**3. The scourge of mental disorders**

As the prevalence on non-communicable diseases increase, mental health and wellbeing have been identified as central to reducing the global burden of this group of diseases [8]. The World Health Organization's mental health action plan for 2013-2020 advocates for this integration because of the significant associations between common mental health disorders and other cardio cardiovascular diseases and common mental disorders, as well as the two groups sharing risk factors. The integration of mental health services seems to be so natural that their separation is regarded as a false divide [1]. Primary health care services present opportunities to offer universal health care to Africa [9]. However, this can be achieved if such services are well planned and adequately resourced with the right quantity of the right categories of staff [10].

#### **3.1 Substance abuse in schools as a mental health issue**

There are reports of an increasing prevalence of substance abuse in schools in South Africa [11], both in rural [12], as well as urban areas [13, 14], which calls for prevention as well as treatment interventions to address the challenges of substance abuse in schools. However, the focus of schools is mainly on academic development and outcomes. This often leaves both short and long-term impacts of other behaviors such as substance abuse, not receiving adequate attention.

On their own, schools are not equipped to deal with substance abuse, which identified a gap, which can and should be met by primary health care services. The inability of the school system to address the challenges related to substance abuse is demonstrated by the existence of the National Policy on Drug Abuse Management in Schools of 2002, which was meant to counteract the use of substances by learners. However, a study to assess the extent to which this policy was being implemented by schools found that the policy is not even known, let alone used by schools [15]. For most communities and schools, there is nothing that has been put in place for the prevention, screening or treatment of substance abuse, and upgrading primary health care services to provide these services will be a highly beneficial asset.

## **4. The urgency of addressing mental disorders**

As the prevalence of mental disorders increase, related mental health services remain chronically under-resourced. The impact of mental illness is not limited to the patient, but also extends to the family, as mental distress has been identified among family members of psychiatric patients [16]. Additionally, those family members also need health care services, thus a continuous addition of people who need mental health services. On the other hand, the high prevalence of substance abuse in South Africa increases demands for mental health services [17]. Mental health services remain chronically under-resourced [18], which implies major unmet needs for mental health care. The lack of adequate resources has been interpreted as apathy by governments and funders to mitigate this human, social and economic costs of mental illness [19].

As in other countries, and in the absence of a well developed primary health care system to address mental illness, the current system of relying on mental hospitals as a mode of service provision is dominant in South Africa. Not only is this mode unrealistic for resource-constrained countries, but it limits the extent to which mental illness needs are met, as these hospitals are too few and expensive to meet the needs of the people who need such services. Moreover, the dependence on this mode contributes to non-prioritization of development of community-based resources and infrastructure.

Primary care delivery platform has been identified as ideal to address behavioral health, including substance abuse and mental disorders, as this level can be enhanced to effectively address these conditions [20]. Due to inadequate access to specialty substance use disorders, it is estimated that only 10% of people with substance use disorders (SUD) actually receive treatment [21], and this could be improved if such disorders were treated at primary health care levels, which is, by design, able to treat a greater proportion of the population. Delays in treating such patients contributes to major poor prognosis.
