If you want to know how mental illness can wreck body, mind and soul, just ask Nonhle Thema. She says, in the end, she had no soul left.

Forever on adrenaline mode for her career, she never stopped to take time to breathe or reflect on her successes.

“I was always rushing to the next thing. For example, I would have just launched a perfume and someone says, ‘what’s next?’ I never lived in the moment. I was always trying to do better than my last achievement,” says Thema.

You may have first heard of Thelma over a decade ago. She traveled the world interviewing stars like 50cent and Pharrell Williams; was the face of Dark & Lovely and Madison Shoes; was and is an entrepreneur; graced our screens as a presenter and actress and brought South Africa’s first-ever reality show – Nonhle Goes To Hollywood.

She was South Africa’s ‘it girl’. Many wanted to be her. She had millions of ‘friends’ and followers on social media, but in real life, she was lonely and alone. The girl who interviewed Pharrell was not happy.

“Because I was doing so many things and traveling the world, my career started side-lining a lot of people. It was very difficult for people to be comfortable to be around me. When I was doing all these things I have always wanted to do, I thought that was my success. But in all of that, I didn’t have friends.”

Nonhle Thema (Photo by Kenosi Radebe)

Thema tried to fill the void with partying and alcohol.

“I didn’t even realize that was making me worse because it was an empty fake world I was going to. I never took anti-depressants but my anti-depressant was wine which was just as bad. I couldn’t sleep and I took sleeping pills a lot and sometimes painkillers just to knock me out.”

Being famous meant pain and glory all at once. She lashed out at people who criticized her work on social media. Some called her the “queen of Twitter wars”. The pressure to be perfect was too much. It almost cost her her career. The Twitter rants and breakdowns cost her money in lost jobs. It was tough. One day, she couldn’t get out of bed.

“I was imbalanced and living to please people. I self-diagnosed myself as depressed when I wanted to kill myself. I had a spiritual and mental breakdown. I had no soul left. I had given myself to my career and it was my God,” says Thema.

Her mother, Cynthia Shange, an actress and the first black Miss South Africa, became her voice of wisdom.

“I told my mom I don’t want to do this anymore, I want to give up. My mom said ‘you can’t end this beautiful life of yours because of this’ and I realized she had a point.”

The online bullies Thema was giving power to, to the extent she even wanted to kill herself, weren’t worth it.

“I also realized people like you when you are on their level, just surpass them a little bit and you will see their true colors. Around that time, I had my daughter who became my saving grace,” she says.

It was time to slow down. She took time out of the industry to learn more about herself.

“That’s when I realized all that happened because I didn’t have God in my life. Now I sleep so well and I struggle to wake up because it’s so restful. I am not traveling overseas or interviewing Pharrell but I am happy here at home with my daughter… I never got formal help. The industry here doesn’t have facilities that prepare us for this pressure, unlike overseas. The stars there have a therapist on their payroll.”

Thema says speaking out about mental health helps those that are struggling to know they aren’t alone.

“Sometimes we put so much pressure on ourselves to achieve all the accolades so we can impress people. It’s important to always do things for yourself and be in the right frame of mind because if you do things for people, nothing will ever be enough. I wasn’t taking care of my mental health, my body or concentrating on the important things,” she says.

It can happen to anyone, but telling her story wasn’t easy. The problem – the stigma associated with psychiatric illnesses.

The High Price Of Addiction

People don’t want to be seen seeing a psychiatrist or seeking treatment because others may judge them or shame them.

“There is a lot of stigma in rural areas, especially in African communities that don’t see mental illness as a real illness. There isn’t even a Zulu word for depression, therefore it is not real. This prevents people from seeking help or treatment in the fear of being treated differently, being shunned from their families or carrying the shame of having a ‘weakness’,” says Cassey Chambers, Operations Director of South African Depression and Anxiety Group (SADAG).

Cowboys don’t cry

The big picture is worrisome.

Studies done by SADAG show 74% of South African workers have trouble concentrating and experience loss of productivity due to depression. According to Chambers, while general members of the public may find it easier to address the topic, the corporate world has been historically reluctant to follow suit, as if pretending these issues do not affect organizations.

Women bear the brunt. If you are a woman, studies show you are two times more likely to be diagnosed with mental health issues than a man.

“Women tend to speak out and seek help, whereas men don’t like to speak out about their emotions, and society doesn’t encourage men to open up about their feelings – ‘cowboys don’t cry’, and therefore don’t seek help until it is too late,” says Chambers.

