“No Word for ‘Depression'”: Justice in Mental Health in South Africa

Written by Aimee Fouche //

The topic of mental health in South Africa (SA) is complex. It is riddled with a lack of both qualified professionals and funding from the state and employment opportunities. Not to have sufficient mental health care services in a violent country like South Africa is obviously a gross injustice. This is compounded by studies that estimate that one in three South Africans suffer from mental illness. SADAG (South African Depression and Anxiety Group) claims that less than 16% of those with a mental illness receive treatment. Furthermore, although over 85% of these patients are dependent on public health services, there are only 18 beds available for every 100,000 people in state hospitals (Mental health in South Africa: Whose problem is it?, 2013). Only one percent of those beds are reserved for children and adolescents. It is not only the lack of resources that is the problem; stigma is a massive issue when it comes to treating mental illness in SA. In Zulu, there is no word that describes “depression.”

It is therefore not regarded as a valid illness in the society. There is also still the perception that a mentally ill person is crazy, weak or unsafe (Mental health in South Africa: Whose problem is it?, 2013). This is the backdrop that I work in. I am not a psychologist, but a registered counsellor. Our vocational title was created by the HPCSA (Health Professions Council of SA) in 2004 to target the lack of mental health services in SA. In essence, the role was created to help alleviate the injustices evident in mental health care. In a just world, there would be no stigma attached to mental illness and everyone would have access to care. Our main role is therefore to provide psychoeducation and supportive counselling, particularly in poorer communities. However, due to the scarcity of jobs in these communities, a lot of registered counsellors have had to either start a private practice or leave the field entirely. This does not help the plight of our traumatised nation.

What I have tried to do to go against the tide of this injustice is to offer my services to children free of charge once a week at Hope House (an NGO that provides counselling services to adults and children). Hope House has a waiting list of 50 children, with issues ranging from behavioural problems to severe trauma such as rape. What is particularly concerning is when a child needs far more advanced care than the centre can offer; the logical conclusion is to refer to a state hospital, but this means long waiting lists that could take months. The state will only treat a child with urgency if they are a direct threat to themselves or others. In a just world, there would be bigger hospital wings solely for mental health, resulting in all children getting timely care.

I am mindful that my one day a week is not much, but at least I am there helping to alleviate the burden. The children I see are being treated by a professional with connections to other mental health professionals for guidance and referrals. What is also encouraging is that Hope House has many other qualified professionals (and psychology students) offering their time to the communities that need their services the most.

I also firmly believe that my work is an act of advocacy because I am providing an affordable counselling service within my private practice. My price per session is much lower than psychologists, providing an opportunity for those who cannot afford counselling from a psychologist but who desperately need it. I also provide free motivational talks to private tertiary institutions. These institutions do not have student services that are as those of equipped as universities.

In conclusion, I would like to challenge you to practice justice by simply engaging in empathic conversations on mental illness. In a just world, talking about mental illness would be as normal as talking about physical illness. For those of you who have an interest in and the time for volunteering as lay counsellors, I would strongly encourage you to do so. The statistics mentioned earlier speak for themselves.

In saying that, I understand that the statistics can make one feel hopeless. However, there are caring professionals and volunteers in the field who are dedicated to making a difference. We can rely on those small victories, and your buy in, to help us keep pressing forward toward justice within mental health.

Mental Health in South Africa: Whose problem is it?: October, 2013) Retrieved from https://www.sacap.edu.za/blog/counselling/mental-health-south-africa-whose-problemcounselling/


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Aimee Fouche graduated from Stellenbosch University with a BA in Humanities (2012). She went on to do an academic honours in Psychology at the same institution (2013). She wanted to be able to practice as a counsellor, so she enrolled in Cornerstone Institutes’ Bpsych Honours Equivalent program (2016). She is now in private practice with offices in Durbanville and Stellenbosch working mainly with trauma, grief and self-esteem.

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