that we use in the intervention context specific for those kids. Does that answer your questions? Okay.

[14:40] for the afternoon is Dr. Yosof Briat, who is a second year psychiatry register at the University of Atvatistrant. He has a passion for mental health and psychiatry, and he has identified mental wellbeing in the workplace as a deficit in terms of research and implementation

[15:00] change and he seeks to inspire this change through innovation, education and collaboration. Good afternoon colleagues, welcome to the graveyard shift. So I will be presenting my research.

[15:20] Just not. There we go. There we go. Presenting my research on the psychosocial work conditions and mental wellbeing of independent school heads in South Africa. Quite a mouthful. So, principals also known as heads have a multifaceted role.

[15:40] in the educational system, the balance of which determines the success of the school. International research has shown that school heads experience higher levels of chronic workplace stress, which makes them more vulnerable to mental illness. There's also a high prevalence of disability and thus poorer work performance in this population.

[16:00] population group. When we think about wellbeing, as understood by keys, it includes psychological, emotional as well as social wellbeing. And wellbeing and mental illness can be seen as opposite sides of the spectrum, whereas poor wellbeing can lead to

[16:20] increased rates of mental illness and thus improving wellbeing can lead to reduced rates of burnout and reduced risk for mental illness. When we think about wellbeing and how it's impacted by the psychosocial work conditions, we think about psychosocial work

[16:40] conditions as factors such as culture in the organisation, division of tasks, scope of practice and repetitiveness of the work, as well as factors outside of the workplace such as the minds at home, personal attitudes and traits of impact on work stress, even our load sheathing. There's also high variability with each

[17:00] demographic categories of the psychosocial work conditions. The job demands resources framework has been used to conceptualise psychosocial work environment and its impact on wellbeing, where an imbalance in job demands and resources can lead to a decline in mental wellbeing.

[17:20] So, looking at what we were trying to do, our objectives were to describe the demographic profiles of African independent school heads, to gain an understanding of the context and the factors that may impact the psychosocial work conditions and their wellbeing. We also aim to describe and

[17:40] quantify the experience of different dimensions of the psychosocial work conditions of South African school heads. Furthermore, to describe and quantify mental well-being, as defined by keys of these South African independent school heads, and then thus to determine whether there are associations between the demographic factors.

[18:00] social work dimensions and wellbeing scores to identify at-risk groups that can be modified by intervention.

[18:20] registered isASA members in South Africa. So the sample, the participants were 296 out of the sample of 817 isASA members and measuring instruments was a demographic questionnaire and the Copenhagen psychosocial questionnaire number three which is the middle version and that

[18:40] uses the JDR or the job demands resources framework to conceptualize the work environment and then the mental health continuum short form. So a longer version was developed by QIES and then this is the 14 item shorter version looking at those different domains of psychological, emotional and social wellbeing.

[19:00] implemented as a Google form and ethic clearance was obtained via VITs and data collection was between the 8th of April 2022 and the 8th of June 2022. Alright, stats analysis was done via starter version 17 and the continuous and categorical

[19:20] variables were summarized as shown. The Copenhagen psychosocial three dimensions, so the Copenhagen psychosocial questionnaire consists of domains and in different dimensions in those domains and the dimensions are a mean scale score is calculated on

[19:40] or work out for those different dimensions. And then the mental health continuum short form gives you a score from 0 to 70 and also categorises participants according to their responses on certain items in the questionnaire. Furthermore, I did three statistical tests, so experiment correlation, because none of the data is there.

[20:00] So all of the data followed a non-normal distribution, the bivariate analysis for variability in these categories and in linear regression for the magnitude of impact. Looking at demographic results, so you can see the majority of the respondents were between 50 and 59, which is

[20:20] 43% of the sample. In terms of male, female, split quite evenly, the religion was predominantly Christian with a predominantly Caucasian or white population. And in the province, distribution also follows the distribution of Hisaasic-registered schools with the most respondents from

[20:40] the Khaoting province and in terms of level of school we have the primary school heads from the majority of the study population which was 43%. Alright, also quite a busy slide but as I mentioned the Copenhagen psychosocial questionnaire has six

[21:00] six domains and then different dimensions under each domain. The scores range from zero to 100, with higher scores generally showing a negative evaluation of this dimension except the dimensions labelled with an asterisk, which means that the highest score is a positive outcome. So looking at those dimensions that were

[21:20] evaluated. In the demands at work domain it is the work base and emotional demands you can see quite high scores there. Quality of leadership is quite low, health and well-being, self-rated health is quite low and burnout scores are also quite high in this population.

[21:40] domains that were positively evaluated, we looked at possibilities for development, meaning of work which was fantastically high score, predictability, recognition, role clarity was also scored very highly, support from colleagues as well as from supervisors was also scored highly, commitment to the workplace was scored very highly.

[22:00] There was low job insecurity and insecurity at work conditions and job satisfaction in this group was also quite high. Looking at the mental health continuum short form, so the scores range quite worryingly from 13 to 70 with a median value of 43. And then in terms of those three categories,

[22:20] disease. The majority of the population, about 50 per cent, were only moderately mentally healthy, 6 per cent were languishing and only 40 per cent of this population were flourishing.

[22:40] scores. So just to note that all dimensions of the Copenhagen psychosocial questionnaire correlated with the mental health continuum short-form scores, but these were the stronger of the correlations. So when we look at the fair positive correlations, first the self-rated health correlated quite strongly, job satisfaction,

[23:00] After that recognition, commitment to the workplace, then we have predictability and organisational justice in that order. Then the negative correlations, the factors that correlate it quite negatively with the mental health continuum short-form scores was stress. So in this essence, stress is feeling tense and

[23:20] irritable, cognitive stress, which means difficulty concentrating and making decisions, and then we have burnout. After that we have the somatic stress, work-life conflict, and the sleeping troubles and emotional demands.

[23:40] marks.

[24:00] show the most variability amongst demographic factors for different dimensions of the Copenhagen cycle social questionnaire, where head is younger than 40 at the highest level of burnout, median score of 61, and head 60 is an older experience's less burnout, which is quite significant, less cognitive stress, better self-rated health and job.

[24:20] satisfaction. Female heads reported higher levels of burnout, a median score of 61. They also had more frequently reported sleeping troubles, scored less in the influence at work, organisational justice, predictability and recognition dimensions.

[24:40] disease slide, but just looking at the magnitude of impact of these individual factors. So gender again had the most significant impact on the mental health continuum short form scores with male participants scoring on average 3.6 points more in the mental health continuum short form than the female participants. Age and gender again had the most consistent impact on the co-pandemic.

[25:00] Copenhagen psychosocial questionnaire, three dimensions, where participants older than 60 years scored significantly more in the following dimensions, influence at work, sense of community at work, job satisfaction, self-rejected health. Conversely, they also scored significant lowers in the following dimensions, emotional demands, illegitimate tasks,

[25:20] work-life conflict, burnout stress, cognitive stress, and somatic stress. Male heads score significant high in the following dimensions, influence at work, predictability, recognition, organizational justice, and low in terms of burnout, stress, somatic stress, and sleeping troubles.

[25:40] There's just so is that all of the dimension encompassing the psychosocial work conditions of heads in the study, except in security over working conditions, had significant correlation of mental health continuum short-form scores. And then considering the JDR framework that was mentioned, the negatively evaluated dimensions could be seen as all those that increased job demand.

[26:00] and the positively evaluated dimensions could be seen as the resources. Therefore, if we think about intervention, we should address those individual dimensions to not only decrease the scores in the negative evaluated dimensions, but also to increase the scores in the positively evaluated dimensions. So the domains that were highlighted that needs intervention is the demands

[26:20] work, leadership and health and in those that can be strengthened as organization, work individual interface and social capital. So looking at specifically at the vulnerable populations, so the younger and the female heads, we can look at job crafting. So basically flexibility in

[26:40] programming, work conditions, enforcing equity and equality in the workplace, induction and preparation programs, especially for those heads entering headship. And then overall recommendations is increasing the accessibility of employee assistance programs, improving leadership styles, strengthening social capital and resources.

