A hundred voices lift in call-and-response song in a hall walled with bright yellow mosaic murals in Khayelitsha, Cape Town. Beyond big glass windows, stalls sell hot meat and cold drinks to the long queue at the home affairs department. Taxis offload and take on passengers while still moving, and the air is full of busy life. Back in the hall, chairs are spontaneously pushed aside as the song moves young bodies to dance. Some stand and sway, some stomp and others follow the leader around the room. Everyone is clapping. There’s a sense they could do this all day – joyfully.
This is not the image that generally comes to mind when we think of “mental health education”, but this is a workshop that was dedicated to just that, as part of a local response to a lack of mental healthcare in Khayelitsha.
Youth mental health
The challenges that brought the group together are generally not an occasion for joy. Mental health among young people in South Africa, especially in places like Khayelitsha, is in crisis. It’s a crisis rooted in two issues: high rates of adversity and poverty, which result in an increased need for services, and a lack of services to meet that need. The South African Child Gauge 2021-22 reports that about two-thirds of children in South Africa live below the upper-bound poverty line of R1 417 a month (2022). Additionally, nearly one in two children have experienced violence and sexual abuse.
These statistics are both significant and concerning — even more so when we recognise that adversity doesn’t merely happen to us; it also happens within us. Just as continuously breathing in polluted air affects our lungs, consistent exposure to stressors in our environments harm how we feel and function. It also puts us at risk of non-communicable diseases (such as heart issues) and social conflict. This relationship creates a self-reinforcing cycle where problems like poor self-regulation caused by adverse environments also contribute to adverse environments. For example, experiencing trauma, such as witnessing violence, affects my ability to manage my emotions and behaviours. I might then act violently or make unhealthy choices, which re-create an adverse environment and add to, rather than reduce, my stress and poor health.
Getting the help they need is also difficult for young South Africans. The mental health treatment gap in low and middle-income countries is estimated to be 76% to 85% for individuals with severe mental disorders; in many communities in South Africa, such as Khayelitsha, it’s as high as 90%. A lack of human resources and funds exacerbates the situation. The national health budget allocates just 5% to mental health services, with 86% focused on high-cost, specialised services, which reinforces rather than closes the treatment gap.
Fortunately, the cause-and-effect relationship between context and mental health also applies to positive environments. Our task therefore must be to help create more positive environments from which positive change can grow.
In this, there is no better place to start than with young people. With more than 50% of mental health disorders beginning before the age of 14, it stands to reason that investing efforts in improving the mental health of our young people is not only the right thing to do, it’s also a strategic investment.
What’s more, as the “problem experts” in their communities — those who understand better than anyone else what needs to change — the youth are essential agents to build into any solution.
By youth, for youth
Foregrounding community-based efforts that help to build more positive environments to support young people is vital if we want to develop mental health services that are culturally appropriate, easily accessible and cost-effective to implement, as advocated by the World Health Organisation and leading South African researchers. This shift also aligns with a move away from pathologising mental health and embracing it as both an individual and universal experience that recognises true health as not just an absence of illness but rather the opportunity to live whole, autonomous and connected lives.
Such approaches also recognise that we cannot simply import solutions — often from “more established” contexts — into any community. Instead, we need to recognise and elevate the solutions that already exist, are familiar and trusted, and that centre the people in that community.
Much more can still be achieved. When it comes to addressing the enormous challenge that is mental health in South Africa, we urgently need to embrace this kind of task-sharing, bottom-up approach if we are to stand a chance of making support more widespread and more accessible to those who need it most. And given that it costs more not to treat mental health than to treat it, the sooner we embed such responses into our communities the more likely it is that the next generation can be healthy, empowered — and joyful.
Ashleigh Heese is the training and partnerships manager at Waves for Change, a nonprofit that offers child-friendly mental health services for under-resourced communities. She is a Bertha Scholar currently pursuing her MPhil in Inclusive Innovation with the UCT GSB.