Mental healthcare in South Africa

Mental healthcare in South Africa faces challenges despite progressive policies, with underfunded public systems, long wait times, and a shortage of professionals. Specialized services exist, but access remains uneven, particularly in rural areas. Therefore, efforts to improve integration into primary healthcare and increase resources are ongoing, supported by community-based and NGO-led initiatives.

The private sector offers various mental healthcare services, including psychologists, psychiatrists, counselors, and specialists. However, these services are expensive, and private health insurance is crucial to ensure comprehensive coverage.

Navigate the mental healthcare system in South Africa confidently by exploring the following topics:

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Mental health in South Africa

The World Health Organization (WHO) estimates that 30% of South Africans will experience mental health challenges in their lifetime. Compared to other nations, South Africa has higher rates of depression and anxiety, with a 25.7% prevalence, according to a Frontiers research journal (2022). The country also has the third-highest suicide rate in Africa.

Perhaps not surprising then that South Africa scored lowest globally on mental well-being as highlighted by the Mental State of the World report (2021), with a Mental Health Quotient (MHQ) score of 46/100, a decline of 3% from 2020. A low score represents distress, while a high score reflects someone thriving psychologically. South Africa also had the highest percentage (36%) of people experiencing emotional distress or struggling with mental health, an increase of 8% from 2020. Countries with higher education and employment rates typically fare better.

The factors contributing to these challenges are complex but may include high unemployment, crime rates, the lingering effects of COVID-19, and even having to deal with continuing power cuts (e.g., load shedding).

Despite these concerning statistics, many South Africans don’t seek help, with only about 27% receiving treatment. Reasons for this hesitance can stem from an under-resourced and understaffed mental healthcare system, medication shortages, and cultural stigma surrounding mental health disorders.

Mental healthcare services in South Africa

The National Department of Health is responsible for healthcare in South Africa assisted by provincial governmental departments overseeing their regions.

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The healthcare system in South Africa

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Residents can access mental health services in the public and private sectors as well as through community organizations.

The overstretched public sector has integrated mental health services into primary healthcare for broader access at state hospitals and clinics. However, there are concerns about having enough resources and specialized services available as it only receives around 5% of the national health budget, which is below international guidelines.

The South African Society of Psychiatrists (SASOP) also criticizes the excessive focus on severe mental health conditions affecting less than 1% of the population and in-patient treatment in psychiatric hospitals. It urges the development of more community programs to promote mental health awareness, early intervention, and treatment for anxiety and depression before these conditions escalate.

As the ratio of patients to psychologists and psychiatrists in the public sector is relatively low, more nurses, clinics, and community organizations are professionally responsible for delivering mental health services.

As such, the South African Federation for Mental Health (SAFMH) is the largest NGO promoting mental well-being nationwide. Additionally, the non-profit South African Depression and Anxiety Group (SADAG) provides free counseling, support groups, referrals, and educational campaigns.

In the private sector, where most psychiatrists and psychologists work, people can access services through their private health insurance (i.e., medical aid). The scope of services tends to be broader, the quality of care higher, and the waiting lists shorter.

How to access mental health services

No matter your nationality or immigration status, you can access state mental healthcare services, which are relatively affordable compared to those in countries like the United States and the UAE. Typically, payments are calculated on a sliding scale, depending on your income.

However, you can expect long waiting lists – often a few weeks – at state-run hospitals and psychiatric facilities or to see a mental healthcare specialist. You would also need a referral from your primary care provider or doctor.

Conversely, if you can afford health insurance and your policy covers mental health services, you can book appointments directly with an independent mental health therapist or ask for a referral from your doctor.

Insurance for mental healthcare in South Africa

While South Africa has not yet implemented the National Health Insurance (NHI) scheme, public healthcare is affordable by world standards; your modest co-payment is based on your income.

However, if you have private healthcare (called medical aid in South Africa), you will have access to a broader range of services and specialists, more resources, and shorter waiting times.