[27:00] mentalisation skills and physical exercise has been shown to increase overall well-being. Study is not without limitations. It was a cross-sectional design that only gave a snapshot of what the situation is currently. Only independent school heads were used in the summer.

[27:20] For one, it was convenient, it allowed us to look at the entirety of South Africa. Measurement in variance analysis was also not performed so it might put the validity of some of these variability categories into question. In conclusion, the wellbeing of hate in South Africa

[27:40] is an under-researched field. This cohort is burdened by a multitude of job and personal demands, requiring emotional and physical resources. The study illustrated much room for improvement in the mental wellbeing and psychosocial work conditions of heads and identified specific vulnerability groups. More research is required to identify specific

[28:00] factors in vulnerable groups that can be addressed and the study was the first to explore the psychosocial work conditions and wellbeing of school heads in South Africa and hopefully we'll stimulate more research. So in terms of what can be done after this is we could have a look at heads of public schools in South Africa to identify moderating factors in the vulnerable.

[28:20] vulnerable groups already identified in the study to incorporate a qualitative aspect to the study design, to investigate the magnitude of impact of headship on wellbeing as compared to other occupations as well as the general population and then to perform measurement invariant studies for the Copenhagen psychosocial questionnaire and mental health continuum.

[28:40] short form which will strengthen the validity of the findings in this study. Thank you.

[29:00] Okay, so maybe just to ask you one question, you mentioned that your future research would look at factors that are associated with the higher levels, maybe of burnout for example, that you see.

[29:20] So have you thought through any of those factors as yet? So I think when we look at concepts such as burnout, it's as influenced out so many different factors in the workplace. So if identified in this study specific population group, so the females and the younger heads that have a higher propensity for

[29:40] burnout. So I think future studies will actually have to have a look and maybe add a qualitative aspect as to what contributes to the factors that increases the burnout in these populations. So in the personal life, because we've also identified in a psychosocial work environment what factors can

[30:00] lead to that. So, organizational justice, recognition, role clarity, flexibility into emotional demands. So, maybe having a specific look or a qualitative aspect into the research to see if there's any areas for intervention. Thank you. I just would like to find out if

[30:20] Dr. Memry is in, okay, sorry Dr. Memry, let me introduce Mr. Laseco first and then you'll be able to come through. Sorry about that. Okay, so Mr. Laseco is a biokineticist with a master's degree and he is, he also achieved the UJ faculty of.

[30:40] of Health Sciences Top Achievers Award and the Golden Key International Honor Society Award. He currently works for the Western Cape Committee of Biokinetics Association of South Africa in the public sector. Thank you. Please, please, and next.

[31:00] presentation is now. Good afternoon everyone. I'll be speaking about mental health based on a biokinesis perspective. So my study is about factors linked to mental health.

[31:20] amongst semi-professional kick-at-ers after reopening of sporting activities after post-lockdown. What is known about kick-at-er? Kick-at-er is a sport between bat and ball played between two teams of 11 players. It comprises of three different formats, which is the test series, which is slightly different.

[31:40] longer. One day international, which is the ODI, which comprises of 50 overs and the last one, the shorter format, which is the 2020, also known as the T20, which comprises of 20 records. Based on these three different formats, they require different physiological needs as well as psychological needs. The shorter format is more explosive, which needs higher concentration.

[32:00] higher physiological needs, whereas the longer format requires more psychological resilience and mental toughness. In cricket, at least pain is approximately 300 days away from home, which also exacerbates the element of mental fatigue as well as mental illness.

[32:20] What is known about mental illness? It is a state of wellbeing in which each person realizes his or her own potential and can deal with typical adversities, can work productively and footfully in life, as well as can make a contribution to his or her community. The prevalence of mental illness is a state of wellbeing.

[32:40] between low income as well as middle income countries has increased quite significantly over the past few years with the most continent being affected as Africa. And with this, there's a stigma surrounding this way, mandon cry, borazons serratae, which also gives us an underrepresentation of what's living.

[33:00] there. Some types of common mental disorders include anxiety, depression, and substance abuse, with substance abuse has been higher in their younger generations. The national of the study will start with the general population, prevalence of 25.7 of probably

[33:20] depression was in port in South Africa, which is, I've said, the stigma around it is still quite high. So the numbers that are represented are only those are reported. However, there's also been cited says there's quite more than 75% of people suffering from mental health, but some of them don't have accessibility to hospitals. Based on the net, based

[33:40] on the revised national disability adjustment life year estimates from the national parent of the disease study reported that neuropsychotic conditions were ranked third amongst all of the conditions listed. A study by UCT from

[34:00] the Department of Psychiatric as well as Mental Health reported that one in three women suffer from post-natal depression. Kingerton had for 1% protected women suffer from depression. Non-binary gender reported the lowest of people suffering from mental illness.

[34:20] Lastly, at least 44% of the 18 to 24 year olds suffered from mental health conditions. So based on this opinion, also the sonatose lead, they said only 5% is allocated to mental health and 75% receive mental health.

[34:40] those fundings. And in those fundings, public sectors always take the strain where most of the people are provided by the private sector that caters for their services. So based on the athletic population, 38% of athletes had sleeved disturbance.

[35:00] 27% in anxiety and depression, 26% suffered from alcohol abuse, 29% due to retirement, which also increased the prevalence of mental instability with the transitioning out of the sport. COVID-19 has also been a catalyst in increasing the prevalence of sports, where some people or some

[35:20] see themselves as a sport, so their athletic identity would always suck with them. So without any physical activity, then identities lost. Hence, high anxiety, high depression, as well as substance abuse. In South Africa, knowledge about performance as well as mental health and how they coincide is still limited and

[35:40] and still started to be explored. And based on these findings, so there's no better screening that's tailored for athletes and how they feel. So with the protocols that are in place, it's only for physical aspect, where for mental aspect, once an athlete becomes injured, they also suffer from the psychological aspect, which is there's no screening tool for them to go back to.

[36:00] to the sport. A study done by Felbay reported that the transitioning out of sport resulted in an increase in prevalence of mental instability, where some athletes opted for substance abuse because now the financial muscle they no longer have also is sponsorship, they longer pay due to their

[36:20] not playing the sport. The objective of the study was to investigate the extent of mental symptoms based on these instruments that will be listed on the next slide among semi-professional kick-iters. And the second one is an investigative relationship between age and age 21.

[36:40] sub-scales as well as how they affect one another. The methods section, with the first one, the study design was a cross-sectional severed design which was conducted between September 2021 and May 2022. With the settings was done in western Cape Town, South Africa. The sample was amongst

[37:00] A semi-professional at least which comprises of 90 players. The outcomes used through the different instruments which is the death training one which is depression, anxiety and side scale. The second one, ABQ which is Atelic Bernard Cuetinha and the last one was satisfaction of side scale. The data was analyzed using distributive analysis.

[37:20] experiment correlation and lastly significant to set at P is less than 0.05. The question is that we use where death training one which comprises of depression, anxiety and second one which comprises of three items or subscales, physical and emotional.

[37:40] emotional exhaustion, devaluation of sport practice, reduced sense of achievement. And lastly, which is satisfaction of life scale, comprises of five items as listed on the slide. So with the DES21, there were three items. As you can see, there were some at-unto-suffering form, one of the three, or some of the other.

[38:00] them, one player suffered from all three of them. As you can see, anxiety reported to be moderate with this with the tight playing schedules, so they're playing constantly as well as with the change of restrictions. Some players were uncertain if they'll play the following week, so this also created that bit of anxiety as you can see there.

[38:20] So with the Antique Bernard questionnaire, there were also three items.

[38:40] reduce that as well as sense of achievement reduced due to their competency or the perceived sense of competence dropping a bit lower. So what satisfaction with life scale, it had five items. With most of them quite similar as you can see with the distribution of the scales where

[39:00] Based on the scales, neither would agree or disagree with a satisfied life. So also we can refer to COVID-19 being one of the catalysts which is being said that with the uncertainty of knowing if you're going to play, you're going to get paid as well as some of them lost jobs because they were working as well as playing since they were semi-professional.