According to the World Health Organization, a suicide occurs every 40 seconds and an attempt is made every three seconds. In South Africa alone, 60% of people who commit suicide are depressed and, according to Chambers, men are more likely to commit suicide than women.

To make matters worse, a leading expert in suicide research, Prof Lourens Schlebusch, from the University of KwaZulu-Natal, says for every one suicide, there are at least 20 other attempted suicides. So, because in South Africa there are 23 suicides a day, it means 460 attempt suicide every 24 hours.

“People don’t take mental health, especially depression, seriously. People still say ‘snap out of it, it’s just depression’ so they don’t take it as seriously as chronic illnesses such as diabetes or hypertension. More needs to be done to educate people about the symptoms of depression and what treatment and support is available. Too many people suffer in silence,” says Chambers.

The tragedy is millions live in pain and take their pain to the grave.

Looking for case studies to interview for this article was hard. People don’t want to talk about it or even admit it exists. The few willing to talk don’t want their names published for fear of victimization.

“I can’t have anyone know that sometimes I get depressed because I will lose my job or never be considered for a promotion,” says one interviewee.

The Pain Of The Business Of Death

Fear makes employees go to work even when they aren’t well.

About 40% of South African employees are highly educated and highly-educated employees with depression are likely to work in highly-demanding jobs and also manage others, meaning the impact of their depression has wider consequences. It costs South Africa more than R218 billion ($17 billion) a year in lost productivity.

“We get many calls from employees who report discrimination or the fear to disclose their mental health issue in the workplace for fear of being treated differently, or having it affect their work appraisals or future promotions,” says Chambers.

Like Thema, 47% of affected people lose friends. To make matters worse, 49% have negative family relationships, 17% cannot take care of dependents, 26% are separated or divorced, and 70% of South Africans who attempted suicide had a mental health disorder.

“The cognitive symptoms of depression, for instance, difficulties in concentrating, making decisions and remembering, are present up to 94% of the time during an episode of depression, causing significant impairment in work function and productivity. Unfortunately, managers and line managers don’t have enough training in dealing with mental health in the workplace.”

This isn’t that surprising. SADAG still comes across dreadful cases of patients being locked up in homes during the day, being tied to trees, or even being punished for having mental illness. Mental health isn’t taken as seriously as it should be.

A 2008 Mental Health and Poverty Project study, led by the University of Cape Town, found that, at the time, in Africa, 76% of countries had a national mental health program or plan, while only 52% had a mental health policy; among them, half had old policies that hadn’t been changed for over 15 years and only a third had a policy that was less than 10 years old.

The Life Esidimeni tragedy

Here at home, policy isn’t the issue. Money and good treatment of mental patients is.

“So much more needs to be done to educate patients about their mental health rights – and then more needs to be done to reinforce those rights. We need to strengthen our local community resources in community clinics and set up more active mental health review boards in various districts,” says Chambers.

Early this year, the death of over 100 mentally-ill patients, in the hands of government, was one of South Africa’s biggest blunders that left many at their wits’ end.

Life Esidimeni had been contracted to the Gauteng government for nearly 40 years, but the then Health MEC, Qedani Mahlangu, terminated that contract, citing costs. In October 2016, Mahlangu said that in 2014/15, the department paid R323 million ($25 million) to Life Esidimeni to treat around 2,378 patients which was too expensive. Patients were taken to 27 unlicensed NGOs. The patients who died, died of dehydration, diarrhoea and other unnatural causes.

“When the Life Esidimeni matter erupted, it was a sad moment for me and for everyone who was involved in the journey of making sure mentally-ill people are treated humanely and get the best care and treatment post 1994. The way we treat the most vulnerable in society tells of how humane a society we are,” says new Health MEC Gwen Ramokgopa, Mahlangu’s successor.

Gauteng Health MEC Gwen Ramokgoba (Photo by Elton Maregedze)

We meet Ramokgopa at her offices in Johannesburg. Dressed in a mustard dress, she says South Africa is a post-violence society and the effects are felt.

“There are studies that have shown that one in three South Africans has a mental health problem… from depression, anxiety and much more serious mental health issues. There shouldn’t be anyone who feels they are not affected,” she says in a calm voice.

