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It’s okay not to be okay

15 October 2020 | Story Angie Vorster | Photo Supplied

Angela Vorster_web read more — Angie Vorster is a Clinical Psychologist in the School of Clinical Medicine, University of the Free State

As a mental healthcare provider, I approach the end of every year with some trepidation. As soon as the August winds start to blow in Bloemfontein, we tend to see a distinct increase in our community’s psychological distress. The year 2020 has not spared us this increased burden of suffering.

This year has presented humanity with extreme challenges and our university community has felt this to our core. The latest research indicates that the South African population has been affected by the pandemic in various ways and on various levels but none less severe than our psychological health. One in three South Africans will present with a psychological disorder during our lifetime (and this was prior to the Covid-19 outbreak); and the effects of the pandemic have caused a significant rise in depression, anxiety and trauma symptoms among South Africans.

In mourning

We are experiencing exceptionally high levels of financial stress due to the impact of the disease and lockdown on our economy. We have endured months of social distancing, fears surrounding our own health and the well-being of our loved ones, our financial safety, managing our children’s home-schooling, adapting to distance-learning and concerns about the academic year being salvaged. We have had to experience loss after loss. We mourn loved ones, colleagues and acquaintances that have become ill or passed away due to the pandemic. We have mourned the loss of our normal lives. The hugs, handshakes, casually touching someone’s arm, the shows, sporting events, weddings, graduations and braais we took as for granted. We grieve for a time before sanitising and masks and avoiding contact with our fellow humans was the daily norm. We miss our offices and tearoom banter. We miss being with our students. Amid all of these losses we know that our rates of gender-based violence, suicide and substance abuse have increased. When people are forced to spend time with others in confined spaces amid increasing financial, health and social stressors, frustration and fear may lead to damaging reactions and dysfunctional coping mechanisms.

World Mental Health Awareness Day on 10 October could not have arrived at a better time. This year the World Health Organisation is encouraging investment into mental healthcare across the globe. While this is an essential step in increasing access to mental healthcare services, it is also only one aspect in the use of psychological treatment resources. One of our most important barriers to providing mental healthcare often lies within us. Mental illness remains one of the most stigmatised conditions in society; even though each one of us will be affected by our own, or our loved ones’ mental-health problems at some point during our lives. Some of the common problematic and erroneous beliefs society holds about people who struggle with mental illness is that they are somehow deviant, dangerous, weak or even faking it. Unfortunately, our healthcare workers are not immune to such prejudicial attitudes and neither are their patients. Self-stigmatisation occurs when we internalise these discriminatory generalisations and fail to access mental health care because we believe that we should be stronger, or just pull ourselves together or worry about the impact of receiving a psychiatric diagnosis on our career or our relationships.

Silence is one of the most insidious barriers

We fear being judged by our healthcare providers, our employers, colleagues, family and friends. This culminates in a situation where we lead lives of quiet desperation – numbing our distress with distractions and substances and perhaps even work. The silence surrounding mental health is one of the most insidious barriers to accessing treatment – because you cannot be helped if nobody knows you are suffering. This is the tragedy of suicide, which more frequently than we wish to believe, is the final symptom of depression and severe psychological illness. I have had to assist more patients than I care to recall to work through the trauma and grief of losing a loved one to suicide. Perhaps one of the most tragic aspects of this is that almost all would sit in utter shock recalling how their loved one had seemed fine. How this came out of the blue. How he or she had never told anyone how difficult life had become for them. How hard it was to get out of bed each morning. How much energy it took to go through the motions of a normal day. How ultimately they were so ill that they believed that they were a burden to their family and friends. How they could see no hope of relief from their pain other than to end their lives. And nobody knew. They were silent in their suffering because of fear of stigma, judgement, rejection or being viewed as a burden.

The surprising gift of the pandemic

Mental illness does not discriminate against anyone. It affects professors, students, support staff and the greater university community equally. Nobody is spared these struggles. This is what we all share, the human experience of life's seasons which we cannot do alone. When we need the help of more than our resilience, support structure and exercise routine. This is where the pandemic has brought some unexpected gifts. Prior to March of this year, it was very unusual for psychologists to provide online or telephonic therapy. In fact, many medical aids were uncomfortable covering teletherapy. Once we had no other alternative; however, we all had to adapt. Suddenly I no longer only saw patients who were able to attend sessions at my office. Now I could assist students and doctors who were in lockdown across the country. I could refer patients to the appropriate therapist, irrespective of where they were. Patients no longer had to negotiate the uncomfortable experience of waiting in a psychologist's waiting room or being seen leaving an office looking upset or need to take time off work to attend a session. Now patients can access their psychotherapist from the containment and confidentiality of their own space, and we in turn, are more freely available as we are not bound to a specific venue.

Receiving psychological treatment is becoming as normal a part of well-being as going for a run, or eating healthily or spending time with our social support system. And this is what is going to save lives. The more we normalise the use of psychological services, the less stigma and silencing we will be subjected to.