[39:20] athletes. So the study also reported that COVID-19 had also a hand in some of the players having a high prevalence of mental instability. 5.6% of educators believe life was futile, 10% thought they were useless in life.

[39:40] 27% of cricketers indicated low confidence. 23% of cricketers reported being stressed. And lastly, 40% of cricketers believe that they do not always perform at their best, as I've said. Now with the resumption of sports, without even training, so now the training and as well as the training.

[40:00] the playing schedule was quite tight, so it was constantly playing game after game without having enough rest. Factors affecting mental instability is the bio bubble, which was a confinement that was in place to reduce the spread of COVID-19 amongst players where there were no interaction with the public.

[40:20] With COVID being said, so with less public interference, so some players suffer because they're needed with support from their families, support from external key stakeholders, as well as other people. With this being said, the pressures of the biobabble as well as COVID compressed

[40:40] resulted in an increase in mental instability. The limitation of the study reported to a self-reporting which was a Google Form format so some the some studies are reported that if an athlete or anyone does their own assessment there might be a bit of variability in there. Secondly, the study comprises of male participants where

[41:00] There were a few teams that were participating of females, but however there were quite a few where the playing schedule for males was quite open and I was able to recruit slightly a bigger sample size. Thirdly, the selection bias, does only males, but lastly the underability of the results can be questioned as well.

[41:20] So with what makes a kick-a-pray successful, with performance it's always two segments. It's the fitness side which is most physical aspect, which is training, eating nutrition. And the fatigue side goes into the mental resilience, mental toughness. And with those there to be at a certain level.

[41:40] equilibrium where both of them have to be equal in order to increase your performance. And based on this diagram as you can see if the training load is too high performance drops. If the sleep is too low performance drops as well. If nutrition as well is not taking into place performance drops. And once these three components are lower then there's a high increase.

[42:00] injury rate. Then lastly, once you're injured, you cannot play. Game time also goes down. So as you can see, mental aspect also plays a huge role in this with the training load as well as a biocanneticist what they do. So with that, we manage the training load where the psychologist and psychiatrist manage the psychological aspect.

[42:20] Now with both sectors coming together, we're able to tell if a player is fit enough to continue after the resumption of sporting events as well as if there's any injuries. In conclusion, these funds can however not be compared to pre-pandemic mental health profiling due to lack of baseline. So this is one of the star

[42:40] studies that has been done post-COVID. So before COVID has never been a study that has been implemented, these results provide a snapshot of mental profile during COVID. Then implementing mental health, wellness and removing of stigmatization inside the sport will also improve in more reporting as well as more studies.

[43:00] done to better provide screening tools tailored to athletes. Then incorporating mental health, monitoring into the existing system of QQSA, would improve players' wellbeing holistically. So you're looking at the player from the inside and outside. So at the moment, most of the players are only focused on the physical component, where the mental side

[43:20] take strain as well and performance drops, then they'll be like, he's not performing. Whereas if you assess his mental capabilities or mental resilience, he might be a bit on the lower side. So as this saying, this comes from the old again, mental health like physical health is a suggestion.

[43:40] It's a resource that helps people operate, manage their own performance and accomplish their goals. So as you can see, based on this saying, by combining physical activity as well as mental aspects, making it one system. The longevity of a kick-ed or the longevity of an athlete will be slightly longer, probably 20 or 30 years.

[44:00] So let's try to avoid looking at only solely the physical aspect and also focusing on the mental aspect of our player. Thank you.

[44:20] that interesting perspective and let's take a question from the audience. Thank you for the opportunity to, I don't know whether I missed it in the beginning. I just want to ask you with these results based only on a

[44:40] a spearmen correlation analysis. So with the, based on the time constraints, with spearmen correlation, so the DESP sub-scales reported that, so there's a paper will come out probably in the next few weeks. So it also reports that based on the DESP 21 sub-scales, they were interrelated, so an increase in stress

[45:00] result in increased indication. But your results were based on the correlation and analysis. So there was correlation as well as descriptive status as well.

[45:20] When the participants completed the form, were they playing cricket again or not yet? So luckily during the questionnaire time, that at the time was an assumption of sport. So they were still playing. So hence you could see some of these results had high anxiety. So would that be a good idea?

[45:40] that were tight playing schedule and also uncertainty if you'll play again because it's the time that as the restriction levels are like level four, level five, you can play, you cannot play, gyms are closed. So that also one of the catalysts at anxiety as well as a reduced sense of achievement was quite slightly higher.

[46:00] Thank you very much. Okay, let's take one last question. I, so maybe by COVID. Thank you very much, Laseko.

[46:20] Before I introduce Dr. Mary, can I just find out if Prof. Mary is in the audience? Okay, and Prof. Solomon? No? Okay. So let me just introduce Dr. Mary. Dr. Mary is the director of Student Wellness Service.

[46:40] at the University of Cape Town, who's responsible for student health and counseling services. She has a special interest in adolescent and youth health, as well as mental health research. Her current PhD study is on the emerging trends in student mental health.

[47:00] with a focus on the influence of social determinants of health. Thanks.

[47:20] for counselling, so I'll just quickly reflect my presentation outline and go for it. So we all know that going to university is a very exciting time for any

[47:40] young adult. It's a time of newfound independence and discovery. However, it brings along with it a whole range of responsibility. For example, managing one's own time, dealing with peer pressure and of course, expiratory...

[48:00] with new relationships. So when we speak about mental health, we refer to the state of wellbeing which enables students to cope with daily stresses of their life and also to focus on their academic routine.

[48:20] To date, the biggest study on student mental health has been conducted by the World Health Organization in a series of surveys through the World Health, Mental Health Surveys, where data was collected in 19 universities and

[48:40] ecologies around eight countries and in some of that data the WHO estimated that mental illness in young adults is between 20 to 25% the prevalence and that prevalence has been pushed slightly

[49:00] towards 30% by the trajectory of the COVID-19 pandemic. Locally, the Medical Research Council has conducted a similar study where data was collected in 17 universities in South Africa and some of the findings were that the prevalence of COVID-19

[49:20] for major depressive disorders was 15%. And despite some of these findings and data availability, it is still limited for South African universities on mental disorders and also preferences regarding counseling.

[49:40] So the aim of our study was really to assess the mental wellbeing of students at the University of Cape Town and to establish their preferences for counselling options. So we conducted the study as a quantitative, cross-sectional study.

[50:00] which was self-administered and data was collected over a period of three months in 2021. The survey was open to all students, post-graduates and undergraduate student. And the content of the survey was a set of demographic questions and we used the available

[50:20] already existing tools, PHQ9 for depressive disorder, general anxiety disorder questions, and also the Odyssey for alcohol use disorders. And additionally, we added the questions for the preferred method of accessing treatment.

[50:40] So just some key characteristics of our respondents. So the survey was responded by 850 students. Of these, 87% were aged 18 to 25 and 79 being undergraduate students, 68%.

[51:00] were female with only 21% being male and 48% were black African while 27% were white students. So we looked at emotional well-being. 41% of the students reported strong concerns about their

[51:20] emotional wellbeing, having experienced problems within the previous 12 months, and nearly 30% had moderate concerns on their wellbeing, and only 4% indicated that they had no concerns. Then we looked at the...

[51:40] depressive disorders and 47% displayed symptoms associated with major depressive disorder and nearly 29% displayed severe depressive symptoms. Then we moved on to look at the severity of anxiety, the risk of alcoholism and the

[52:00] impact of emotion. 35% reported severe levels of anxiety and 89% reported slow risk of developing alcoholism. And significantly, 45% of the students indicated that their emotions had impact on their cost of life.

