Addressing the mental health crisis in South Africa: 92% of individuals go untreated

In a startling revelation about the state of mental health care in South Africa, reports indicate that up to 92% of individuals living with mental health conditions do not receive the necessary treatment. This alarming statistic, highlighted by the South African Society of Psychiatrists (SASOP), underscores a dual crisis of resource scarcity and accessibility, particularly for common disorders like depression, anxiety, and substance use, where a staggering three out of four individuals remain untreated. For severe mental illnesses, the situation is even more dire, with fewer than one in 10 patients receiving care.

According to Dr Siki Gwanya-Mdletye, Chair of the upcoming SASOP 2025 Congress, mental health care cannot remain confined to traditional consultations between psychiatrists and patients. “We can no longer rely solely on one-on-one consultations; our expertise must extend beyond consulting rooms,” Dr Gwanya-Mdletye emphasised. The Congress, taking place in the Eastern Cape from 17 to 19 September, aims to address these pressing issues under the theme “Reimagining Mental Health Care Access.”

Compared to global benchmarks, South Africa's public mental health systems are dramatically under-resourced. The World Health Organization recommends a minimum of one psychiatrist, eight psychosocial care providers, and10 trained nurses for every 100,000 people; however, in the public sector, South Africa only manages to provide 0.31 psychiatrists and fewer than one psychologist per 100,000. The emphasis on hospital-based resources leaves communities, especially in rural provinces like the Eastern Cape, with scant access to mental health care.

Dr Gwanya-Mdletye stated, “This is why people in rural provinces…often have no pathway to help. The solution lies in reimagining access — equipping frontline health workers, schools, and workplaces with the knowledge and tools to respond early.” This approach includes a strong mandate for task-sharing among various health workers to maximize the limited expertise available.

The cost of inaction presents another layer of urgency, not only as the rates of suicide spiral upward but also as economic losses mount in the billions due to absenteeism, untreated mental health issues, and substance abuse in the workforce.

“The reasons to act on mental health care are not just humanitarian; they are economic,” Dr Gwanya-Mdletye remarked.

To address this crisis effectively, Dr Gwanya-Mdletye advocates for a multifaceted strategy:

• Integration of mental health into primary care, enabling individuals to access help within their communities.
• Task-sharing with nurses and community health workers to extend the reach of expertise.
• Formation of equitable and sustainable partnerships across sectors and borders, reducing dependency on international funding.
• Public awareness initiatives to combat misinformation and stigma, thereby making mental health understanding both accessible and trustworthy.

These critical discussions and innovative approaches aimed at closing the treatment gap will be the focus of the SASOP 2025 Congress. “Too often, misinformation fills the space where expert voices are silent,” Dr Gwanya-Mdletye pointed out. “By encouraging collaboration and innovation, both locally and globally, we can work towards every South African having a fair chance at mental wellbeing.”