South Africa ranks among the worst countries in the world on treatment of psychological disorders.
South Africa is facing a dual crisis that threatens to undercut its future prosperity: a spiralling mental health epidemic and one of the highest youth unemployment rates in the world.
According to Stats SA, 45.5% of young people aged 15 to 34 are unemployed. And yet, both challenges remain under the radar and their alleviation dangerously underfunded.
South Africa’s mental health crisis is not abstract — it is deeply personal, widely felt, and statistically staggering. The country ranks among the worst globally on the Mental Health Quotient, placing third from the bottom in the 2023 “Mental State of the World” report. A sobering 35% of South Africans report being in psychological distress — an estimated 15.1% of adults experienced a mental health challenge in the past year alone, and one in three will face a mental illness at some point in their lives.
Early findings from a recent prevalence study by the Foundation for Professional Development (FPD), which provides management and clinical skills development courses to health sector professionals, underscore the urgency: in a sample of 440 young people in the Eastern Cape, 69% screened positive for depression, while 60% showed signs of anxiety.
Statistics on access to care paint a grim picture. According to the South African Depression and Anxiety
Group, 90% of uninsured South Africans in need of mental health services are unable to access appropriate care. The reasons are as structural as they are systemic: a chronic shortage of mental health professionals, misallocation of already scant resources, and a funding environment at provincial level that still disproportionately favours hospital-based treatment over community-based prevention and care.
Statistics on access to care paint a grim picture. According to the South African Depression and Anxiety
Group, 90% of uninsured South Africans in need of mental health services are unable to access appropriate care. The reasons are as structural as they are systemic: a chronic shortage of mental health professionals, misallocation of already scant resources, and a funding environment at provincial level that still disproportionately favours hospital-based treatment over community-based prevention and care.
Mental health disorders now account for 13.8% of the national disease burden —more than HIV/Aids or musculoskeletal disorders — yet only 5% of the national health budget is allocated to mental health.
Worse still, 86% of that meagre budget is still spent on hospital care, which is required for only a fraction of people living with a mental health condition, leaving minimal support for services at the community and primary care level, where most South Africans seek help. This situation remains entrenched despite
progressive strategies by the national department of health to switch care away from hospitals.
But this crisis is not just a public health concern. It is also an economic one. Untreated depression and
anxiety in just the full-time employed population costs South African businesses an estimated R170bn to R210bn each year through absenteeism, presenteeism, and lost productivity. Mental health is not a “soft issue ”, it’s a hard economic challenge
Against this bleak backdrop, the FPD has launched an initiative that may well be a game-changer. Known as the Time to Act IPC Counsellor Project, it aims to tackle both the mental health treatment gap and youth unemployment through an innovative, scalable, and evidence-based approach.
The programme trains young people — many of them previously unemployed or excluded from the job market — to become interpersonal counselling (IPC) counsellors. IPC is a globally recognised, short-term form of therapy proven effective for mild to moderate depression, anxiety, and relational issues, used in 33 countries. It is designed to be delivered by trained lay workers under supervision, making it an ideal solution for resource-limited settings.
Participants undergo intensive online and in-person training, followed by supervised counselling practicum sessions with clients. Once certified, IPC counsellors are deployed and remotely supervised in community settings, NGOs, clinics, and workplaces — wherever the need is greatest, but the services most scarce.
Crucially, these roles are not just symbolic. Thanks to funding from the Jobs Boost Fund, all training and practicum costs are covered, including performance-based stipends, and the FPD assists newly qualified IPC counsellors with placements in at least a minimum wage position, gaining meaningful employment while delivering an essential service. The project plans to train and deploy 500 IPC counsellors by June 2025, with the long-term vision of building a self-sustaining ecosystem of counsellors, supervisors, and master trainers across the country.
But turning this vision into reality will take more than passion — it demands investment. Mental health
has long been the poor cousin in global health funding, drawing less than 2% of all development assistance. In South Africa, the consequences of this neglect are clear: even cost-effective, scalable solutions like IPC remain chronically underfunded. The challenge has only grown more acute in the wake of sharp global aid cuts by the current US administration, a move that has dealt a heavy blow to many large South African NGOs. This is where donors and partners — government, corporate, philanthropic — must step in.
First, there is an urgent need for financial support to bolster training, supervision, and deployment. Donors and corporate social responsibility funding can help by underwriting cohorts of IPC trainees and facilitating placement in the public sector. Second, corporate partnerships are crucial. Forward-thinking companies can integrate IPC counsellors into their employee wellness programmes, improving both worker wellbeing and productivity while contributing to job creation. Finally, advocacy partners must help reshape the narrative around mental health. We need to reduce stigma, increase literacy, and galvanise political will. If South Africa is to emerge from this crisis stronger and more resilient, we must invest in scalable, practical, and people-centred solutions. The IPC programme is one such solution.
Article by Dr Gustaaf Wolvaardt and Ms Boitumelo Maimela