Ramokgopa said the Gauteng Health Department will spend R6 million ($461,000) to transfer up to 763 psychiatric patients from NGOs to suitable medical facilities. That’s a significant amount considering the national Department of Health allocates less than 4% of its entire budget to mental health, with the Gauteng government spending R200 million ($15.3 million) on mental health programs for about 8,000 patients. This isn’t enough, according to Prof Crick Lund, from the University of Cape Town; only 25% of people with a mental illness receive treatment.

“It was humbling for me to come and step in. The ombudsman has said he is encouraged by the progress we made. For example in June, there wasn’t any death in the cohort. We were not aware there was a problem. If we were, we could have prevented it because the capacity is there in Gauteng. Everyone was taken by surprise. We were shocked with disbelief. There was no compliance with the law and regulations… even now, I’m still trying to find out how it was even possible for this to happen,” says Ramokgopa about the Life Esidimeni deaths.

Ramokgopa says she is prioritizing mental health and working on building the trust that was lost because of the Life Esidimeni tragedies.

“We are also working with families to oversee our work. We have revised licence requirements because transparency begets accountability. Institutions that have long-term care must have family committees that can help them. Families need to be able to voice their views so that our services continue to improve,” she says.

Ramokgopa also points out there is more work that needs to be done because specialists tend to work in silos.

“Another thing is the shortage of psychiatry-trained nurses and we don’t have enough infrastructure which includes facilities for long-term chronic patients and human resources infrastructure. These are challenges we can overcome if we work together,” she says.

Those with a bit of money that can afford medical aid are in a better position. Figures supplied by Discovery Health, the country’s leading medical aid company, show a 41% increase in pay-outs relating to mental illness from 2009 to 2014.

Happy states and happiness officers

The quest? To be happy! Ramokgopa says companies should consider hiring Chief Happiness Officers because being happy boosts mental health and improves company performance.

Making society’s happiness a governmental responsibility is far from universal, but it is gaining momentum.

Happiness has been a focus since the early 1970s. The tiny Buddhist Himalayan kingdom of Bhutan, between India and China, led the way when it introduced a Gross National Happiness Index to measure prosperity by gauging its citizens’ happiness levels, not the GDP. Venezuela’s President Nicolas Maduro followed.

In 2013, the South American country coined a Vice Ministry of Supreme Social Happiness and Ecuador appointed Freddy Ehlers as State Secretary of Good Living with a $2 million annual budget.

There are more examples. Last year, the United Arab Emirates appointed Ohood bint Khalfan Al Roumi, as Minister of Happiness.

The world is paying attention.

The United Nations now publishes the World Happiness Report, which ranks 155 countries by their happiness levels. The study found Norway to be the happiest place on Earth this year, followed by Denmark, Iceland, Switzerland, Finland, the Netherlands, Canada, New Zealand, Australia, and Sweden.

The happiest countries have less suicide, an improving economy and growing number of businesses.

Maybe it’s time governments worldwide joined in, rather than turning the other way to issues of wellbeing.

Mental health (Photo by Motlabana Monnakgotla)

‘I Chose Life’

Jabulile Mbuli’s story is evidence depression is not a death sentence.

Jabulile Mbuli* (name changed) first noticed something was amiss when she was 12 years old. She tried to be a happier person, many times, and failed.

“When I got to university, I realized there is more to the story than being moody. The more I was around people, the more anxious I got. We don’t really talk about depression in my culture so at 19 years old, I didn’t even know what to do about the problem,” says Mbuli.

Mercy Or Monster?

To seek clarity, she started sharing her worries with friends. At first, it didn’t help.

“I would say ‘I think I have more sad hormones than happy ones’ and people would say ‘don’t worry you will be fine’. Whenever I would say I am depressed, they would say there is no such thing as depression. Just shake it off and choose to be happy.”

Mbuli questioned herself. She says she thought she was overly sensitive. Everyone was right and she was wrong. Like any university dorm, the University of Cape Town student residency was crawling with students, day and night. It almost ruined her life.

“I stopped talking to anyone, I couldn’t go to class, I locked myself in the room and just couldn’t go out. I can’t be around that many people all the time. I was at the peak of depression,” she says.

She lost all functionality. It forced her to drop out of university in her third year.

“Had I stayed longer, I wouldn’t have made it alive,” says Mbuli.

She got her way and went straight to PricewaterhouseCoopers for vacation work. In just two weeks, she impressed. They offered her funding to go to another university and finish her studies. She couldn’t.