[52:20] work. So then we moved on to look at the options and we started off with looking at the online counselling. 33% of the students were completely comfortable with online counselling and 36% were somewhat

[52:40] moderately comfortable with the online counseling, but only 2% indicated that they were completely uncomfortable with online counseling. So we further went on to look at the various options of counseling and looking at individual counseling, the options that we compared was the

[53:00] in-person counselling, audio only counselling, or the telephonic hotline, digital audio with video and for group counselling we looked for in-person and online modalities and then

[53:20] Counseling courses are also considered the in-person counseling mental health courses or self-help tools with videos or workbooks that you can self-help on your own or online courses such as webinars, etc. Our findings were that student

[53:40] students find all of the different options acceptable. In person, individual and group counseling is still the most preferred as per our finding. And just looking at some limitations, response rate of 3.2% was in similar range to the

[54:00] MRC national survey and other similar studies where the invitation to participate had been sent to students as a single email. Then of course the lack of waiting for some of the aspects and also a lack of diagnostic criteria.

[54:20] It relied on subjective reporting and so some of our rates appear higher than some of the studies that are similar, especially compared to the MRC study where they had to meet a diagnostic criteria.

[54:40] So our findings show that there is a need to further explore student treatment preferences in our universities because students are struggling with mental health and the ease impact on their post-work and other aspects of their lives.

[55:00] mental health interventions that match their preferences would be more effective in supporting their academic journey. And secondly, our findings show that there is a need for data-driven recommendations and solutions to student mental health services.

[55:20] advances in technology and not withstanding the fact that many students were exposed to online learning when it comes to mental health care and counseling. Many of the participants still preferred the in-person option. And so it is still significant.

[55:40] however that there is uptake for the other preferences. So going forward, a holistic approach is needed for policy makers to better understand how best to invest and support student mental health by providing the necessary resources.

[56:00] that enable the universities to provide the different options. There is limited funding to support mental health in universities. And so collaborative efforts should be made to strengthen the campus-based mental health services.

[56:20] and encourage the implementation of innovative public health approaches which are informed by research. And so on a final note, I think we should start to consider the use of e-health and digital technologies to supplement the services offered at universities.

[56:40] given that young people are technologically savvy and is a group that can utilize the services for prevention, promotion and health education beyond the therapeutic side of things. Thank you very much.

[57:00] Thank you, Dr. Mamrie. Are there any questions?

[57:20] Thank you. Just to check quickly, so were you looking at counselling options strictly within universities or also outside? We were looking at the preference

[57:40] is for UCT students in the study.

[58:00] whether there was some correlation, even if just anecdotally, between the observations of the presenting problems or the depression and anxiety or whatever the diagnoses were in those measures and in the preferences. For example, those saying

[58:20] they were starting with anxiety, were they more comfortable with certain kinds, not the groups, or was any sort of correlation observed in those two things, between those two variables? Thank you. Those are interesting questions, and in fact there were some of our limitations around

[58:40] not waiting some of the responses and looking at the correlation. We focus the correlation on coursework as part of why they are at university and how that penned out. We didn't quite extend to looking at also access

[59:00] and whether that was linked to their preference, but that's something that could be looked at. Hi, Dr. Mary. So this may not be a fair question. So it's probably a bit of a question and also a comment.

[59:20] Between yourself and two speakers, one earlier in the session and the session before, and all of those studies were with children and youth, there is a measurement of alcohol use. And we understand that there's a correlation between alcohol use, stress, trauma and so forth. But what this young

[59:40] younger generation using other means of numbing that is more readily available to them, cell phones, digital stuff, Netflix, are it, so in your environment and maybe in your thinking, are you looking at assessing how more readily available numbing things, sorry my brain is dead it's late.

[01:00:00] Numbing things are available to young people because alcohol is maybe an old school measurement that we need to have there, but what else are we thinking about that they have access to? Thank you. Someone looks like they would like to answer? Or is it a question? Elis Elisar Elisar numbing things are available to young people because alcohol is maybe an old school measurement that we need to have there, but what else are we thinking about that they have access to? Thank you. Someone looks like they would like to answer? Or is it a question? Elisar numbing things are available to young people because alcohol is maybe an old school measurement that we need to have there. But what else are we thinking about that they have access to? Thank you. Someone looks like they would like to answer? Or is it a question? Elisar Okay.

[01:00:20] I will not jump up as soon as she was done speaking. Yes, thank you for raising that. So we are still quite interested in alcohol on our campuses because it is still the most abused substance by most people.

[01:00:40] of the students and there is quite a, it seems a lack of knowledge among students in terms of what is used and what is a little bit above that and so we tend to look at the trends but you are also correct that they are that

[01:01:00] could be looked at and our study didn't really focus on that. We did observe from a clinical perspective that trends decreased during COVID when alcohol, for example, was less accessible and students also were not on campuses because if they are at home with families.

[01:01:20] There is also a change in the type of habits and so we are still keen in what that looks like post-pandemic comparing to what the alcohol levels and usage were before the pandemic.

[01:01:40] Dr. memory will be around after the presentation, after the meeting and maybe the additional questions if you can pose it to her. We just would like to give Prof. Mary a chance to do a presentation. Thank you, Dr. memory. So Prof. memory, sorry, Prof. Mary is an associate professor.

[01:02:00] in the Department of Advanced Nursing at the Faculty of Health Sciences at the University of Bender. Her focus is on mental health, mental health promotion and community engagement. Currently she is working on several research articles and other projects that grapple with mental health promotion.

[01:02:20] and its connections to larger societal structures. Thank you so much for the wonderful introduction.

[01:02:40] And I know it is very challenging to be, almost be, the last presenter because people's energy, in as much as people are trying to wake up, taking coffee is going down, it's almost 5pm. I'll try to be shot as much as I can.

[01:03:00] So you can see the topic, I won't even go through it. You want me to read it? Okay, I will start here. We all wish and aspire that our children are here.

[01:03:20] our relatives when they go to VASI T, they must get a very great education. I think I'm right. But the reality is there is this overall experience, not from classroom but outside the

[01:03:40] last room. As you can see the pictures, the other one, got a reality, you will see someone's writing there to say no, what, what, what and then the police officer is there to take that person out. The others, I think, were familiar with these pics. They were on social media and they are still on social media. And this picture

[01:04:00] are from the universities. The problem is this study was conducted in one of the universities upon realising that despite all effective intervention measures that are there, they chatted,

[01:04:20] the students counseling unit, you name them. But when it comes to the throughput rate, half of the intake, they graduate on time. The rest they did not. It's either they failed the remaining second level or cathartic level. So there is a

[01:04:40] researchers realized, they need to understand the non-academic triggers to their mental health, but they are very much aware that there could be other factors leading them not to complete on time. But for this study, they focused on the mental health issues. So now the question that was asked

[01:05:00] Just in the grey area it was what are the experiences of the undergraduate students regarding this versatility outside room life on their mental health. Therefore, they used the qualitative approach and the narrative, descriptive design. Whereinland students were allowed to be.

[01:05:20] allowed to write the narratives regarding the non-outside classroom experience. What is happening outside the classroom, but on campus. Not at home, but on campus. And then the population consisted of the third levels and the fourth levels because the researchers believed

[01:05:40] that this was accumulated enough experience to tell a story. And then if you were to be in this project, you ought to have failed a module somehow because the target was on those who failed the module and they did not do it on time. So the sample consisted of 4,000 people.

[01:06:00] eight of them, including the third year and the fourth year. So now the data was collected in this fashion. They were given a piece of paper which has got the name, gender, then they were supposed to write the name, age, gender level of study and number of modules failed. The second parallel line it was

[01:06:20] It was a play to say, write, narrate your experiences outside the classroom. That you think affected your mental health. So now here are the findings for these results that demographic, gender part of it.

[01:06:40] both genders were there, were in it. I can't see clearly because I'm, yeah I could see there. The females were higher than the males but this was not the purpose of the study to check the who is higher, who is not but they both were there and then age, age started from because when they, some of them,

[01:07:00] they find themselves at the university early at the age of 16, 17, so it ranged from 19 up until 30 something. It helps the issue of failing. If there is something and you are still doing undergrads, something is not going right somewhere. Then the level of study, the third years, there were

[01:07:20] level 81 and then the third year, something and I can't see and then the fourth level 81. And then that other side, the modules failed. You can see the number of modules that will fail. And on top, there are number of modules that are higher. Now the narratives.

[01:07:40] The narrative results are esfulus. Three themes emerged. The students protest sexual violence and roommates. Drama. These were the most written down to say. So let's go to the student protest theme one. We're familiar with these pictures, right? We know them.

