Mental Health Care in South Africa: Overcoming Barriers to Build an Accessible Future

Mens Foundation SA 

November 2024

Proactive Content Stream 4: Humanitas Research 

By Garron Gsell, CEO at the Mens Foundation SA & Armand Prinsloo, Head of Corporate and Client Relations, Spokesperson at Humanitas

South Africa faces a growing mental health crisis that is deeply rooted in historical, socio-economic, and systemic factors. The scale of mental health challenges, compounded by limited accessibility, demands urgent attention from the public and private sectors today. A recent study by the Human Sciences Research Council (HSRC) underscores the gravity of this crisis, linking untreated mental health issues among South African men to increased aggression and violence against women. The study highlights how societal expectations of masculinity, coupled with economic pressures and a lack of mental health services, exacerbate the problem. Addressing these interconnected challenges holistically could pave the way toward a more equitable mental health care system, particularly for marginalized communities.

The availability of mental health care in South Africa is critically limited, especially in rural and under-resourced regions. With a population surpassing 60 million, the World Health Organization (WHO) recommends one psychiatrist for every 10,000 people. Yet, in South Africa, there are fewer than one psychiatrist per 100,000 people. Rural areas, where access to healthcare is already compromised, bear the brunt of this crisis. People in these regions often travel long distances to understaffed clinics, only to encounter waiting lists and inadequate resources. Approximately 27% of South Africans experience mental health disorders, yet many live in underserved areas where mental health services are minimal.

The HSRC study also highlights how untreated mental health crises in men ripple outward, affecting families, communities, and society at large. This is particularly concerning in rural provinces like Mpumalanga and Limpopo, which are especially affected by the dual challenge of scarce mental health services and entrenched stigma. For many men, societal expectations around stoicism and self-reliance discourage them from seeking help, while inaccessible services further deter those who might consider reaching out. These dynamics contribute not only to personal suffering but also to broader societal challenges, including gender-based violence and economic instability.

The digital divide compounds these issues. The COVID-19 pandemic underscored the potential of telemedicine, but rural communities, hindered by unreliable internet and electricity, struggle to access digital mental health services. In addition, cultural stigma further discourages individuals from seeking help, with fear of judgment or discrimination deterring many men, specifically, from addressing their mental health needs. The economic impact is also significant, with mental health-related absenteeism costing the South African economy billions annually, highlighting the need for accessible mental health solutions that not only support individuals but also contribute to economic stability.

Economic disparities create further challenges in accessing mental health care. Private mental health services, often the only option for timely care, are out of reach for many South Africans. Inadequate coverage from medical aid schemes leaves many to cover therapy, medication, and rehabilitation costs out of pocket. Those who rely on public care face hidden costs, such as transport fees, making mental health services inaccessible for low-income individuals and families.

The overburdened public sector, constrained by funding and resource shortages, cannot meet the demand, exacerbating the mental health crisis for vulnerable populations.

There is also a stark geographical inequality in South Africa’s mental health services. Urban centers like Johannesburg and Cape Town house most of the country’s mental health professionals and facilities, while rural areas remain severely under-resourced. Residents in remote regions often need to travel long distances to access mental health care, facing challenges in making follow-up appointments and remaining consistent with their treatment.

Many rural clinics are overburdened, with mental health workers juggling multiple roles without adequate support or resources. For rural communities, the lack of local, accessible care exacerbates existing health disparities, leaving mental health needs unmet.

Despite increased awareness, mental health issues remain stigmatized in many South African communities. In some areas, mental illness is associated with shame or even witchcraft, particularly in rural and traditional settings. This stigma prevents individuals from seeking care, as they fear judgment from family or social circles. Men, in particular, often avoid seeking help due to societal expectations around masculinity. These cultural and social barriers discourage people from addressing their mental health needs, while certain cultural beliefs may lead individuals to seek spiritual or faith-based remedies instead of medical treatment.

This delay in care contributes to untreated mental health needs, with severe consequences for those affected.

Although the South African government has recognized mental health as a priority, funding remains disproportionately low, typically around 4-5% of the total health budget. The government’s Mental Health Care Act of 2002 is often not fully implemented due to resource limitations and interdepartmental gaps, which has created significant service disparities across provinces.

These policy and funding shortfalls, combined with a lack of trained mental health professionals, limit the government’s ability to provide consistent care and support.

To address South Africa’s mental health crisis, a multi-pronged approach involving the public and private sectors, as well as civil society organizations, is essential. Reducing stigma is crucial to encourage individuals to seek help, and mental health literacy campaigns across schools, workplaces, and community centers can play a vital role in normalizing conversations about mental health. Schools and workplaces can foster supportive environments and provide resources, helping to change the narrative around mental health and encouraging proactive care-seeking behavior.

Campaigns, such as the annual Brovember initiative which is targeted toward men, who are older adults, and marginalized groups are especially important, as these individuals are often the least likely to seek support and often suffer in silence. For those who may be unaware, the Mens Foundation of South Africa, in partnership with Build it, recently launched their Brovember campaign to help raise awareness about the stigma that surrounds men who ask for help. The Foundation recently invited South African men to support this important initiative, by growing a moustache, getting active during the month of November, or by making a donation to support cancer and mental health treatments for South African men in need.

By signing up to the campaign online, men from all walks of life unite to the purpose of reducing the stigma, while fundraising will enable can gain access to vital information surrounding men’s mental health via brovember.co.za.

Decentralizing mental health services, such as these, can make a big difference in the long-run. We can also begin to move the needle on this issue by empowering local clinics in underserved communities. Training staff members to provide basic mental healthcare, counseling, and referrals, could help make care more accessible. Employing more community health workers, social workers, and wellness counselors could help relieve the burden on overstretched specialists while providing culturally relevant support.

Telehealth services present an effective way to reach individuals in remote locations, and virtual therapy, mental health apps, and online support groups could provide immediate assistance where physical healthcare facilities are limited. Addressing the digital divide by improving infrastructure in rural areas is essential for these tools to reach their full potential. Partnering with telecom providers to ensure reliable internet access in rural areas would support the scalability of these digital solutions, making mental health resources more widely available.

A robust approach to improving mental health access must also involve strengthening mental health policies and securing adequate funding. Increased investment in mental health initiatives, especially in rural regions, could expand resources and improve service delivery. Effective implementation of the Mental Health Care Act of 2002 could make mental health services more accessible, and collaboration between government sectors, such as health, education, and social services, could lead to integrated service delivery. This approach could also create more comprehensive care, addressing mental health needs as part of a broader wellness agenda.

The private sector and NGOs play a crucial role in addressing South Africa’s mental health crisis. Initiatives such as workplace wellness programs and community-based interventions could expand mental health support to employees, especially in underserved areas. Collaboration between companies, government, and NGOs could fund and develop scalable mental health initiatives that expand access to care.

Mental health programs in the workplace not only support employees but also enhance productivity and job satisfaction, creating benefits for both individuals and businesses.

South Africa’s mental health care system faces significant challenges, yet these obstacles are not insurmountable. By fostering public awareness, improving, and investing in collaborative initiatives, South Africa can build a more inclusive and effective mental health care system. Ensuring that mental health care is accessible, affordable, and stigma-free will not only benefit individuals but also enhance the well-being and resilience of communities across the nation.

Without concerted action, as highlighted by the HSRC findings, the current gaps in mental health care will continue to exacerbate the challenges facing South Africa’s communities. Addressing these systemic issues is not just a public health necessity—it is essential for breaking the cycles of violence and inequality that threaten societal well-being.