“It was a great opportunity but I just couldn’t take it. I was already in a deep dark hole. People thought I was crazy but I knew I was not ready to die. If I went back to a [residency] setting I could have killed myself. The blessing for me has always been that I have a great sense of self. I know how much I can take,” she says.

Stepping back meant disappointing her family and friends. She didn’t let it get to her. Mbuli says, at any given point, she always chose life. This was the lowest point in her life but she didn’t want to feel like she had failed, so she found a job, waiting tables at a restaurant in Cape Town.

“If I listened to people I could have ended up killing myself. I felt I had spent too much of my mom’s money just to go home empty-handed. No matter how tough, I refused to say I had hit rock bottom and went to work.”

Hard work paid off. In five months, she was promoted to manager at just 21 years old. She ran the restaurant for two years.

“I didn’t take the time to stop and deal with what had happened. I was excelling in that job but deep down I knew I was broken. I had to stop and deal with myself,” says Mbuli.

She moved back home with her mother. The reality of what had happened, two years ago, kicked in. The effects of dropping out were clear.

“I wasn’t working and I was home for the first time since I dropped out. I could see my mom’s disappointment in her eyes. But still, no one was talking about depression.”

“There was a time I couldn’t sleep for two weeks straight and I was losing a lot of weight. I think my mom only then realized something was wrong.”

Her mother bought her anti-depressants without her knowledge.

“I think that was her way of helping because she didn’t know how to deal with this beast but could no longer ignore it as well,” she says.

Mbuli stayed home for a year, then moved to Pretoria to study, but instead went to work and has never looked back. She is enrolled with UNISA were she has a few modules left to finish her degree. Challenges remain.

“At one point, I mentioned my condition to my manager and it was used against me. If anything didn’t go well at work, instead of acknowledging the problem or mistake it would be ‘but you know she has an illness’ even when it wasn’t about that. I have had to push myself too hard sometimes and then I would crash,” says Mbuli.

It didn’t stop her from climbing the corporate ladder. Today, Mbuli works as a financial manager at an accounting firm. She regularly takes time off and visits a therapist.

“People always think depression is about problems but it’s not. It is an illness. It can be triggered by anything. Sometimes I hear people saying ‘I broke up with my boyfriend, I am depressed’ or ‘I had a fight with someone and I am depressed’; no, you aren’t depressed, you are sad,” she says.

Mbuli’s story is evidence depression is not a death sentence.

An App For The Mind

Wellbeing is a big industry, from wellness destinations, mood recorders to apps that check your mental state, it presents opportunities for entrepreneurship.

Photo by Getty Images

Sixty percent! That’s the number of depressed South Africans who commit suicide.

Prof Lourens Schlebusch, from the University of KwaZulu-Natal in South Africa, says for every one suicide, there are at least 20 other attempted suicides. Technology might help decrease the number.

“Technology and its devices have become more affordable and accessible, to the point where, in today’s world, the majority of people, even those in low to no income brackets, have cell phones,” says Charlene Sunkel, Programme Manager: Advocacy & Development at the SA Federation for Mental Health.

The SA Federation for Mental Health is creating an app to improve accessibility to information about mental illnesses.

The app has an information library that directs the user to a wide range of information on the types of mental disorders and resources on finding help. It also has a human rights section that provides information of the rights of persons living with mental disorders with links to relevant policies and legislation.

“There are two important functionalities to support persons with mental disorders. These are a mood recorder, keeping track of one’s moods and emotions; and a reminder, being reminded of when to take medication and when to follow up for treatment,” says Sunkel.

Sunkel is a leading South African voice for the rights of people with mental health problems. She was diagnosed with schizophrenia in 1991, which led to her passion for mental health advocacy and human rights, where she received a number of awards for her work. She won the Jim Birley Scholarship Award which is funding the development of the app.

Through the app, according to Sunkel, their aim is to address challenges experienced in the mental health field, such as stigma and discrimination, the widespread lack of accurate information related to mental disorders among the general public, non-compliance to treatment, the lack of skills to manage mental disorders, the lack of knowledge on rights, human rights violations going unreported, unfair dismissals, and unfair discrimination in the workplace.

“We believe that the app truly has endless possibilities, including expansion outside of South African borders into developing countries, with some adjustments of the ‘resource and help’ feature to accommodate local resources within a specific country,” she says.

This is proof that necessity is the mother of all apps.