[01:08:00] So they were said to be this one so frustrating them. So now let's see their narratives. This one said I am now on anti-anxiety drugs. Then let's hear why she's saying this. Those are the drugs.

[01:08:20] That is the narrative. I cannot read it. It is a bit far for me. But we can read, Agar. One second to read, all of us.

[01:08:40] Are we done? Can we proceed to the next one? Okay. So let's go to the next explanation. The other one said I suffered acute

[01:09:00] PTSD. That is a picture. This is the narrative. One second, two seconds to read please.

[01:09:20] Are we done? We heard it. The theme too. The pictures, even if we did not read the narration here, theme too, we can see the pictures. So now let's hear what they said.

[01:09:40] Then they lived with VA, worries and frustrations. That is a sign of a fear if we look at that pic and then VA is the story.

[01:10:00] Listen carefully, Acaco. My worry is that even if you report rape, you will end up with a police cross-examining you. That adds more frustration than you are. In other ways, you are the one who is

[01:10:20] is in trouble because always the police are after you, not the perpetrator. Let's see the picture. You see, always when the police would come to campus looking for you, the victim, not the perpetrator, that is what they said. Another one, the rep victim

[01:10:40] felt and believed and a mind ashamed by the police officers. That is the narrative. The police officer was very

[01:11:00] and changing my ways. I was asked the same questions over and over again and at some point I was asked if I was making it up. Then you can finish reading, how she felt and

[01:11:20] And then she ended up canceling the case. Let's see the interrogation of police officers. Can you imagine? That is the charge office. She sit her down, having stressed the two police officers that are asking her, and they are the males. So now?

[01:11:40] Alcohol is my strategy, coping strategy. This is what she said. After being raped, I used to receive lots of SMSs, instructing me to cancel the case or else campus will be hot for me.

[01:12:00] No one understood my pain, the fear I went through daily. Then I am drinking alcohol. I can't help it. I can't. Sometimes I go to attend lectures being drunk.

[01:12:20] Let's see. She is doing that at a study. Temporary roommate. We can see those roommates. Now let's hear the storage and roommate.

[01:12:40] My roommate turned me into a mental health care user. Let's see what happened.

[01:13:00] she explained there why now she's on medication. Five minutes left, there is the roommate who died through medication and then there she is, another roommate, roommate from hell.

[01:13:20] Then those are the narrations. And then you see the roommate, she's closing her ears, you see the roommate shouting, this one, the roommate is having sex in front of her in the very same room.

[01:13:40] Conclusion. The aim of this study was to explore and describe their lived experiences of outside class to their mental health. They drew a whole range of experience in describing

[01:14:00] what's going on into their lives, then a triggered mental health problems were alleged to be responsible for poor academic progress. Thank you so much.

[01:14:20] Thank you so much, Prof. Are there any questions? Just would like to find out while Sima passes the mic if Prof Salomon is available.

[01:14:40] We will just have Prof Solomon as our last speaker after the question.

[01:15:00] of study. And you shared with us some of the students' experiences. Did all of them have those experiences? How many were they? How many did you interview?

[01:15:20] How many students? Okay, there were 48. Second and third levels of a particular qualification. Okay. Yes. And then all of them had experiences like this or just some of them? Some of them.

[01:15:40] They had different experiences. Otherwise the slide was going to be too much. For example, sexual violence, they talked about the lecturers. Yes. Now, I was interested, the must have had some problems, the others as well. But yeah, that was very interesting.

[01:16:00] I hope you had more time to tell us more. Thank you very much. Okay, thanks. Let me ask you. Thank you. Thank you. Thank you so much. So our final speaker for this afternoon is Prof Solomon, and Prof Solomon is the head of department of St. Louis.

[01:16:20] psychology at the University of Lompopo. His interests are in the areas of health behavior and in psychometrics. Thank you.

[01:16:40] Good afternoon. The topic is reflected there. I hope you have seen it. Focus on self-protective behaviours during COVID. I will take it that we will

[01:17:00] not dwell on the history. We basically have a general idea, most of us, about it. We just put it there for formality. We also will appreciate the fact that there is still no clear cure for COVID-19.

[01:17:20] whatever is there is experimental most of the time. And because of that, we have to have concern and also be interested in alternative methods of preventing infection because if we get infected, chances are that it's going to

[01:17:40] get complicated. I would like to invite you to appreciate that we would have followed proper procedure to establish the study, the sampling that it was properly done, also the data connection process.

[01:18:00] That we would have observed protocols and standards of prevention of infection during study, and also that we would have made sure that the participants are protected.

[01:18:20] And we also made sure that our selection of schools is properly done, you know, that the sampling was randomized, although we didn't have succeeded to randomize because we're dealing with humans. They have choices.

[01:18:40] schools will tend you down, sub-schools will delay all those complications, collecting data using human subjects. The data analysis, I will not dwell on the discussion.

[01:19:00] of the sample except to say that, well, by the way, this was a study that involved four districts, two in Limpopo, one in Hauteng, and one in the eastern cape. So the stats and the parameters that you see will most likely

[01:19:20] repeat in all the provinces. That's what we have observed. Just by choice we end up reporting on two of them. But they are not very far from each other. There are slight differences, you know, between learners in each of the districts, but they are likely to be more similar than dissimilar.

[01:19:40] Here's our main interest, the issue of self-protective behaviors. Well, we know individual behaviors, we have been told time and time again about them, where masks are.

[01:20:00] tasks, keep distance and so on. In this study we attempted to bring together all of these directives and hope that we will make sense of them as a totality rather than dealing with them individually. That is why the focus will be on all of the

[01:20:20] known at least the known methods of self-protection. We attempted to bring them together into some kind of index whereby we will be able to inspect them as a total. Here's an interesting observation that we make.

[01:20:40] Translating the response patterns, we end up with a graph of this nature, a graph that sort of congregates the responses at the centre of the distribution, meaning that

[01:21:00] Well from a psychometric point of view it becomes something like a normal distribution with a fine bell-shaped calf. That's what we see, isn't it? But here's the problem. In this type of research you would have liked

[01:21:20] acute distribution where the respondents get the answers correct most of the time because if they are just average like in your normal distribution the problem is the extremities are problematic the extreme ends of the distribution are problematic

[01:21:40] That's our main point, to say that out of this 550 plus respondents, this is what we get, nearly 72% of them scoring in the central tetra, meaning that there's many of them who can't get, sorry, let me do it again.

[01:22:00] different, meaning that the majority of them do get average, you know, total and many of them will not know many of the items and very few will get most of them right just like many very few

[01:22:20] will get most of them wrong. Remains a problem because there's a number of these protective behaviors that the learners don't get right. When we look at the individual analysis, I will just skip to the table and hope that.

[01:22:40] it projects well. You will notice that when we've used about 12 items, those are the items that we've used, those that have an asterisk next to them. It's those that would need to be reverse caught for a simple reason. They are actually based on common needs,

[01:23:00] about self-protection or common behaviors that we observe or alternatively misguided knowledge about self-protection. Those are the items that we reverse-call. So what you see there, it's actually responses that are supposed to be correct or respondents

[01:23:20] who are supposed to have gotten the item right. So if you see a low percentage, it means that it is fewer individuals getting the item right. So we have a problem about seven of these items are difficult for the learners.

[01:23:40] And by the way, the standard was that self-protection is effective when you observe these standards. Right? If you wear a mask, you are safe. If you wash your hands, you are safe. Now, if you remember to wash your hands and you don't wear a mask, it doesn't help. So if we have a number of these self-protection standards,

[01:24:00] protective behaviors, being problematic for the learners, it means they were always at risk. That's the message that we put across. I don't want to keep you long here. You know, let me just give one of the results that we got. Prediction.

[01:24:20] Why would we use a totality of these self-protective behaviors? Probably because we want to predict certain behaviors, we want to predict certain reactions. Knowledge, can it help in terms of fear? Well, we also measured convict fear, and it turns out...

