Graphic: John McCann/M&G
While Mental Health Awareness Month (May) and Men’s Mental Health Month (June) have ended, the conversation about mental health must not. In a country where mental health issues are becoming an epidemic, sustained dialogue is essential.
Men are often underrepresented in mental health statistics, not because they face fewer problems, but because they are less likely to seek help. When they do respond to mental distress, it is often in extreme ways such as substance abuse, isolation or suicide.
In South Africa, socio-economic stressors are primary causes of mental health crises especially for black men and people of colour. As such, socio-economic interventions should be prioritised, with therapy serving as a complementary, not primary, solution.
This perspective may seem controversial, but we are not against therapy; we encourage people to use it. Where trauma that has no economic aetiology therapy should be the first line of action. We make the above very clear here and an exception.
When poverty, unemployment and financial stress are the root causes of mental health deterioration, especially in the context of high unemployment, the solution must begin with economic rehabilitation, job creation, social investment and poverty alleviation.
In their book Money, Mental Health, Hip-Hop, Dr Becky Inkster, a neurologist and digital mental health adviser affiliated with Cambridge University, and Dr Akeem Sule, a consultant psychiatrist (both are founders of the Hip-Hop Psych) illustrate the connections between financial stress and mental health, focusing on the narratives expressed in hip-hop lyrics. They highlight how numerous artists, predominantly male, in the United States and United Kingdom have used their lyrics to convey the psychological burden of poverty, economic pressure and hopelessness, many leading to depression and, in tragic cases, suicide.
Although their study focuses on hip-hop in Western contexts, the parallels to South Africa in terms of financial meltdown are undeniable. The majority of the artists discussed in the book were men, and common themes included financial hardship and limited opportunities. The authors found that those facing economic insecurity reported higher levels of hopelessness, anxiety and depression, often precursors to suicide. The same pattern is visible among South African men.
Africa has one of the highest suicide rates in the world, according to the World Health Organisation (WHO). The global suicide rate stands at nine per 100,000 people; Africa’s is 11 per 100,000. Among African men, the rate rises to 18 per 100,000, well above the global male average of 12.2.
South Africa ranks among the top 10 countries globally with the highest suicide rates. In 2019, the country recorded 13,774 suicide deaths, 10,861 of them men.
In 2021, the suicide rate rose to 18%, highlighting the urgency of addressing the root causes behind these figures. An article published in the Cape Argus by a psychologist, Mandisa Mireldah Mashaba of Stellenbosch University, explores the issue further by citing real-life situations. The author underscored that many men she interviewed during her master’s research reported battling depression, stress, eating disorders and anxiety. They coped by isolating themselves, using humour, drinking or overworking, often only seeking help after a suicide attempt.
Given the above, the next step is to advise these men to seek help through therapy.
But context matters. Considering the state of the economy in the country, the economic lens should be the first lens we need to observe the state of men’s mental health.
First, a single therapy session costs R600 to R1,800. For someone whose primary stressor is the inability to feed their family or afford housing, therapy is costly and a luxury.
Second, gaps in public healthcare do not allow effective therapy sessions, because they are overwhelmed and under-resourced. South Africa has only 2.6 psychologists per 100,000 people. Even if therapy is offered through public channels, men may have to wait months between appointments.
Third, despite having one of Africa’s most advanced healthcare systems, South Africa lacks a robust national mental health policy.
Fourth, therapy is still seen as foreign and unfamiliar by many men. Asking them to expose emotional vulnerabilities to a stranger, without addressing their material struggles, often feels not only impractical but also alienating.
Men, often expected to be family providers, are at breaking point given their inability to provide for their families. They migrate to urban areas in the hope of financial upliftment, only to be met with limited opportunities and high expectations from family back home. This drives them towards depression and anxiety. We cannot use therapy alone to solve mental health problems.
Therapy is necessary but it cannot resolve the country’s lagging economy and unemployment. There is a necessity for urgent and massive economic reforms to address this crisis.
The mental health crisis among South African men is not only a psychological issue; it’s also a socio-economic one. Therapy can support healing but there must be broader structural change: job creation, economic investment, and sustainable livelihoods.
By reframing the conversation around men’s mental health to include economic justice, we will move closer to real solutions. Until then, we risk treating symptoms while ignoring the disease.
Edmund Terem Ugar is a doctoral candidate at the Department of Philosophy, University of Johannesburg. Zimasa Klaas is the head of human resources at Opti-Num Solutions. The opinions expressed in this article do not represent the views of their employers.