Why 92% of mentally ill South Africans don't receive treatment
The realities of mental well-being creep up on us day after day as we get sucked into a world of unrealistic beauty and life standards, global unrest, and a general feeling of despair brought to us on our smartphones. While we may find some coping mechanisms that help slightly, the truth is, most South Africans don’t have access to mental healthcare.
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Almost 92% of South Africans living with mental illness never receive treatment.
For common conditions like depression, anxiety and substance use, three out of four people go without help.
When it comes to severe mental illnesses, the figure is even more stark: fewer than one in ten patients receive the care they need.
The South African Society of Psychiatrists (SASOP) says this is not only a crisis of resources, but also a crisis of access.
“We can no longer rely solely on one-on-one consultations between psychiatrists and patients,” says Dr Siki Gwanya-Mdletye, chair of the SASOP 2025 Congress taking place in the Eastern Cape from 17-19 September.
“Our expertise must extend beyond consulting rooms, through collaboration with general practitioners, nurses, social workers and psychologists so that accurate and effective mental health knowledge filters into every level of care.”
Compared to global benchmarks, South Africa’s public mental health services are dramatically under-resourced.
The World Health Organisation recommends at least one psychiatrist, eight psychosocial care providers and 10 trained nurses per 100,000 people.
In the public sector, South Africa has only 0.31 psychiatrists and fewer than one psychologist per 100,000 people, with most resources locked up in hospitals rather than accessible at the community or primary care level.
“This is why people in rural provinces like the Eastern Cape, where psychiatrists are extremely scarce, often have no pathway to help,” Gwanya-Mdletye explains.
“The solution lies in reimagining access—equipping frontline health workers, schools, and workplaces with the knowledge and tools to respond early and building partnerships that share expertise rather than hoard it.”
Gwanya-Mdletye says the costs of inaction are enormous, from rising suicide rates to economic losses in the billions due to absenteeism, substance use and untreated depression in the workforce.
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To tackle this crisis, Dr Gwanya-Mdletye says there is a need for:
- Integration of mental health into primary care so that people can access help where they live.
- Task-sharing with nurses and community health workers to extend scarce expertise.
- Partnerships across sectors and borders that are equitable and sustainable, avoiding dependency on international donors.
- Public awareness efforts to cut through misinformation and stigma, making mental health knowledge accessible and trustworthy.
“Too often, misinformation fills the space where expert voices are silent,” Gwanya-Mdletye says.
“By encouraging collaboration and innovation, both locally and globally, we can work towards every South African having a fair chance at mental well-being.”