[01:24:40] that it is possible to predict COVID-19 on the basis of knowledge. Make sense. If you are afraid, you probably, in terms of beliefs for self-protection, you probably will be more encouraged to act right.

[01:25:00] out of fear of the consequences of acting wrong. And then, in terms of vaccination, surprisingly also, knowledge seems, as listed the type of question that we asked, seems to assist in terms of getting an individual to appreciate

[01:25:20] indicates that the presence of vaccines, effective vaccines, may actually be positive and an individual may be encouraged to take the vaccine, depends on the level of knowledge that the individual has. Well, in conclusion, I would like to conclude this way.

[01:25:40] Most of the behaviors seem to be behaviors that are connected to an individual. They are individual-based reactions. Is it helpful to target individual behavior so that we expect an individual to act responsibly? Maybe it is complicated.

[01:26:00] The fact that many of these lenders are unable to act correct all the time means that their properties are ineffective beyond knowledge itself. That will encourage self-protection. Where will this come from? Our recommendation is that maybe

[01:26:20] future we should also try to move away from preventing infection by focusing on individual behavior and rather focus on system-based strategies. If you don't have water at home, why would you be inspired to be watching your ads all the time?

[01:26:40] you have a problem with getting a mask made because you don't have sufficient money to buy a mask and you end up with hitting the mask and it ends up getting damaged but you are encouraged to wear a mask. It doesn't help because the mask then to a wearing is damaged and you are inspired to wear it but it doesn't help you.

[01:27:00] So now you might have to focus on system-based factors of self-protection, rather than expect individuals to be inspired as individuals to engage in behavior that they themselves have control of and they are unable to control their environments. Thank you.

[01:27:20] Thank you.

[01:27:40] Thank you everyone, thank you to all our speakers, it was a very interesting session and thank you to all who did that stage to attend the last presentation. Thank you.

[01:28:00] hotel, and I am the director at the South African Federation for Mental Health, and I have the opportunity to chair the session this morning. So I do understand that people were attending a lot of sessions yesterday morning and during the afternoon.

[01:28:20] the day. It was a very long day. The sessions, I am told, started quite emotionally. Yesterday morning we heard from community members what the reality on the ground really is. We talk about wonderful programs, we talk about excellent policy.

[01:28:40] but none of that really translates into real access to mental health care in South Africa. And I think this is the message that is coming out of each and every session and from the people who are speaking to each other in the foyer. During the discussion,

[01:29:00] discussion this morning, we have quite a few speakers and from my understanding, many of these topics that we will be addressing this morning come out of the tracks that we have during the day. So the plenary this morning is to

[01:29:20] up a discussion which will be continued in the tracks as we attend sessions later today. So I do hope that the track or the discussions this morning will provide you with a background and I invite you to actually

[01:29:40] participate, ask questions and raise discussions as we hear what our experts have to say. Without much delay, I want to start the session with Marsha Becker and she is from Sesame Workshop International South Africa and she will

[01:30:00] Also tell us more about the special feature of the show. Marsha Becca, thank you. Morning, everyone. Thank you, Barty, for the lovely introduction.

[01:30:20] It is my pleasure to represent Sesame Workshop International South Africa. As Barty said, my name is Marsha. Thank you so much for inviting us to this conference. Sesame Workshop is the creators of award-winning children's television show, Takalani Sesame. We are an edutainment brand that

[01:30:40] that tries to use the powerful medium of television as well as our community outreach work to help children aged zero to six grow smarter, stronger and kinder. Currently, season 12 and 13 of Taka'lani's season is being aired on SABC. These seasons were put

[01:31:00] produced in the midst of the COVID-19 pandemic. As we all know, COVID took all of us by surprise, and we quickly realized that as an entertainment brand, what we need to do is to develop content that will help children deal with big feelings. These are feelings of

[01:31:20] of being alone, being scared, being afraid and isolated. Today, I'm proud to share with you a short trailer of a very special feature that we've developed specifically for tapalanic sesame, featuring the big feelings. And we call this the big feelings family.

[01:31:40] family special. As the name suggests, this family special is meant for parents, caregivers and children to be watched together. In this session, we try and teach children how to identify big feelings, how to develop coping strategies for how they can

[01:32:00] manage these feelings so that these feelings do not become so big that they are debilitating and preventing a child from carrying on with their daily chores. We are very excited that during this production we had a fantastic opportunity to collaborate with our very own national soccer team, the Banyan

[01:32:20] Banyana female soccer team as well as their coach, famous comedian David Kao as well as our furry mother friends. Some money is taking a screenshot. The Big Feelings family special will air on Saturday the 20th of May

[01:32:40] at 5.30 pm in the afternoon. We're excited about this lot because we hope that families will then be calm, chilling at home, relaxing and being able to tune in and watch the show together. I invite you to sit back and watch the very short trailer and when it's done, I'll say two more words.

[01:33:00] If the trailer can please be applied. Thank you.

[01:33:20] It was in excitement. When I feel anxious, I call a friend or just listen to music. Big feelings, there's something I've experienced recently. And when I was out of anger for someone I actually cared about. How do you help your children with big feelings? We sit down and we discuss whatever feeling they are feeling and then we come up with a big thing.

[01:33:40] with ideas to deal with those feelings. It's so important for families to talk about big feelings. And our very friends are joined by some special friends to help. Comedian David Cowell.

[01:34:00] players are benign in father and the whole family can choose into the takkalani

[01:34:20] As we share and learn more about big feelings, watch the big feeling show on SABC1 on the 20th of May at 5.30. Big feelings are okay! Hey, hey, hey! Thank you.

[01:34:40] Thank you so much. So yeah, please diarise 20th of May at 5.30pm in the afternoon on SABC and grab all the youngsters and family and friends to watch the show together. We hope it will be fun.

[01:35:00] Lastly, Sesame Workshop teaches social and emotional learning through our television programs across the globe. We currently have a presence in more than 100 countries. We invite you to attend a special session later this afternoon where my colleague, Fatima Rawat, will speak to us about

[01:35:20] research findings from the CCV workshop, Aklan Simpson television show, which is a show that is currently aired in the Middle East. And the research specifically looks at how social and emotional learning is being taught through media, television broadcast in the country of Jordan. And that session was

[01:35:40] will be at 1.30 p.m. this afternoon. Thank you so much.

[01:36:00] Thank you, Marsha. I think that was a great start to a morning session. Light, very entertaining. And I was talking to Marsha earlier this morning and telling her my children actually grew up with takalani sesame. So it's a heartwarming feeling, knowing that the children in our country have something positive.

[01:36:20] to look at and there is some learning taking place within the mental health space. So thank you for that. And definitely we want to see more happening and more promoted so that we reach more children in this country. Thank you, Moshe. Our next speaker is Katie Catapodas.

[01:36:40] Katie is a director and co-founder of Nala Media and she is the trainer and chair of Sanaf's Journalism, Wellness and Safety Committee. Katie is going to speak to us on the role of media in shaping the narrative around mental health. Welcome, Katie.

[01:37:00] Thank you.

[01:37:20] now in our country to openly discuss issues of mental wellness and wellbeing. But how do we navigate this? It's really tricky and often really, really treacherous, knowing that we are dealing with a lot, as individuals in our personal capacities, in our homes, in our families, in our communities.

[01:37:40] and as a nation. How do we take care of our mental health when, let's face it, realistically, we are faced with sometimes over 10 hours of no power at a time. And we can't even laugh about it anymore because I don't know about you, but I've officially lost my sense of humour when it comes to that, and I suspect we all have.

[01:38:00] And more critically, what role does the media play in all of this? As Barty said, I am the Chairperson of SAMF's Journalism, Safety and Wellness Subcommittee and this is such an important focus area for us. But it's not so simple. It's also not a

[01:38:20] It's far more nuanced than what we think. If I were to ask you today, do you agree by a show of hands, media reports can fuel stigma. I also agree. And by a similar show of hands, media reports can bring stigma.

[01:38:40] And so the role of the media and the way it, we, specifically handle and shape this narrative becomes all the more critical.

