07 July 2025
Yolanda Mzimela
South Africa faces a high burden of mental health disorders driven by a range of factors, including childhood trauma, poverty, unemployment, the ongoing impact of HIV, and a history of political and social violence.
Research shows that 30.3% of South Africans experience a mental disorder in their lifetime, yet most of them won’t get the care they need.
“There’s clear epidemiological evidence that 16% of South Africans experience a mental health condition in any given year. But more than 90% of people living with mental health conditions don’t receive the care that they need, despite clear evidence of cost-effective interventions,” says Professor Crick Lund, co-Director of the Centre for Global Mental Health at King’s College London.
At the heart of the issue seems to be a lack of investment and failure to implement policy.
South Africa spends only 5% of its health budget on mental health, and most of this is allocated to inpatient psychiatric and not community mental health services.
“We completed a national mental health investment case for the Department of Health and National Treasury. It clearly shows the economic return on investment through improved labour market participation and productivity as a result of receiving mental health care,” says Lund.
He provides an example: for every R1.00 invested in treating adult depression, there is a R4.00 return over 15 years. “Investing in care for perinatal depression yields an even higher return of R4.70. So, from an economic standpoint, investing in mental health care is a sound decision that will benefit the South African economy in the long run.”
Factors contributing to poor mental health
Lund says that there is good evidence that poverty and mental illness are linked in a negative cycle.
“On the one hand, living in circumstances of poverty increases one’s risk for mental health conditions through stress of financial insecurity and food insecurity as well as increased exposure to violence and increased risk for other health conditions.”
He says living with a mental illness increases one’s risk of drifting into or remaining in poverty because of the cost of healthcare, and the disability and stigma associated with mental illness exclude people from work.
To break the cycle, it is essential to enhance financial and food security, and provide timely, evidence-based mental health care.
“Fortunately, there is growing evidence of the effectiveness of interventions addressing both pathways. For example, poverty reduction interventions like cash transfers have been shown to reduce common symptoms of depression and anxiety,” Lund says.
