Dan Stein: challenging the mental health stigma

Psychiatric disorders account for the third largest portion of South Africa's disease burden. Yet mental disorders remain the most stigmatised and grossly neglected of medical conditions. Professor Dan Stein, head of the Department of Psychiatry and Mental Health, has dedicated more than 20 years of his life to the study of mental illness, with work ranging from clinical neuroscience through to public mental health.

Stein was awarded the Alan Pifer Award in part for the role he played in the first nationally representative epidemiological study of mental illness in South Africa, or indeed in Africa. This large-scale study produced a wealth of new information about psychiatric disorders in South Africa, including the finding that, although there is significantly more impairment associated with mental illness than with physical disorders, mental disorders are less likely to receive treatment. This is in part because of the continued high levels of stigmatisation associated with mental illness, and the lack of parity in health services for mental and physical conditions.

Stein’s work has successfully highlighted that parity for mental health services is a human rights issue, but also makes good economic sense. “While work on mental health literacy and barriers to care for mental illness has been undertaken by a number of groups in the developed world,” says Marian Jacobs, dean of the Faculty of Health Sciences at the time, who nominated Stein for the award. “Prof Stein and his colleagues have made a particular contribution by studying these issues in an African context.”.

Stein and his colleagues effectively used data on the prevalence, morbidity and under-treatment of psychiatric disorders to argue for higher priority attention to mental health services. Jacobs partly attributes the gradual increase in spending on mental health services by the Western Cape Department of Health to the work of Stein and other colleagues in the Department of Psychiatry.

Stein’s research has focused on the anxiety and related disorders, including obsessive-compulsive and related disorders, and trauma- and stressor-related disorders, which are the most prevalent of the psychiatric disorders. His work includes neurogenetics research, brain imaging research and treatment studies, and he has been director of UCT’s interdisciplinary Brain and Behaviour Initiative as well as the Medical Research Council Unit on Anxiety & Stress Disorders. At the same time, he has also dedicated much of his research to a better understanding of public health aspects of psychiatry, including the stigma associated with mental illness and why it is that people with mental illness are often reluctant or unable to seek help.

Stein says mental disorders have a strong association with disadvantage, and the stigmatisation of mental illness can further marginalise those suffering with a psychiatric condition. During the course of his career he has therefore focused on trying to diminish that stigma.

“I’m proud that in the 10 years I’ve been in the Department of Psychiatry, members of the department have won the award three times,” says Stein. “These Alan Pifer awards to members of our department reflect the valuable work being done in a range of different areas, which have key relevance for the country and the continent.”

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