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Health insurance in South Africa

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Always do your research when looking for a medical aid provider, and ensure that your policy covers mental healthcare. A good starting point is looking at the following reputable insurers:

• Allianz Care
• APRIL International
• Cigna Global

Typically, you will pay for the sessions and claim reimbursement from your insurance provider.

Local editor

Magdalena Laas

Insider Tip

Importantly, the therapist’s invoice or statement should also display their Board of Healthcare Funders (BHF) number; otherwise, the health insurance will not pay out.

Please refer to our comprehensive article, Health Insurance in South Africa, for more information.

Psychologists, psychiatrists, and counselors in South Africa

To be referred to a psychiatrist or psychologist in the public system (i.e., clinic or hospital), you’ll need an assessment from a psychiatric nurse or approved medical practitioner (e.g., your doctor).

Psychologists and psychiatrists must be registered with the Health Professions Council of SA (HPCSA) to practice. Most psychologists listed with the HPCSA are clinical, educational, or counseling psychologists.

Depending on their qualifications, counselors must register with the Association for Supportive Counsellors and Holistic Practitioners (ASCHP) or the HPCSA. Many are also members of the South African Association of Counsellors (SAAC), one of the country’s largest registration bodies for counselors, life coaches, and facilitators or mentors.

However, as they can’t diagnose or treat mental disorders, they may refer clients to other specialists.

Many counselors, therapists, psychologists, and psychiatrists work in private practice or have consultation rooms at private hospitals across the country, such as MediClinic and Netcare. If you’re going private, you can contact the specialist directly. However, for admissions to psychiatric clinics, you may need a referral.

You can ask your health insurance company for a list of preferred professionals or search online databases, such as Therapy Directory. You could also find a psychiatrist via the South African Society of Psychiatrists (SACOP).

Always ensure your chosen specialist is registered with the Health Professions Council of South Africa (HPCSA), which regulates mental health professionals’ training, qualifications, and service.

For immigrants, finding an English-speaking therapist across South Africa should not pose a challenge. English is one of the 12 official languages, and most university training for therapists is conducted in English, ensuring accessibility to mental health support.

Local editor

Magdalena Laas

Insider Tip

A 50−70-minute session with a psychologist or psychiatrist in private practice can cost between R1000−3,000, while a counselor’s fees may start at R600.

You can also access online therapy via the Headroom platform, which is more affordable. Alternatively, organizations like Lifeline offer free community-based counseling.

Drug and alcohol services

According to the Global Burden of Disease (GBD, 2019) statistics, South Africans are slightly above-average alcohol consumers (2018), with an estimated 9.52L for users aged 15 and older. This is almost equal to countries like Australia (10.51 L), above other African countries, such as Botswana (6.59 L) and Angola (6.94 L), but far below some European countries, for example, Spain (12.72 L) and Germany (12.91 L).

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Nevertheless, for alcohol use disorders, South Africa has a lower average (1.9%) than many European and South American countries, the United States, New Zealand, and the United Kingdom. Other studies, however, estimate that around 13.3% of South Africans meet the diagnostic criteria for a substance use disorder (including alcohol and illicit drugs).

Many South Africans tend to engage in high-risk drinking behavior, which can have significant social and health impacts on the users and their loved ones. For example:

• Heavy drinkers (binge drinking sessions in 30 days): 59%, only lower than Russia, Angola, Gabon, Democratic Republic of Congo, Central African Republic, Fiji, and Papua New Guinea
• Alcohol use deaths: 27,060 (2019)
• Pre-mature deaths attributed to alcohol: Ages 15–49 (43.02%), higher than the global average (27.38%)

Alcohol abuse is also a social problem, given the link with increased incidences of gender-based violence (GBV).