[01:39:00] and nuanced because we need to interrogate this a lot more deeply and also turn it on its head, friends. The role of the storyteller in the telling of the story cannot just be about the story itself. We have to look at the storyteller too. We have to look at that

[01:39:20] person behind the lens, behind the mic, the person holding the pen, something that far too few of us ever do. For we are the sharers of information, the truth bearers, the news anchors, the field reporters. We are the one with the bulletproof vests running through bombed-out streets of Ukraine. We are the invincible ones.

[01:39:40] Right? Wrong. As I said, it's not that simple. The stories being told in our country have become far worse over the years because in the world of media, my world, in the world of hard news, breaking news, politics, current affairs, it is never-ending and it's totally relentless.

[01:40:00] In the world of stages 4, 5 and 6 of empty reservoirs and dried out tatas, in a world of oncology units that have ground to a halt of ever-changing mails and failing coalitions. In a world where COVID threw us and then destroyed homes and lined up.

[01:40:20] livelihoods, where masks and sanitizers became the order of the day, in that world we were fearful and gutted. In a world where state capture has eaten us up from the inside out, and former presidents take journalists to court. When daring prison escapes and fake corpses, suitable

[01:40:40] only one would have thought for a Netflix documentary are actually true and when tub or bestest actually exists amongst us, that's hectic you'll agree. We're devastatingly the bodies of two young children.

[01:41:00] Just 55 kilometres from here, not far, the mutilated bodies of two young children are found in a field. That world is heartbreaking. Some call that world and all of those stories the news cycle. I call it something else. I call it the news cycle.

[01:41:20] cyclone. It sweeps us all up, every single one of us in a room, one story at a time. And there's never a shortage of news in our country and I know that many of you will say you've tried to switch off from news and you've tried to go on a social media detox and you don't listen and you don't watch and you don't.

[01:41:40] read for your own mental safety and wellbeing and you are right to do that. But you know what? The World of News will find you in South Africa. It will find you and do you know where? It will find you in the dark, as you're sitting in total darkness. Then despite all of your very best efforts to shield yourself from the bad news that you know.

[01:42:00] will depress you. Without a shadow of a doubt, you will know that we're in Stages 4, 5, 6, what feels like 8, despite Escom's denial that we've ever been to Stage 8. All of that affects every person in this room. And it's not a news cycle, my friends, it is a news cyclone.

[01:42:20] crime.

[01:42:40] prison escape undetected for nearly a year, the story that's now grabbed the attention of many parts of South Africa. Following a series of exposés by ground up, the correctional services department has now confirmed that the badly burned body found in Tabobesta's Mungo prison cell in May last year is not his.

[01:43:00] have caused havoc in the city of Durban, one of Africa's largest ports. Shipping containers have been carried away or strewn across submerged motorways.

[01:43:20] The scenes will be when murder trial does continue today.

[01:43:40] Something I...

[01:44:00] In this sub-silence, do you know the core? Do you think you'd like to know what the core is?

[01:44:20] that freaks us out and I'm going to ask our team at the back just to assist us because there's more to that video. We don't choose which stories we want to focus on. These are the stories colleagues that are affecting us every day. Hello my name is Mungi Zikok, a pro-carcineralist at

[01:44:40] high news. Now when Katie asked me to come forward with my experiences out on the field, this was quite a touching matter to me. I am currently covering a story where two very young children were found mutilated and murdered in various areas.

[01:45:00] counter-stories or something that is cheerful, something that is positive. So it is a difficult journey being able to tell stories of people who've lost loved ones, people who've experienced the most traumatic events and to hold space for their men, but to also need

[01:45:20] need to speak to them so that you can also write your story so you have to engage with people who are in a difficult circumstance and who are still processing their own pain. And it's really, really hard, but it's so fulfilling to see. People also heal through time as you're doing.

[01:45:40] telling their story and I think sometimes there is some healing even for the person who's chatting to you as a journalist who keeps telling their story and for them as well I guess there's some healing process but it's definitely a lot to take in and oftentimes we do need a little bit of help and support.

[01:46:00] from family, from friends and even professionally so that we can remain sane and healthy as well.

[01:46:20] wrong. The reality is we don't choose to cover these stories. We have to cover these stories. We have a responsibility to reflect what's happening in our country. We also, however, have a responsibility to be fair and to be accurate. And I believe that by featuring people with lived experiences, the media can help break down these stereotypes.

[01:46:40] We can certainly avoid stigmatizing language. We can avoid sensationalism. We must challenge stereotypes and misconceptions. We must talk to and feature people who've had brilliant and amazing careers, despite some of their mental health challenges. Just last year, I was lucky enough to have a sit-down with DJ Black Coffee.

[01:47:00] very openly about his struggles, about how he goes to therapy when he cries. That is amazing in helping us destigmatize. I treat my brain like my pet, he told me. I feed it, I nurture it, I love it. So yes, as a media we certainly do have the potential to either fuel

[01:47:20] or to help break down the stigma around mental health. I hope that we're doing the latter. By portraying mental health issues in a sensitive and accurate manner, giving voice to those with lived experiences, avoiding stigmatising language, educating the public, challenging stereotypes, we can positively influence understanding.

[01:47:40] understanding and beliefs in mental health. And in so doing, we can then try to cope all the better when the new cyclone comes and sweeps us all away. Thank you very much.

[01:48:00] Thank you, Katie. Another round of applause for Katie, please. I'm amazed. In 15 minutes, you've touched everyone's hearts. Hearing from journalists themselves what they

[01:48:20] go through. But I think the essence or the critical point for me, Katie, is really the voice of the loved experience. I think you cannot overestimate that people actually have feelings and learning from what they experience. We've had people share their experience yesterday.

[01:48:40] And I know each and every one of you who would have heard Christine speak, it should remind us and it should not deter us from our mission. We need to learn that if people have been traumatized, we need to do things differently. And we all have a response.

[01:49:00] responsibility to make sure that we get to see that difference. Thank you. The role of the media and how it can shape the story around mental health takes us to our next speaker, Professor Leslie Robertson, who is the head of.

[01:49:20] psychiatry in Citi Beng district, specialist mental health team, and she's also professor in the department of psychiatry at Wurz University. Prof. Robertson, she will address us on what it means to think about mental health in context. Thank you.

[01:49:40] Thank you, Barty. So I'm going to be talking on a subject I'm going to try and do it in under 15 minutes, but I think it actually needs a book.

[01:50:00] Okay, a two. So I'm going to touch on the concepts first of mental health and mental illness because we want to understand our mental health in context. A little bit on the burden of disease, spheres of influence, contextual examples, both local and international.

[01:50:20] just to touch on how we address mental health in the context of South Africa. So just a reminder that to be mentally healthy it requires healthy neurocircuits. And I really like to talk in very nice terms. I am a doctor and have a

[01:50:40] tendency to go to the biology. And we can't treat if there isn't biology involved. That's the nature of the way medicine has developed. So to be healthy, we want to have healthy cognition, healthy emotions and healthy behaviors. Those are also the manifestations of healthy.

[01:51:00] neurocircuits. American Psychiatric Association emphasizes function in mental health. We've talked about being productive, about having healthy relationships, but very, very importantly,

[01:51:20] presentation, the ability to adapt, to change, to cope with adversity is a sign of mental health. Signs of mental illness, often subjective feelings of distress, as the manifestation of a disturbance in

[01:51:40] the way we think, how we feel or how we behave. And it's often manifest in our impaired functioning, so we're looking at disability in our social, occupational or leisure functioning. And it's this very manifestation of mental illness that creates stigma.

[01:52:00] Instead of reaching out, offering the person a wheelchair, as you would to somebody who can't walk, whether it's permanent or temporary, we ostracize. That behaviour is not tolerable, it's not acceptable. Get out. Including get out of my clinic.

[01:52:20] So the staging model, this is a staging model proposed in the Lancet's Global Mental Health Commission on Sustainable Development. I think it's a really, really useful model. I'm primarily a primary care doctor actually and actually before that a mom.

