State of Mind
South Africa

The background on October Health's State of Mind Report

The world is facing a growing mental health crisis.

According to recent estimates, up to one in three people will experience a mental health disorder at some point in their lives. However, the world's mental healthcare system is deeply under-resourced and struggling to cope with the high demand for services.

There are a number of causes that have contributed to today's mental health crisis in South Africa. First, South Africa has high rates of violence and trauma, which significantly impacts mental health. Many South Africans have been exposed to violent crimes, physical or sexual abuse, or other traumatic events, which can lead to conditions like post-traumatic stress disorder, depression, and anxiety. Second, inequality and poverty also play a role. The inequality and economic struggles that many South Africans face put them under significant stress and hardship that negatively affects well-being.

Access to mental health support and treatment is profoundly lacking. There are only about 400 psychiatrists in the public sector for South Africa's entire population of over 55 million people. Many South Africans with mental illness receive no treatment at all due to the severe shortage of resources and mental health professionals. The mental healthcare system is underfunded and struggling.

To address this crisis, South Africa needs to urgently invest in its mental healthcare system. This includes training more mental health professionals, increasing funding for mental health services, especially at the primary care level, and working to make treatment more accessible, especially for the poor. Raised public awareness about mental health issues can also help reduce the stigma around these topics. With greater support, expanded access to treatment, and reduced stigma, South Africa can work towards a system that can more adequately address today's high rates of mental health needs.

Worst in the world for mental health

South Africa scored the lowest average score on the mental health well-being scale. The rate of distressed or struggling on the scale increased by 8%, from 28.5% in 2020 to 36%. Driven by:

• High rates of violence and trauma. South Africa has extremely high rates of violent crime and physical abuse. Many South Africans have directly experienced or witnessed violent trauma, which severely impacts mental health and well-being. Those who have lived through violence or abuse are at higher risk of developing post-traumatic stress disorder, depression, anxiety, and other issues that reduce wellness.
• Inequality and poverty. South Africa is one of the most unequal countries in the world. This inequality, along with widespread poverty, creates significant stress, hardship, and struggle for many. Concerns about accessing basic needs, affording healthcare or education, and high unemployment take a toll on well-being. Financial stress and inequality negatively impact both physical and mental health.
• Lack of mental healthcare. The mental health system in South Africa is profoundly under-resourced. There are not nearly enough professionals or treatment facilities to provide adequate care to those who need it. As a result, the vast majority of people living with mental illness do not receive proper diagnosis or treatment. Without treatment, conditions worsen and people are left struggling with little support.
• Stigma around mental illness. There is still a stubborn stigma that surrounds mental health issues in South African culture. This stigma causes people to avoid seeking treatment, as they fear judgment or shame. More must be done to educate people about mental illness and reduce negative stereotypes. Greater openness and acceptance would encourage more people to access care without fear of stigma.

Businesses are suffering without realising

Poor mental health has extremely significant costs to businesses:

• Lost productivity. Employees with mental health issues like depression, anxiety, or substance use disorders may be less productive and miss more work. This lost productivity results in lower output and revenue for businesses. Estimates suggest mental health problems reduce productivity and economic growth by up to 4% per year.
• Presenteeism. Some employees may come to work but not be fully productive due to poor mental health. This "presenteeism" still costs businesses money in the form of reduced performance and effectiveness. Presenteeism can be harder for employers to detect but can be even more costly than absenteeism.
• Higher healthcare costs. When mental health issues go untreated, they can lead to more severe health problems and higher healthcare costs. For example, untreated depression can increase the risk of chronic physical health issues, resulting in greater spending on healthcare premiums and services. Providing mental health benefits could help address issues early and reduce long-term healthcare costs.
• Recruitment and retention challenges. If a company does not provide adequate mental health support, it may struggle to attract and retain top talent. In today's market, mental health benefits and a supportive work culture are appealing to employees and candidates. When people's needs are met, they are more likely to join and stay at a company, which reduces costly turnover.
• Safety and risk issues. Poor mental health can impact judgment, focus, and decision making, which may put employee and public safety at risk in some jobs. Proactively supporting mental health and monitoring risks is important for companies where safety is a concern. Doing so could help prevent dangerous incidents and legal issues.