Other illicit substances used prevalently in South Africa include:

• Cannabis (often called dagga, weed, ganja, grass, or marijuana in South Africa)
• Mandrax (methaqualone, synthetic, barbiturate-like, central nervous system depressant)
• Amphetamine-type stimulants such as methamphetamine (called crystal meth or TIK) and opiates
• Crack cocaine and cocaine
• Heroin

Treatment

There are public, community-based, or free substance abuse treatment centers nationwide, including inpatient and outpatient facilities and halfway houses, for example:

• Eden Recovery Center: 027 115 685 197
• Houghton House Rehab Center: 011 787 9142 or 2779 770 7532
• SANCA Soweto Treatment Centre: 011 984 4290

You can also call the helpline, South Africa Rehab Centres, at 081 444 7000 for an assessment and guidance on finding the most appropriate service for your needs. If you live in the Western Cape, the local government has a database of recovery centers that you can access.

However, South Africa’s public health services are stretched. While the government has increased state-funded services and improved staff shortages, access to treatment remains limited, and waiting lists for state inpatient facilities are long.

The largest NGO helping individuals and communities is the South African National Council on Alcoholism and Drug Dependence (SANCA). They’re often the first port of call for people seeking treatment, and you can contact them at 011 892 3829.

South Africa has many rehabilitation centers in the private sector, but these can be expensive, for example:

• Changes Addiction Rehab: 081 444 7000
• Riverview Manor: 033 701 1911
• Tranquility Home Rehabilitation Clinic: 011 782 3418
• The Foundation Clinic: 010 900 3131
• Twin Rivers Addiction Recovery Centre: 027 828 633 159

The Recovery.com database lists more private rehabilitation facilities across the country.

Fortunately, most medical aids, hospital plans, or private health insurers will pay for a rehab stay. How much, though, depends on your coverage and the treatment.

For sobriety support, the main 12-step recovery groups are free in South Africa. These include:

• Alcoholics Anonymous: 0861 435 722
• Narcotics Anonymous: 0861 00 6962

If your partner, spouse, or a family member’s alcohol use impacts your life negatively, you can also contact Al-Anon for support and resources.

Services dealing with eating disorders

Eating disorders (ED), as defined by the DSM-5 TR (Diagnostic and Statistical Manual of Mental Disorders), are mental health conditions characterized by abnormal or disturbed eating habits that significantly impact one’s physical health and emotional well-being. These disorders include:

• Anorexia Nervosa
• Bulimia Nervosa
• Binge-Eating Disorder
• Avoidant/Restrictive Food Intake Disorder (ARFID)

Treatment can be complex, involving a team of clinicians following a holistic plan. This may include psychotherapy, nutritional counseling, possible admission to a treatment facility or hospital, and perhaps medication.

Some public hospitals (e.g., the Tara Hospital) and clinics offer treatment and support for eating disorders, though these services are often more concentrated in urban areas.

Many medical centers also specialize in treating eating disorders privately.

To find a specialized therapist, support group, recovery centers, resources, or information, contact the following:

• Eating Disorder South Africa (EDSA) or Recovery Direct: 081 444 7000
• Eating Disorder Hope: 866 932 1264
• Relapse Prevention: 073 593 2722 (national helpline)

Alternatively, ask your doctor for a referral.

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Hospitals in South Africa

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Limited research makes it hard to gauge the prevalence of eating disorders in South Africa. However, there are signs of rising cases, especially among adolescents, influenced by urbanization and cultural changes.

Stigmas still prevail, particularly the misconception that eating disorders do not affect Africans or males, making it harder to recognize and treat these conditions. More research and better treatment options are needed to address this issue effectively in South Africa.

Mental healthcare for people with severe mental health problems in South Africa

Severe mental health disorders are typically those that significantly impair a person’s ability to function in daily life, have a profound impact on their quality of life, and may require intensive treatment and support. These can include:

• Major Depressive Disorder
• Severe Anxiety Disorder
• Bipolar Disorder
• Schizophrenia
• Borderline Personality Disorder
• Obsessive-Compulsive Disorder (OCD)
• Post-Traumatic Stress Disorder (PTSD)
• Panic Disorder

Admission

If you need more information about specific mental health problems or the process of admission to a psychiatric facility, call the national Mental Health Helpline at 0800 12 13 14.