[01:52:40] that as a wife, or an adult. But this speaks to me. But what I'm concerned about, so if you have a look carefully, this is referring to three syndromes, anxiety, mood and psychosis syndromes. And at the top is our state of wellness. We're functional, we're healthy,

[01:53:00] were happy. We dip down sometimes. We lose energy. We're unmotivated. Our mood drops. Some of us dip down a little bit more. I think the judge who gave what's it, Section 174 discharges just recently and

[01:53:20] And she said, I know that South Africans will be dejected at this judgment. For some of us it's dejection. Others who have a predisposition, that can trigger a psychotic relapse. And I'm not joking. We recently had a patient tell us

[01:53:40] how he went, floridly, psychotic. He abandoned his vehicle, he just walked for miles after hearing that Desmond Royan was made finance minister, and his business in Soweta was going to be under threat. He felt embarrassed and this triggered off his first

[01:54:00] take a sip. He didn't see survival in that situation. What is important here is that the top is our wellbeing. The middle is kind of our more nonspecific signs, which is what we're talking about a lot of here.

[01:54:20] A lot of self-help, some therapy, some support can address this. But at the bottom are what we call full-blown syndromes. And this is where we have bipolar disorder, schizophrenia, very serious and impairing conditions, highly disabling, severe anxiety disorders.

[01:54:40] What is not included is the vulnerability of somebody with, say, intellectual disability, whether it's mild and they're trying to make it in society, moderate or severe. ADHD, autistic spectrum disorder, or a personality disorder, who also exist on the mild through to severe.

[01:55:00] So the global burden of disease data makes very interesting reading. I find it quite stimulating and sometimes it can be quite addictive. But what is really interesting is to look at the regional comparisons and the country comparisons and this is always in the supplementary material.

[01:55:20] And you can really go and see, where is our data lacking, and what are we doing, and what is serious in our country. What I find very interesting is that there's a lot of regional disparities and differences on the depression and anxiety, the less specific

[01:55:40] illnesses, but it's very much similar when you're coming down to more severe conditions like bipolar disorder and schizophrenia. So sub-Saharan Africa has the highest prevalence for depression. This suggests that there's something in our context that we're living in

[01:56:00] predispose us to depression, people who would be otherwise healthy. But we have similar prevalent rates of more what we could think of as biologically driven illnesses. This is taken from the WHO 2022 mental health report and it very, very nicely.

[01:56:20] shows the intersection between stressors and individual vulnerability. So people with a low risk, a low level of vulnerability, they've got positive genes, positive DNA, a good, healthy family. They feel loved. They cope with their

[01:56:40] stress by adaptation. For some this is emigrating to New Zealand. For others it's putting a soapbox at the robot and doing some acrobatics to get money. For me these kids who do this have unbelievable resilience.

[01:57:00] movements, to spend their Saturdays and Sundays in the heat, dancing in choreographic movements altogether to collect money, shows innovation, it shows high level of intelligence, social cooperation, discipline.

[01:57:20] and incredible resilience. And they've got, what, how much stress in their lives? Compared to us, I think we'll be ashamed. So what happens to people with high risk, those people who exist at the bottom of that spectrum who are trying to live their lives with a

[01:57:40] chronic severe illness. And then they see that those friend Roy and has made finance minister and what is going to happen to their advertising business. What will happen to the economy? How will they support their children? And you get a psychotic relapse. Sometimes you get a

[01:58:00] rather counter-intuitive manic relapse, severe, impairing and often long-term disability. So the spheres of influence, we're born into a society, we're not born as individuals, but we live in relationship with each other

[01:58:20] live in relationship with the world around us. So if we look at our global influences around us, I think many of us are quite destabilised mentally by the geopolitics we're witnessing, by the global transnational crime syndicates, human trafficking, drug trafficking.

[01:58:40] trafficking, the corruption which is actually global, this is not just South Africa, and it fuels each other, each country, as well as the crime syndicates, and then the climate change and of course they're coming up with a whole load of eco-induced mental distress syndromes.

[01:59:00] Peace and social order is what we need nationally to achieve higher on our happiness index, social order being the rule of law and order. So when police don't validate documents which they could validate and the justice system is not

[01:59:20] fails the citizens, not because we haven't proven somebody innocent or guilty, but because we haven't done our job. There's no social order. We need effective state capacities, health systems, education systems, justice systems. And this gives the background for a greater

[01:59:40] growing economy, and this gives the background for better mental health. And then in our community, we'd like to know we're safe. We'd like to know our kids can play in a local green space without being raped, attacked or assaulted. And so on.

[02:00:00] So contextual examples, I'm going to only touch on those three, global, national and community, because the individual and family are born into this and they have to survive in this. And if the systems around them don't work, we can't expect them to just choose a healthy lifestyle, to manage

[02:00:20] their depression. So firstly for climate change if you have a look this is from the WA Child Framework on Climate Change Policy Breathe and on the right are all the mental distress syndromes but at the bottom are the vulnerabilities and who is listening.

[02:00:40] amongst the vulnerabilities are those with pre-existing mental health conditions who overlap with those who live with poverty, who live in crime-ridden areas, who are unemployed. This is a study done following Hurricane Katrina. They used the Kestla 6th

[02:01:00] scale and a post-traumatic syndrome scale. And what they found is after Hurricane Katrina, you had a significant rise in post-traumatic stress syndrome was new at 40% of the respondents, but you had a rise in psychological distress, both mild to moderate.

[02:01:20] which is the small dotted line, and severe serious mental illness, which is the dashed line at the bottom. And 12 years later, that hasn't gone back to what it was before the hurricane. Now that bottom line, which would have gone from 6% to 10.7%

[02:01:40] percent are the kind of people who might need to access or who would need to access something in the health care system to help them to get back to where they were. What have we have done in KZN with our floods? What's happened to those people who now have more severe illness?

[02:02:00] When we look at our human right situation, and I'm afraid the Human Rights Watch report for 2023 is damning and not pleasant reading, but what I'd like you to think about is when we feel vulnerable, our rights are being assaulted or you feel

[02:02:20] that you can't speak up. What does it feel like to somebody who's got a neurodevelopmental condition, who can't control their impulsivity, or who battles to concentrate, or is prone to delusional thinking?

[02:02:40] The CRPD report on South Africa for 2018 highlights the psychosocial disability issues, people who cannot access health care, not just mental but physical as well. So they've described four positive aspects on South

[02:03:00] Africa on the front page. There are then 13 pages of principal areas of concern and recommendations, and 28 comments on the needs of people with psychosocial disability and recommendations regarding our legislation and policy. So it's not as

[02:03:20] right-spaced as we would like. So the context of our mental health systems, this is the study done by Dokvet Ethello, which most of you would be familiar with, and nationally they found we actually spend quite a lot. We spend 5% of our budget on mental health care, our health care budget.

[02:03:40] is on specialised hospitals, which is the vast majority on the left, and other specialised hospitals, which in cutting would be somewhere like Cullinan Care Centre, rehab centres, standalone institutional centres. The other 50% goes on the general health centre.

[02:04:00] setting. Now in Cartang, I studied this quite thoroughly. 65% of the budget goes on specialised hospitals and other specialised hospitals. 15% goes on the tertiary and central hospitals. And the rest...

[02:04:20] 20% is divided between district and regional hospitals, which provide 50% of the admissions for mental illness, and 8% from primary health care, which provides over 80% of the outpatient care.

[02:04:40] So an analysis of the psychotropic medicines that we use in cartoon in our database shows that 94% of medicines for mental and neurological disorders, 94% of the individual doses are procured for use in the general health

[02:05:00] setting. 60% in PhD, which only gets 8% of the budget. So this is integration. These are media photographs that are on the internet. This is integration. This is the context of integration in our health system, in Khartan.

[02:05:20] 94% of the care is in this setting in the general health system. But this is a very good way forward. And I see Melvin over there and really I found this report really, really interesting to read. I would just criticise it for one thing.

[02:05:40] thing, you've got to tell people what to do in detail, because they don't know.

[02:06:00] outside the health sector. Thank you very much.

[02:06:20] Lots of information, lots of reality. Thank you, Dr. or Prof. Robinson. I'm actually so tempted to talk about key points. You know, you raise valid issues around human rights and what came out of that

[02:06:40] diagram for me was what goes beyond.