We survived a pandemic

As a clinical psychologist I proudly tell my students, colleagues and patients that I have my own psychotherapist without whom I would not be the therapist, colleague, friend and mom I am. There is no shame in owning our vulnerability and reaching out for assistance in order to make meaningful and even enjoyable the few journeys around the sun that we have left. So this October of 2020 should be the month when we start the conversation about our mental health. And by doing, so we permit those around us to do the same. We have survived a pandemic that changed the world and our daily lives. It's okay not to be okay.

Opinion article by Angie Vorster, Clinical Psychologist in the School of Clinical Medicine, University of the Free State

News Archive

UFS responds to concerns around high costs of higher education

2015-10-15

Dear Students

UFS responds to concerns around high costs of higher education

There is an understandable and shared concern among students in the country around the high costs of higher education. As you know, this also is a matter of deep concern on our campuses, which the University of the Free State (UFS) has made a priority in discussions with student leaders - and through new strategies to relieve the burden of costs on poor students and their families. In fact, in the past two weeks, the UFS leadership has again engaged students on the matter of fees in the future.

This is what we have done so far. We have maintained our position as one of the universities with the lowest tuition fees in the country. As you would have seen from recent newspaper reports on the cost of a degree at various institutions over the past five years, the UFS has had consistently low fees. This is not an accident; both the University Council and the executive leadership of the UFS is of one mind that we must offer a high quality education at minimum cost to all our students, despite the rising costs of operating a large multi-campus university with 30 000 students. Our commitment to you is to continue to keep those costs to students as low as possible, without compromising on the quality of education.

In addition, we took a decision earlier this year to become the first university to drop application fees for first-year students. We are proud of that achievement, since so many students fall at this first hurdle as they contemplate post-school education and training. We also waived registration fees for postgraduate students and now Research Master’s and PhD students can study tuition free under certain conditions. We raised more than R60 million from the private sector to enable talented students, who do not receive NSFAS funding, to complete their degree studies at the UFS. We set aside some of the university’s own funds to enable even more students to access finance for their studies. And we now have a special office set aside to counsel and assist students to apply for more than one scholarship to support their studies. The university does not follow a policy of maximizing exclusions. It has endeavoured and succeeded to turn around the majority of its potential deregistration cases. During 2015 we had 2 700 students at the risk of being de-registered, but our serious efforts resulted in only over 200 instances of exclusion we could not mitigate. As is the practice for the past few years, these students’ debt for 2015 has been reversed.

But, we do not only look for funds from outside to support our students. Last year we set up a Staff Fund to which ordinary members of the academic and support staff can contribute from their own, and sometimes very modest, salaries to enable Kovsie students to finish their degrees. We have volunteers who work on the No Student Hungry (NSH) Bursary Programme to raise funds for students who cannot afford a regular meal. We have an open line to rural and township schools to nominate poor students with good results for support by the Rector’s Fund, and some of those students are now in their final year of studies. And many of our staff support individual students in their homes and with their families, without being asked to do so. This is what we call the Human Project and it remains central to the way in which we deal with students.

We will of course continue to make representation to government, the private sector, and individuals to increase funding, especially for first-generation students, and for families where more than one student is at university. We will continue to take to the road to raise funds from companies and foundations to finance our students. We will expand on-campus opportunities for limited working hours for students who wish to earn some money to support their studies. As we have said often before, no student who passes all their courses or modules will be turned away simply because they do not have the funds to study.

The UFS discusses and agrees to fee increases with our students well in advance of the next academic year. None of these decisions are taken without the agreement of the student leadership and thus far these engagements, while tough, have always been done in good faith and with the students’ interests at heart.

It is important for you to know that, with the declining government subsidy, in real terms, and the expanding needs of our students, we will not be able to keep the university running without fees - even though this source of revenue comes mainly through scholarships and bursaries. We need to compensate staff, purchase new library books and renew journal subscriptions (which is very difficult given the low value of the Rand), upgrade computers and software, pay rates and taxes, purchase laboratory equipment, pay the water and electricity bills, expand internet services, upgrade campus security, and hire more academics to keep class sizes reasonably small. It is important for you to know that the university has managed to avoid increasing student fees as a result of much higher municipal rates. Our lecturers are not the highest paid in the country and financially we run a tight ship. We consistently achieve unqualified audits and we are known to be one of the universities that manage its NSFAS contributions with great efficiency. We do this because of our commitment to ensure that our students are able to enjoy a high quality of education on a stable campus where there is a deep respect for all campus citizens.

Despite all these efforts, the most important message we wish to communicate, is that the door remains open for continued discussion with student leaders as we continue to find ways of keeping university education open and accessible to all qualifying students. At the same time, the UFS leadership is involved in discussions with government about how to best manage the escalating cost of higher education for our dents.

Thank you for your support and understanding at this time and be assured, once again, of our commitment to students as a matter of priority to the university leadership.

Best regards

Prof Jonathan Jansen
Vice-Chancellor and Rector

University of the Free State
19 October 2015

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