Only a spouse, next of kin, partner, associate, parent, or guardian of the person with severe mental health problems can apply for admission to a psychiatric hospital. If none of these relatives exist, a healthcare provider may apply.

The admission process will involve the following steps:

• Contact a doctor or a clinical psychiatrist
• The medical professional will access and examine the person and write a referral if needed
• Contact a psychiatric facility or hospital for admission
• Provide these supporting documents
  • Referral letter
  • Patient’s written consent
  • The parent/guardian’s written consent if the patient is a minor
  • Copy of the identity document of the person admitted

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Doctors in South Africa

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The waitlist depends on when a bed becomes available and the severity of the person’s mental health condition. Of course, if your mental health condition is so serious that you are a threat to yourself or others, a court will order you to be committed to a psychiatric unit.

If the person is too ill to consent to medical intervention, the stay and treatment will be free. Otherwise, the hospital will charge for therapy on a sliding scale (i.e., Uniform Patient Fees Schedule).

With health insurance, you can consider one of the many private hospitals offering mental health services nationwide.

The most established psychiatric hospitals and facilities in South Africa include:

• Crescent Clinic (private): 021 762 7666
• Denmar Psychiatric Hospital (private): 086 117 3322
• Elizabeth Donkin Hospital (public): 041 506 6100
• Fort England Psychiatric Hospital (public): 046 602 2300
• Valkenberg Hospital (public): 021 440 3111
• Weskoppies Psychiatric Hospital (public): 012 319 9500

For more information on where to go for help, contact the South African Schizophrenia and Bipolar Disorders Alliance (SABDA) or use SADAG’s useful guide on schizophrenia that includes a list of state hospitals, assisted accommodation, or support groups.

Suicide

There are an estimated 23 suicides and 230 serious attempts each day in South Africa, according to the South African Depression and Anxiety Group (SADAG). Men and teenagers are most at risk.

If you need help, do not hesitate to call any other following numbers:

• Netcare Akeso Crisis Helpline: 0861 435 787
• SADAG’s Suicide Hotline: 0800 567 567
• SADAG 24-hour helpline: 0800 12 13 14
• Lifeline: 0861 322 322
• Cipla Mental Health Helpline: 0800 456 789

If you are worried about a loved one, friend, or colleague, you can also phone the following helplines:

• 0800 21 22 23  (8:00 to 20:00)
• 0800 12 13 14  (20:00 to 08:00)
• SMS 31393

The trained counselors can also refer you to local support groups and therapists.

Mental healthcare for children and young people in South Africa

In South Africa, it’s apparent that 20% of children and adolescents have a diagnosable and treatable mental health disorder. However, there’s a concerning trend where many young people with mental health issues refrain from seeking assistance. According to Unicef’s U-Report (2021), 65% of them avoid seeking help for various reasons: over a quarter don’t consider their issues serious enough for intervention, 20% don’t know where to find assistance, and 18% worry about what others would think if they sought support.

Moreover, a 2022 survey conducted among South African university students revealed alarming statistics about their mental well-being. Around 21% of them exhibited signs of PTSD, while mood disorders were present in 16.3% of respondents. Additionally, 10.9% experienced General Anxiety Disorder (GAD), and 24.5% reported social anxiety.

Despite these staggering numbers, there’s a significant gap in mental health service delivery for children and adolescents in South Africa. Although the South African Constitution protects children’s rights to quality healthcare, mental healthcare remains under-resourced. While there are top-rated children’s hospitals and psychiatry units in the Western Cape, the availability of child psychiatrists in the state system overall is limited.

Supporting young people

Child and Adolescent Mental Healthcare Services (CAMH) in South Africa address various mental health issues among young people, including depression, anxiety, and other psychiatric conditions. However, services are limited, especially in public healthcare settings, with urban areas like Cape Town, Johannesburg, eThekwini (Durban), and Tshwane (Pretoria) having more coverage compared to rural areas.

