By Gauta Mashego
Substance abuse is both a symptom and a consequence of untreated mental illness, and government needs to urgently step in to confront this dangerous overlap, argues Gauta Mashego of SECTION27.
Mental health globally has been in crisis for years. The strain on mental health was especially visible when the world stood still during the COVID-19 pandemic. The prevalence of anxiety and depression increased by 25% in the first year of the global outbreak of the SARS-CoV-2 virus, according to the World Health Organization. However, as the pandemic eased and life returned to the usual, open conversations around mental health also tapered off.
In South Africa, as in many low-and-middle income countries, people struggle with mental health disorders such as anxiety and depression. Around 3.8 million people in South Africa developed depression in 2024, estimate researchers in a major modelling study published as a preprint in March on medRxiv.
Mental health is shaped by many factors
Several studies worldwide report a high prevalence of substance use among people with mental illness compared to the general population.
Researchers have found that patients who suffer from psychotic disorders, such as schizophrenia and bipolar mood disorder, were more likely to abuse alcohol and illegal substances. Indeed, findings from a community survey highlighted a substantial burden of co-occurring mental disorders and alcohol use among men in three provinces in South Africa.
What also makes our society vulnerable to both mental health conditions and increased use of drugs and the development of substance use disorders, is our historical context of apartheid as well as socio-economic factors such as poverty, unemployment, and violence. Researchers have argued that mental health problems are related directly to poverty, while others also make the case that the poor are at greater risk than the rich to suffer from mental illness. At the same time, those living with mental illness are more likely to remain trapped in poverty due to high treatment costs, reduced productivity, and stigma around mental illness.
The kids are not alright
Underage drinking further complicates an already complex problem.
Up-to-date statistics of underage drinking in South Africa are limited, however the matter was thrust into the spotlight on Christmas day in 2025 when a disturbing video circulated on social media showing children between the ages of 6 and 12 consuming alcohol in the presence of adults.
Providing insights into the drinking behaviours of adolescents aged between 11 and 18, a 2019 Human Sciences Research Council study in townships across three provinces found that most had their first drink at the age of 13 or 14 years.
Highlighting the extent of underage drinking among Grade 8–11 learners from public schools in all nine provinces, the 2011 South African Youth Risk Behaviour Survey recorded that around 17% of 13-year-olds and 18% of 14-year-olds had engaged in drinking five or more drinks within a few hours on one or more days in the preceding month.
Mental disorders that commonly co-occur with alcohol use disorders in adolescents include antisocial disorders, mood disorders, and anxiety disorders.
Young people’s drinking habits are often linked to factors such as social norms, and the accessibility and affordability of alcohol. Added to this, since young people are often prolific consumers of media, they are frequently exposed to alcohol advertising and marketing, which encourages the consumption of alcohol.
But there is some hope.
The Liquor Amendment Bill aims to amend the Liquor Act of 2003 to prohibit the advertising, promotion or product placement of liquor in all forms of media. The Amendment Bill is at a very early stage in the legislative process, and it is likely to take time before we see any changes to the law (and longer before we see its implementation).
Other legislative changes debated include raising the legal drinking age from 18 to 21 and keeping schools alcohol-free, and more generally to place a moratorium on new liquor licences and stronger enforcement against Liquor Act violations.
South Africa also has a National Drug Master Plan 2019-2024. It was released by the Department of Social Development, and importantly, it recognises addiction as a chronic disease affecting the brain and behaviour.
However, experts say that while it is a great document, the Central Drug Authority which is tasked with implementing the plan, needs more power and resources to implement the plan’s recommendations.
South Africa also has a National Mental Health Policy Framework and Strategic Plan (2023-2030), that was introduced by the Department of Health. Similarly to its previous iteration, the latest plan envisions the integration of mental healthcare into primary healthcare. A key objective of the new plan is to ensure that mental healthcare users have access to care near their places of work. Another aim is to strengthen collaboration between government departments like education and social development to ensure that mental health is incorporated in planning and service development.
However, as it stands, many public healthcare facilities lack mental health professionals, with rural and underserved communities having little to no access to care. Only about 50% of public hospitals offering mental health services have a psychiatrist, while the country has less than one psychologist for every 100 000 people.
Shortages of mental health professionals mean patients often wait months for appointments. For an adolescent or a child who experiences anxiety, depression or suicidal thoughts, these delays can feel unbearable and it is quite possible that they may give up before receiving help. Currently, only one in ten children diagnosed with treatable mental conditions will have access to care.
While South Africa developed extensive legislative and policy frameworks to give effect to the constitutional right to healthcare, including mental healthcare, constitutional promises must make a difference in the lives of people. Unfortunately, millions of people in the country face barriers to mental healthcare, exposing the persistent gap between constitutional promises and lived reality.
When families lack access to counselling, community-based mental health services and early intervention programmes, harmful coping mechanisms continue to be passed down rather than prevented. To achieve the objectives of the Mental Health Policy Framework by 2030 and to catch up with the National Drug Master Plan that lapsed in 2024, stronger political will and meaningful action are urgently required. This is a crisis South Africa can’t evade.
*Mashego is a candidate attorney with SECTION27.
Note: Spotlight is published by SECTION27, but is editorially independent – an independence that the editors guard jealously. Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.
Republished from Spotlight under a Creative Commons licence.
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