Addressing the mental health plight of our country, and the needs of the women of our country specifically, requires service models that are innovative, integrated, effective and efficient.

Carol Dean

Chief Executive Officer

Valkenberg Hospital

Western Cape Province

On the 9th of August 1956, Lian Ngoyui, Helen Joseph, Rahima Moos and Sophia Williams led a march of approximately 20 000 women to the Union Buildings in Pretoria. The demonstration aimed to show their opposition to the abhorrent “pass laws”, as proposed in the Urban Areas Act of 1950.  They said “no” to black women carrying a pass that sought to restrict movement, while maintaining population segregation and urban control. The proposed pass system was a strategy to entrench limitations on movement and economic freedom, which was a cornerstone of migrant labour during the apartheid era.

To those women and the many more who remain nameless to us, we pay homage to their courage in the face of oppression. They have provided us with the launchpad for our own development, accomplishments, boldness and resilience.

As mental health practitioners, and individually as women, we cannot be complacent as the burden of mental illness continues to overwhelm us. For example, South African studies reveal that: just over 30% of adults will suffer from some form of mental illness in their lifetime; 40% of people living with HIV in South Africa have a diagnosable mental disorder (1); approximately one in three women in low-income and informal settlements in Cape Town reportedly suffers from postnatal depression (2);  and that close to 50% of pregnant women in rural KwaZulu-Natal are depressed (3). 

In the province where I work, the Western Cape Department of Health data reveals that mortalities for HIV and interpersonal violence are both over 10% of all deaths. Over the past six years (2012 to 2018), teenage pregnancies have increased from 10 980 to 16 303 (4).  Substance use, especially crystal methamphetamine (tik), in the Western Cape, is ravaging our youth, especially those from previously disadvantaged communities. As indicative of the overlay of the social and economic challenges that continue to plague our country, the inter-connectedness of the current bleak economic climate, high unemployment rates, the incidence of violence, substance use, and the high school dropout rate cannot be dismissed. Public health scientists and practitioners rightfully declare health, and specifically mental health, as a complex system, where linear and straightforward responses are hardly effective; where stigmatised attitudes towards mental health further exacerbate efforts to make a real impact; and, importantly, where gender inequality remains deeply implicated in the mental health profile of South African women.

As mental health care professionals and leaders, we have the opportunity to change this dominant narrative. We are challenged to find our collective voice and to say “no” to the continuance of the many social ills that underlie mental health problems. We need to work cooperatively as government and civil society. We need to think innovatively and act creatively to promote healing, recovery, wellbeing, fortitude and gender-equal attitudes and behaviours. This is possible! The future of the next generation depends on the decisions and actions we take today.

As South Africans, we are resilient, and the majority of us remain dedicated and committed to the greater good of all.  We have sound policy direction too. The National Mental Health Policy Framework and Strategic Plan 2013-2020 sets clear goals and strategies that aim to redress the mental health issues of the population.  Women, in particular, have been targeted for their specific mental health needs. In the Western Cape, the 2030 Plan further refines these strategies and goals for the province and prioritises women’s health care, including mental health. Locally, as an inclusive clinical and management leadership group, we are examining how we can use our limited resources more effectively to respond to those in need.

Addressing the mental health plight of our country, and the needs of the women of our country specifically, requires service models that are innovative, integrated, effective and efficient. A future model must include the sharing and transferring of knowledge and skills, of the specialist, into the broader system, that seeks to be far more responsive. Psychologists from all three psychiatric hospitals in the Western Cape will be participating in the ASSET programme, which aims to equip community health workers with standardised counselling skills programme. This intervention is an example of the new direction that we are pursuing. The momentum is building. This, together with other innovations and contextually-appropriate efforts, promises an exciting future for psychology and mental health services as a whole. What we once only imagined as a possibility is coming; an integrated mental health service for all who are in need, and mental health care for women and girls that seeks to be apposite, respectful and dignifying.


  1. Allen, A.H., Stein, D.J., Seedat, S., Heering, S. G., Moomal, H., Williams. D. R., (2009). The South African Stress and Health (SASH) study: 12-month and lifetime prevalence of common mental disorders, South African Medical Journal,   99 (5 Pt 2): 339–344
  2. Freeman, M., Kafaar, Z., Nkomo, N & Kelly., K. (2008) Mental Disorder in People Living with HIV/Aids in South Africa, South African Journal of Psychology, 38(3):489-500 
  3. Manikum, L., Burns, J.K., (2012) Antenatal depression and its risk factors: An urban prevalence study in KwaZulu-Natal, South African Medical Journal,  Vol 102, No 12
  4. Hassan Mahomed, Western Cape Data Report. (Unpublished).
  5. Crick Lund, et al. The Health System Strengthening in sub-Saharan Africa (ASSET) study is a collaboration between the University of Cape Town and King’s College London in the United Kingdom and is aimed at reducing the burden of common mental disorders (CMD) and violence against women during the perinatal period in the Western Cape (WC). The study includes supporting the WC Department of Health in scaling up a screening and counselling service for perinatal women as well as developing and piloting an intervention for the care and support of perinatal women who experience violence. Researchers hope that results will inform a sustainable solution to ease the country’s burden.
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