Londiwe Buthelezi
24 September 2026
This Heritage Day, a quiet but consequential conversation is happening in consulting rooms and rondavels across South Africa. It is a conversation about who gets to define illness, and who gets to heal it.
The numbers explain why this conversation cannot wait. South Africa carries one of the highest documented mental illness burdens in the world, with lifetime prevalence of any mental disorder sitting at roughly 30 percent, according to national research cited in recent public health literature. Roughly one in six adults meets diagnostic criteria for depression, anxiety or substance use disorder in any given year. Yet an estimated 75 percent of South Africans living with a common mental health condition never receive treatment, and when severe mental illness is included, that treatment gap widens to 92 percent. Fewer than one in ten people who need care get it.
Part of the reason is supply. South Africa has approximately 1.5 psychiatrists per 100,000 people, and in the public sector, where more than 80 percent of the population seeks care, that figure drops closer to 0.3 per 100,000. Most specialists are concentrated in Gauteng and the Western Cape; rural provinces are left with almost none.
Traditional healers fill that gap, and then some. South Africa has an estimated 200,000 traditional health practitioners – sangomas, izinyanga, and others recognised under the Traditional Health Practitioners Act – a number that dwarfs the country’s medical workforce many times over. Between 60 and 80 percent of South Africans consult a traditional healer at some point, often as a first port of call rather than a last resort. In one qualitative study of healthcare workers, a forensic psychiatrist put it plainly: “We are Africans and most of our people still believe that traditional medicine can assist in managing some of the psychiatric conditions.”
Cassey Chambers, director of the South African Depression and Anxiety Group, has spoken about why so many people skip biomedical care altogether. In isiZulu, she has noted, there is no direct word for “depression” – the condition simply isn’t recognised as a real illness in the way a physical ailment is, which leaves many sufferers afraid of being seen as weak, cursed, or dangerous if they speak up.
That gap between language and lived experience is exactly where 2026’s dialogue is taking shape. Earlier this year, University of Pretoria psychiatry registrar Dr Raksha Singh and her supervisor documented something rare: a traditional healer and a psychiatrist-in-training independently assessing the same patient at Weskoppies Hospital. Both spent about ninety minutes with her. Both took a detailed history, asked about family mental illness, and probed for earlier episodes. Singh later reflected that watching the healer work was “worlds apart” from her own training, yet she found him systematic rather than superstitious, ruling out ordinary explanations before turning to spiritual ones. The healer, given the pseudonym Phenyo to protect his identity, told Singh that when he judges a patient truly mentally ill – a finding he says is confirmed by the patient’s own ancestors – he refers her to hospital using his own standard healer’s referral letter.
Two different epistemologies, Singh concluded: hers naturalistic, his transcendent. But both, in that consulting room, were reaching for the same thing – a woman’s return to herself.
None of this is simple. Legal liability, herb-drug interactions, and the sheer unevenness of 200,000 practitioners operating without a fully functioning central register remain unresolved. But for a country where ancestors and antidepressants are already being reached for by the same families, often in the same week, the question is no longer whether these systems will meet. It’s whether they’ll be given the structure to do so safely.
