Even though a third of South Africans experience a mental health condition and more than 27% are affected by depression, only 5% of the national healthcare budget is allocated to mental health services.
Prof Renata Schoeman, head of Healthcare Leadership at Stellenbosch Business School, says limited access, stigma and an underfunded system leave millions without support, exacerbating the burden on hospitals and emergency services.
“The lack of investment in mental health is shocking,” says Prof Schoeman. “We cannot continue to treat mental health as an afterthought when it is central to the overall wellbeing of our citizens.”
According to the Sapien Labs report Mental State of the World in 2024, South Africa, with a mental health quotient of 50, ranks 69th out of 71 countries across all mental wellbeing dimensions. The country also has the highest percentage of mentally distressed or struggling respondents (35%).
A third of South Africans suffer from a mental health condition, yet the majority do not seek help. Teen mental health issues are escalating, fuelled by economic hardship, social instability, and lack of access to services.
“The 2024/25 national healthcare budget increased by only 3,5%, failing to keep pace with inflation. Even more alarming, the 2025/26 budget is set to drop to R28,9 billion, despite mounting healthcare needs,” says Prof Schoeman.
“This money will mainly cover salaries and pharmaceutical supplies, leaving little room for infrastructure development, innovation, or system-wide improvements.
“South Africa spends 8–9% of its gross domestic product (GDP) on health, which is high by global standards, yet our system remains inefficient and underperforming. It’s not just about a lack of funds – it’s about how funds are used. Corruption, mismanagement and inefficiencies are bleeding the system dry.”
Prof Schoeman says the healthcare system is under-resourced. “Shortages of mental health workers, a lack of experienced practitioners as well as insufficient resources to follow up and ensure compliance with treatment all contribute to a persistent treatment gap.”
The South African state sector has an average of only 0,31 psychiatrists per 100 000 population, with an unequal distribution between rural and urban areas. Some predominantly rural provinces have only 0,08 psychiatrists per 100 000 population in the state sector. There is also a critical shortage of child psychiatrists, with only three of the nine provinces having any child psychiatrists in the state sector. Around 50% of state hospitals offering psychiatric care do not have a psychiatrist, and 30% have no clinical psychologists.
“The gap between policy and implementation is stark. While frameworks exist, the lack of dedicated resources and trained professionals means that mental health remains the ‘poor cousin’ of the healthcare system,” says Prof Schoeman.
According to her, South African healthcare workers are among the hardest hit, struggling with understaffed hospitals, extreme workloads and stagnant wages. Many are leaving the public sector or emigrating, further destabilising an already fragile system.
“Our country’s system is buckling under the strain of an overwhelmed workforce, neglected mental health services, and inefficiencies that drain critical resources. We are not just facing a funding crisis – we are dealing with an emotional recession among healthcare professionals,” says Prof Schoeman. “Doctors and nurses are running on empty, and this affects patient care and the future of our healthcare system.”
She argues for a shift to a value-based healthcare model – a system that prioritises patient outcomes, efficiency and accessibility, while reducing costs. “We cannot continue to apply Band-Aid solutions to a system in distress,” she says. “It is time for real reform, or we risk the total collapse of our healthcare sector.”
Value-based healthcare focuses on:
improving patient outcomes rather than just increasing service volumes;
enhancing patient experience and satisfaction;
eliminating inefficiencies to make the most of existing resources; and
reducing costs by focusing on long-term quality improvements.
“The proposed National Health Insurance (NHI) is not a solution – it’s a funding model, not a service reform plan,” says Prof Schoeman. “Without tackling corruption and inefficiencies, simply pouring more money into the system will not achieve fundamental restructuring of South Africa’s healthcare system. Addressing staff burnout, strengthening mental health services, eliminating corruption and adopting a value-based healthcare model are crucial steps towards a sustainable future.”
