OVERVIEW

FPD has been active in mental health since 2011 and violence prevention from much earlier. Our work in mental health cuts across all FPDs major priority areas namely:

Providing high-quality affordable education

We offer a wide range of asynchronous online, webinars and in-person training aimed at rapidly addressing the mental health workforce crisis some supported by mentoring. These courses are designed to:

  • Expand and improve MH workforce capacity ranging from community level up to health care professionals.
  • Introduce a new cadre of counsellors trained in Inter-Professional Counselling
  • Promote competency in use of telemedicine
  • Build the mental health resilience of frontline healthcare professionals
  • Create the awareness amongst health managers of the critical role they have in creating a workplace that reduces stress and burnout.
  • Eradicate stigma against MH
  • Integrate mental health into HIV/TB programming
  • Webinars on MH and virtual Grand Rounds for HCPs

Hosting impactful local, regional and local conferences

FPD conferences address major societal challenges where such conferences can create awareness, serve as a call to action, promote inter sectoral collaboration, promote consensus building and stimulate the generation of new knowledge through research. In 2023 we launched the 1st SA Mental Health Conference. In 2025, FPD facilitated the 2nd SA Mental Health Conference. In September 2026, FPD will also facilitate the 16th World Conference on Injury Prevention and Safety Promotion.

Conducting research

FPD has always had a MH research focus, and this is rapidly expanding around mental including an increasing portfolio of implementation science projects to test service delivery models designed to meet a rapidly increasing need and a rapidly decreasing number of specialized mental health professionals.

Implementing catalytic system strengthening projects to enhance access to health care

FPD system strengthening focus has moved to a more traditional above-site model looking at the challenging areas in the TB/HIV response, the so called “high-hanging fruit”, expanded to include intractable challenges such as Gender-Based Violence (GBV), improving access to services for survivors of sexual assault and improving access to mental health services. Since January 2022, with funding from PEPFAR, we have been able to substantially start impacting the policy environment to address barriers to accessing MH care. We have also built muti-sectoral alliances in this process and created a national resource www.masiviwe.org.za to provide access to resources.

While this work began with a focus on people living with HIV/TB and the healthcare workers who care for them, it has expanded to reach at-risk and vulnerable individuals more broadly — a population estimated at between 24 and 30 million South Africans. This reflects a deliberate shift from a treatment-focused approach to one that emphasises prevention, early detection and the redesign of mental health service delivery. Our response is built for scale, sustainability and replication across South Africa and beyond.

Introducing and testing innovative solutions to address service delivery challenges

FPD recently launched Africa’s first app-based serious game for adolescent mental health, The Stepwell Saga, designed to build mental resilience skills. We are also working with Vula Mobile to support mental health referrals through its app and to test multidisciplinary care models for insured healthcare workers.

Click here to read more about the game

Click here to read more about FPD's Work in Mental Health



SITUATIONAL ANALYSIS

Recent global evidence from the Sapien Labs Mental State of the World and Global Mind Health reports highlights a sustained decline in mental wellbeing, with a pronounced generational divide. While older adults (55+) continue to exhibit near-normative mental functioning (average MHQ ~101), younger adults (18–34) show substantially lower scores (~36–38), with over 40% experiencing clinically significant distress. The latest analyses shift away from precise country rankings toward age-based and regional comparisons, indicating that mental health outcomes are shaped by broader social, technological, and lifestyle factors. Notably, young adults in several Sub-Saharan African countries outperform peers in wealthier nations, underscoring the importance of strengthening protective factors such as social cohesion, resilience, and early intervention to address a growing global mental health crisis. It is estimated that 20-30% of all Years Lived with Disabilities (YLDs) are attributable to mental & substance use disorders, while the South African Depression and Anxiety Group (SADAG) estimates that more than one in three South Africans will develop a mental health condition during their lifetime. A 2017 study that analysed the burden of disease by Carpenter, Nyirenda and Hanass-Hancock, indicated that mental health disorders accounted for 13.8% of the disease burden in South Africa, which was higher than HIV (11.8%) and musculoskeletal disorders (10.4%).

