South Africa at a crossroads: latest SA Health Review calls for urgent action on mental health
"South Africa stands at a decisive crossroads. Mental health must move from the margins to the mainstream."
The latest edition of the South African Health Review (SAHR), released by Health Systems Trust today, World Mental Health Day, has issued a clear and urgent message: South Africa's mental health system is in crisis, and policy alone will not fix it. As the country rolls out its latest National Mental Health Policy Framework and Strategic Plan (2023–2030) and advances toward National Health Insurance (NHI), it is critical that leaders and policy makers bring mental health care to the fore and look to effective, evidenced-based solutions to bridge the gap between policy and practice.
Mental health, the Review argues, must be recognised as a cornerstone of national development not a peripheral issue or line item. With rising inequality, deepening poverty, and the lasting psychological toll of the COVID-19 pandemic, the burden of mental illness is growing daily. Yet services remain underfunded (only 5% of the health budget is for mental health), fragmented, and inaccessible to many.
While the country has made progress on mental health policy, the Review notes that implementation remains uneven and inadequate. Key barriers include:
- Provincial disparities in access to care, services, and essential medications
- Severe shortages of mental health professionals, especially in rural and underserved areas
- Weak governance, poor data systems, and limited accountability
- Underutilisation of community-based and culturally relevant care models.
The Review stresses that without bold action, even the best policy frameworks will fail to deliver meaningful change.
The SAHR showcases a range of promising approaches already being piloted across the country:
- Community-based care is showing results from training rehabilitation care workers to partnering with traditional healers in rural areas.
- Digital innovation is improving transparency and decision-making, with real-time hospital dashboards now guiding resource allocation in some provinces.
- Mental Health Investment Case data shows that scaling up key interventions offers strong economic returns proving that investment in mental health is not only just, but smart.
- Integrated services are expanding care access, including within maternal health, HIV programmes, and schools bringing mental health support closer to where people live and learn.
- Rights-based recovery models are reframing care to focus not just on clinical outcomes, but on dignity, inclusion, and social connection.
The SAHR calls for a bold, co-ordinated effort to transform South Africa's mental health landscape. Key recommendations include:
- Sustained political and financial commitment to mental health within NHI planning and beyond
- Expanded mental health workforce, including upskilling of mid-level and community-based practitioners
- Decentralised, community-driven services that are culturally adapted and equitably distributed
- Robust, disaggregated data systems to support monitoring, accountability, and resource allocation
- Integrated, intersectoral responses that embed mental health across all levels of the health system.
"Mental health is not a luxury, it is the foundation of a just, inclusive, and healthy society. The time to act is now" observed the editors.
About the South African Health Review
Supported by the National Department of Health and published annually by the Health Systems Trust, the South African Health Review provides an evidence-based overview of the country's health system. The 2025 edition focuses on mental health drawing on the expertise and experiences of practitioners, researchers, and community leaders across South Africa.
For further information:
Ashnie Padarath: Ashnie.Padarath@hst.org.za; 083 299 7129
Emma Mackie: Emma.Mackie@hst.org.za; 082 932 4889