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Children’s healthcare in South Africa

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Primary healthcare clinics, district hospitals, and specialist CAMH facilities all provide mental health services for children and youth. Nevertheless, understaffing and a lack of facilities lead to significant delays in referrals, resulting in long wait times for specialists, which can exacerbate a child’s condition and worsen their situation.

Some mental health services may not be fully subsidized by the state, requiring families to pay out of pocket. Even though the fees are calculated on a sliding scale, specialized care is sometimes unaffordable.

Fortunately, the non-profit ChildLine South Africa has a free counseling helpline and online chat for children, teenagers, and adults with concerns about children.

Schools may have counselors or life orientation teachers who give career guidance and teach life skills. They are also the first port of call for students struggling with their mental health.

You can access private mental health services for your children if you can afford the fees or if your medical aid policy covers it, as children under 18 can be listed as dependents on their parents’ health insurance.

Your local doctor or pediatrician can refer your child to the appropriate public mental health services, or you can contact a private specialist directly. Note that children under 18 need consent from a parent, legal guardian, or court-appointed officer.

Mental healthcare services for special groups

In South Africa, women, LGBTQIA+ members, people with disabilities (intellectual and physical), migrants, refugees, and older adults may be more vulnerable to experiencing mental health challenges.

Refugees and migrants often encounter unique challenges, such as integration difficulties and post-traumatic stress due to migration experiences. Consequently, the prevalence of xenophobia in South Africa puts foreign nationals at risk of severe psychological distress.

Despite progressive laws, LGBTQIA+ discrimination and violence are significant issues in South Africa. Being a victim can exacerbate a person’s mental health problems, and stigma may hinder them from seeking help.

According to the 2021 South African Federation for Mental Health (SAFMH) report, individuals with intellectual disabilities often face additional challenges, including discrimination, social exclusion, and limited access to appropriate services, which can contribute to their vulnerability to mental health issues.

Due to the high rate of gender-based violence, mostly against women and girls in South Africa, this population group may be more vulnerable to specific mental health issues, such as PTSD, anxiety, and depression.

Organizations assisting special groups

South Africa offers targeted mental healthcare services for various special groups, including women, minorities, people with disabilities, migrants, and refugees, for example:

Mental health prevention and education programs

The SA Mental Health Conference was launched in 2021 as part of the Masiviwe movement to increase access to mental healthcare nationwide.

With limited government budgets available, many health districts fund their own community campaigns. SAFMH also works with community-based organizations to spread mental health awareness.

See SADAG’s Mental Health Calendar for campaign dates, including:

• Teen Suicide Prevention Week (12–19 February)
• Bipolar Awareness Day (26 May)
• Substance Abuse Awareness Day (26 June)
• Psychosocial Disability Awareness Month (July)
• Mental Health Awareness Months (July and October)
• International Month for Deaf People (September)

Emergency support and crisis lines

For detailed information on emergency services and numbers in South Africa, refer to our comprehensive article. Below are a few handy numbers for quick reference:

Useful resources

• World Health Organization (WHO) – worldwide suicide statistics
• South African Human Rights Commission (SAHRC) – 2017 report on the status of mental health care
• South African Society of Psychiatrists (SASOP) – the professional body for psychiatrists
• South African Association of Counsellors (SAAC) – the largest registration body for counselors, life coaches, and facilitators or mentors, you can search their members’ list for a practitioner
• South African government – list of health departments and associations
• Mental Health Act – download the act for more information
• MedicalAidE – list of medical aids (health insurance) in South Africa
• South African Federation for Mental Health (SAFMH) − the largest national mental health federation
• South African National Council on Alcoholism and Drug Dependence (SANCA) − info, support, and resources
• South African Depression and Anxiety Group (SADAG) – info, support, and resources
• Therapist Directory − directory of psychologists, psychotherapists, counselors and social workers
• Headroom − licensed therapists online