The Mental Health Care Act (No. 17 of 2002) prescribes that mental health should be integrated into general health services including primary, secondary, and tertiary levels to improve access to mental health services and reduce stigma associated with mental illness. Integration also promotes treating patients holistically, which is proven to improve health outcomes. Despite the provisions of the Act, access to MH care is severely limited for uninsured people with MH conditions, and in 2022 it was estimated that 90% of people who require mental health support are unable to do so.

The reasons are multiple and complex and include a severe and rapidly worsening shortage of skilled professionals, especially Psychiatrist and Psychologists, MH maldistribution of professionals between the public and private sector and between provinces, historical professional protectionism that limits the scope of practice of other healthcare professionals in MH, an unwillingness, until recently, to employ mid-level MH workers, (Registered Counsellors-4-year psychology graduates) in the public sector. Antiquated scheduling of all antidepressants as habit forming schedule 5 drugs has prevented primary care nurses, who provide most of the care at primary care clinics, from prescribing them and as such it is estimated that only 1-12% of people who should be on antidepressants are currently on treatment. Despite this need and the high disease burden, only 5% of the national healthcare budget is allocated to MH with 86% thereof redistributed to psychiatric hospitals, leaving virtually no resources for community or primary level care.

Not only does this lead to unnecessary human suffering but the country pays a hefty economic cost in loss of productivity. Just the cost of untreated anxiety and depressions amongst the employed South African population is estimated to range between R170 to 210billion per annum – a devastating cost that our economy can ill afford.

Aligned with our vision to build a better society through education and capacity development, FPD aims to be more than a voice in this conversation. We seek to catalyse action to address the social, political and structural barriers that limit access to mental health services, while helping to ensure that everyone can access affordable, quality care when they need it. More importantly, we are committed to building a society that promotes mental wellbeing and resilience to reduce that need over time.

SOLUTION

FPD technical approach (How we do it)

 

The FPD technical approach is delivered through a series of targeted workstreams [WS] and uses South Africa as a springboard to test innovative approaches that can be replicated and expanded across the continent and serve as models to support international efforts.

 

WS-1 Technical Assistance: We have established a team of highly skilled local and international experts with extensive experience in all aspects MH health including the interphase between MH and HIV/TB, Gender Based Violence, the World of Work and Climate Change who not only influence our programme design but provide valuable technical assistance to stakeholders including policymakers, organizational management, civil society organizations, researchers, and implementers. Our technical advice targets all relevant stakeholders (NGOs, community organizations, civil society, employers, donor implementing partners and government at all levels) to assist in evidence-based mental health service planning, delivery, supervision, and improved performance.

 

WS-2 Training and capacity development: FPD, as a registered private higher education institution based in South Africa with a global reach, offer a wide range of accredited courses (online, virtual, and in-person formats) customized to the requirements of all role players. Capacity development programmes cover the spectrum of developing competency from policy and planning, increasing the MH workforce, strengthening the role of civil society, educating the public and building mental health resilience amongst the health and general workforce.

 

WS-3: Technology and innovation: The massive online migration over the past few years and the dramatic growth of artificial intelligence (AI) has created an opportunity to leverage technology to dramatically lower barriers to access to MH care and self-care, Technology allows us to deliver training at low cost, improving MH literacy, developing capacity of HCWs to provide MH care, improve screening, simplify referrals, provide mentoring, and overcome geographic barriers to access. FPD partners with technology and academic partners to introduce innovative technologies to the MH landscape. The FPD research Unit also actively pursues the development of new knowledge through implementation science projects in MH.

 

WS-4: Creating structures to foster cross sectoral collaboration: FPD leverages more than 25 years of HIV/TB system strengthening and community engagement experience, which has included establishing several national scientific conferences, the 1st health think tank in Africa, local and international NGOs and several extraordinarily successful social media campaigns to build broad coalitions in support of advancing public health goals. This allows for coordination of activities, pooling of resources and focussing advocacy and research activities.

