By Reinette Lotz, Allied Services Manager at Platinum Health Medical Scheme

Mental health has come a long way in the past 20 years. Where mental illness was once hidden or frowned on, society now accepts it as a common and often treatable condition.

According to the WHO, in 2019, 1 in every 8 people, or 970 million people around the world were living with a mental disorder, with anxiety and depressive disorders the most common. Left undiagnosed and untreated, mental health conditions can prove debilitating or could seriously impact personal lives and work.

Prioritising mental health support in mining operations – through awareness, counselling and access to care – is not only a moral imperative but a strategic investment in the sustainability of the workforce and the resilience of the communities that depend on them.

The importance of mental health is also emphasised in the National Mental Health Policy Framework and Strategic Plan 2023–2030 by the Department of Mineral and Petroleum Resources, as well as organised labour. The Department of Minerals and Petroleum Resources has also issued a directive to include regular mental health screening at occupational centers to ensure early detection. Interventions to improve the safety of women in mining is also among their 2034 milestones, as the industry strives to realise its ambition of Zero Harm to all.

Common mental health concerns in mining

The mining sector is characterised by high-stress and potentially hazardous environments that can take a toll on workers’ mental wellbeing. Mine workers are often breadwinners in their households and their psychological wellbeing directly affects the stability of their families and the broader social fabric of their communities.

In the mining sector, much like in the broader population, the most common mental health issues we see are depression, substance abuse, anxiety and relationship problems. Coming to the fore in recent years are also issues like bullying, harassment and victimisation, while many may also suffer from grief, trauma or post-traumatic stress disorder (PTSD). A recent study in the South African Journal of Psychiatry assessed 927 mine workers and found that 31% experienced moderate to severe psychological distress — indicators consistent with symptoms of anxiety and depression. The research also highlighted a strong association between hazardous alcohol use and mental health distress.

Identifying and treating mental health conditions

It must be noted that an employee on treatment for a mental health condition is much less of a risk than an employee who has not been identified and treated.

For example, concentration and memory are affected by depression. So if you work with equipment and there's a lapse in concentration, it could cause a mining accident. Mines have come to understand the importance of proper screening and treatment for mental health conditions such as depression, anxiety and substance abuse, as part of general health screening. As a closed scheme tied to occupational health services, these comprehensive periodic screenings are compulsory and help to identify and treat physical and mental health conditions early.

Employee Assistance Programmes (EAPs) provide access to counsellors 24 hours a day, 7 days a week, making treatment convenient and accessible. They are also geared to educate the mining community – normalising these issues, removing the stigma of mental illness, and highlighting the importance of getting treatment and support.

This growing awareness through the EAP campaigns could account for the fact that the bulk of our referrals are what we call self-referrals. People know where to access the service and patients would come and request assistance – both on the Scheme side, but also on the EAP programme side. Referrals also come from GPs at the mines, and from mine HR or management in cases where an employee exhibits problems with work performance, late coming or absenteeism. They typically refer those clients to the EAP social workers, who would assess them and if they need more specialised treatment, they would send them to the psychologist and we would triage them to the psychiatrist.  

Our pragmatic approach to mental health treatment

Our pragmatic approach is designed to offer the best outcome to patients. For example, patients with schizophrenia struggle to adhere to taking medication daily so we may prescribe injectables to improve treatment outcomes. We believe that if you treat mental health conditions early and appropriately, you ultimately reduce the need for hospital admission.

Mental health treatment can be costly, so many medical schemes limit their benefits to only the prescribed minimum benefits, such as a 21-day in-hospital treatment or a 21-day programme in a rehab facility, or chronic conditions such as bipolar depression. When comparing mental health services, it’s important to check if all mental health conditions are covered, and if patients can be treated on an outpatient basis. We find it is not always beneficial for patients to go to mental health institutions because of personality factors. In the mining environment, we seek alternative treatment options before hospital admission to help normalise the condition and remove the stigma of the patient being removed from their family and community for treatment.

Other considerations when selecting a medical scheme are whether medication is provided with no restrictions on the long-term treatment, and whether the mental health department is well-supported and integrated with a network of GPs and EAPs.

Our in-house mental health services enable close collaboration and overcome the silos and disconnects that can occur in private practice: occupational health teams collaborate with our medical teams, our social workers can speak to the GPs and the psychologists, and they can speak to the psychiatrists to develop an individualised treatment plan. This also fosters more holistic approaches to healthcare, with greater accessibility and better outcomes for patients.