As a concept and a practice, mental health care is simply not part of the South African cultural zeitgeist. Just like other developing nations, South Africa has a severe mental health gap. Between 75% and 95% of people with mental disorders in South Africa are unable to access mental health services. The Department of Health spends only 5% of the total health budget on mental health services, leaving mental health underfunded and under-resourced.1 There are simply not enough resources to cope with basic health problems, let alone complex and chronic mental health diagnoses. Like in other lower to middle-income countries, mental health is severely underreported, underfunded, and underrepresented.

And yet the fundamental problem is not necessarily underfunded mental health services. Even if by some miracle, Scandinavian-level mental health care was available for all South Africans tomorrow, most would not utilise the services.

The primary issue is that the language, values, and theories used to explain and explore mental health are based on an entirely different cultural foundation. Implementing a Western-orientated mental health system in a developing country with a completely different cultural milieu has proven problematic. As a result, mental health is a concept that has yet to permeate the South African national consciousness.

Mental health is such a slippery term, dependent on context. What is ‘normal’ to one culture will be alien to another. Our ‘normals’ are shaped by our culture, language, and education. These are the lenses through which we make sense of the world, particularly concerning mental health.

Obviously, every race and cultural group is affected by mental health problems. Yet culture has an intangible influence on what that demographic understands to be the cause or cure of mental health problems. The intersection of mental health and culture is key, especially in developing countries.

That is not to say that there has never been any understanding of mental health in Southern African contexts. Rather, no space has been made for the South African conception of mental health or indeed health in general to develop in the same way the medical model has in the West.

The field of psychology is burdened with historical and conceptual baggage. Western Europe and North America claim ownership of the origins and development of modern psychology. Since then, the biomedical conception has dominated the mental health discussion, internationally and in South Africa.2 But psychology did not exclusively originate in the West. There is evidence of studies in Asia dealing with what can now be interpreted as mental illness from as early as the 1880s.3 A psychological laboratory was founded in South America in 1916.4 Unfortunately, much of the indigenous psychological research remains oral, unpublished, or published in non-English language sources.5 Most African universities did not have psychology departments until the late 1980s, and those that eventually emerged used predominantly Western theories and vocabulary. Instead of exploring indigenous principles, academics have attempted to insert African behaviour patterns into Western moulds.6 Consequently, South Africa and many developing countries like it, haven’t had centuries for the concept of mental health, as defined by external standards, to saturate the population’s consciousness.

Even basic fundamental principles are lost in translation. Take, for instance, the biomedical notion of the separation between the parts of self, the 'mind' and the 'body'. It has been argued that even the boundary between disorders of the mind and the body is in itself a cultural construction that underlies the categorisation of illness which we have classed as 'mental' .7 Within this framework, mental health has been confined to the body, a physical ailment that can only be cured through medical intervention.

Compared to the South African model of health, the separation of mind and body is somewhat arbitrary. Instead, health is holistic, linking the body, mind, and soul. A sickness in the body could be related to an imbalance in an individual’s social life or relationship with their ancestors.8 A study showed that four developing countries including South Africa often attributed mental illness to supernatural or spiritual causes.9

In many South African communities, mental health problems are understood to be caused by ‘witchcraft or demonic possession’.10 People will turn to traditional healers in their communities, who often offer a range of services for people living with mental illness.11 They identified three potential causes for mental health problems, biological, social, and spiritual.11 And while this does not necessarily negate the medical understanding of mental health, the understanding of the cause, and thus the cure of mental health problems is fundamentally different.

Given South Africa’s political history of discrimination, seeking help from more traditional communal avenues is decidedly preferable to turning to the medical system. For centuries, the medical system in South Africa was used as a vehicle to marginalize and exclude people of colour. ‘Black’ hospitals were more often than not, overcrowded and understaffed as the majority of resources were funnelled towards ‘white’ hospitals. In 1981, there was one doctor for every 330 whites, but only one for every 91,000 non-white persons.12 A remnant of the horrific racial policies is the often reasonable mistrust many South Africans can have of a medical system that never represented them. Instead, people will rely on their community during times of emotional distress, and delay seeking medical treatment until absolutely necessary.

As a result of this disconnect, advocating for improved mental health care systems is made even more complicated. Suppose government officials, policymakers, policy advocates, and the general public do not see mental health as a high-priority issue. If no one is calling for it, the government will feel no need to place it high on the agenda. Lack of mental health awareness will also prevent civil society from advocating for policy change. In South Africa, while there are mental health service groups, they generally support the specific person with mental health problems, rather than advocate for policy change and development. Advocacy groups play a vital role in the formation of a country’s policy. without them, an issue will not be considered as big a problem to solve as compared to other more popular lobbying issues.

It is not surprising that the fundamental principles of the modern idea of mental health have not as yet been assimilated into the South African national consciousness. We cannot assume that the principles of mental health are culturally neutral or are easily transferable. Introducing Western models of health to African behaviour patterns is at most ineffective, and at worst, damaging.

And yet the alternative is far trickier and will take far more time. A model needs to be established based on a country’s specific value systems, beliefs, and philosophies surrounding health. Mental health awareness will increase dramatically because the theories are aligned with the beliefs the population already hold. It will be easier to advocate for mental health if we are all on the same page foundationally. A monumental mind shift must take place before mental health can truly become a priority in developing countries and people can receive the best possible treatment.


1 Christine Lochner, Mental Health in an Unequal World, Mental Health Information Centre, 2021.
2 Joanna Moncrieff, The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. London: Palgrave Macmillan, 2008, p. 217.
3 Alison Turtle, Psychologising Asia or Asianising Psychology: A New Prescription for Dr. Watson? Psychology and Developing Societies, 1989. p. 69.
4 Rubén Ardila, Psychology in Latin America today. Annual Review of Psychology. 1982. p. 106.
5 Faith Martin, Psychology, religion and development: a literature review, 2009. P. 9.
6 Bame Nsamenang. Psychology in Sub-Saharan Africa. Psychology and Developing Societies. 1992, p.173.
7 Susan Fernando. Mental Health, Race and Culture. 3rd ed. London: Red Globe Press. 2010. p.37.
8 Anthony Chiorazzi. The Spirituality of Africa. The Harvard Gazette. 2015.
9 Maye Omar et al. Mental health policy process: A comparative study of Ghana, South Africa, Uganda and Zambia. International Journal of Mental Health Systems. 2010. p.3.
10 Sandisiwe Shoba. What HHP has taught us about mental health in the black community. 2018.
11 Crick Lund et al, Mental health policy development and implementation in South Africa : a situation analysis, Country Report, 2008.
12 Rajendra Kale. Impressions of health in the new South Africa: a period of convalescence. BMJ (Clinical research ed.), 1995. p.1119.