 

WS-5 Building scalable, task-shared service-delivery models: One of the greatest challenges in South African mental health is the gap between the scale of need and the limited, shrinking pool of specialised professionals. FPD designs and tests task-sharing models that enable appropriately trained non-specialists to provide safe, structured mental health support under supervision. Central to this is a new cadre of Registered Counsellors and lay counsellors equipped with brief, evidence-based methods, including Interpersonal Counselling (IPC), Motivational Interviewing and Safety Planning, and supported by the ENGAGE wellness model and its validated open-source screening tool. The approach is designed to be self-sustaining: once local Master Trainers and Supervisors are in place, the system can produce its own counsellors, enabling rapid and affordable expansion of frontline care. These models are designed to be embedded within existing HIV, TB and primary care platforms so that screening, support and referral become part of routine care rather than a parallel system.



RESULTS

POLICY DEVELOPMENT AND ADOPTION AT NATIONAL LEVEL

FPD's technical assistance has helped position mental health more firmly within South Africa's national health agenda. This work has strengthened national policy frameworks while also influencing practical shifts in service delivery, medicines access, human resources for mental health and medical scheme benefits.

POLICY IMPACT AT PROVINCIAL LEVEL

National policy gains are increasingly being translated into provincial implementation, with mental health written into strategies, referral systems and routine monitoring tools that shape day-to-day service delivery.

HEALTH SYSTEMS STRENGTHENING

Beyond policy, the project has strengthened the workforce, tools and coordination mechanisms needed to support sustainable mental health care.

TRAINING REACH AND WORKFORCE DEVELOPMENT

A large-scale blended training and mentoring programme has equipped frontline providers to recognise and respond to common mental health conditions within HIV, TB and primary care services.

SERVICE DELIVERY AND ACCESS

Mental health screening and referral have been integrated into HIV and TB service platforms, expanding access for people who might otherwise never have been identified or supported.

INFORMATION, EDUCATION AND COMMUNICATION

The Masiviwe — Let's be heard! Movement for mental health continues to grow as a trusted multi-channel platform that reduces stigma, promotes mental health literacy and connects the public and healthcare workers to support. Search for MasiviweZA on all social media channels and join the movement.

TECHNOLOGY

A potential game changer has been our work with Columbia University Psychiatry Department to validate their electronic mental wellness screening tool (e-MW Tool) algorithm in South Africa, this algorithm allows for rapid screening, diagnosing, and triaging of MH conditions and make it ideal for outreach field-based HCWs. Validation of the South African version of the mwTool for use in adults has been completed and the adolescent validation project should be complete in mid-2024.

A growing range of digital tools have been introduced to extend reach, support providers and improve access to mental health information and services.

GLOBAL ADVOCACY

Donor funding for mental health and for people living with MH conditions remains extremely limited. In response, FPD actively leverages the massive donor investment in HIV/TB in Africa to advance MH activities and promote the integration of mental health into broader health programming. Through this approach, we also secured support from the Office of the Global AIDS Coordinator for the integration of MH into HIV/TB programmes in Africa. By leveraging this platform, policy changes are starting to improve access to care for people with MH conditions. See Godfrey, C. and Nkengasong, J., 2023. Prioritizing mental health in the HIV/AIDS response in Africa. New England Journal of Medicine, 389(7), pp.581-583.

Within the HIV donor programming environment, Key Populations status attracts dedicated budget allocations and targeted programmes. FPD fully believes that people with severe mental health issues meet all the criteria for being designated as a Key Population. To advance this position, IMHSI team members (Melvyn C Freeman, Milton L Wainberg, Jean D Slabbert, Selaelo Mabela, Gustaaf Wolvaardt) published a peer reviewed article in the AIDS journal titled 'Persons with severe mental health conditions should be included as a key population in HIV programmes' in August 2022.

This advocacy work is increasingly gaining recognition on regional and global stages, validating the model and creating opportunities for wider influence.



THE NUMBERS

12

TRAINING PROGRAMMES

1

Conferences Organized