Taryn Townsend

Every year, World Mental Health Day invites us not only to reflect, but to face a difficult truth: mental health remains the silent emergency within South Africa’s health system. This year’s theme, “Access to Services: Mental Health in Catastrophes and Emergencies,” is a powerful reminder that in our rural communities, there can be no true health without mental health. For too long, mental health has been treated as a luxury, or worse, a stigma to be whispered about in clinics and homes. Yet, in rural districts like John Taolo Gaetsewe, ZF Mgcawu (in the Northern Cape), and Thabazimbi (in Limpopo), the realities of poverty, unemployment, gender-based violence, HIV, and substance use mean that mental health is not peripheral, it is central. Without addressing depression, anxiety, trauma, and substance use we cannot realistically expect sustained gains in HIV prevention, adherence, or broader sexual and reproductive health. At Anova Health Institute, through the Ke Botlhokwa Mental Health Programme, aptly named “I Matter” and funded by the Sishen Iron Ore Company- Community Development Trust (SIOC-CDT), we have learned that solutions must be both innovative and localized. We are not waiting for psychiatrists to arrive in every village. Instead, we are investing in capacity building, equipping nurses, lay counsellors, and community health workers to screen, manage, and refer clients with mental health concerns. We are embedding mental health and psychosocial support into the everyday flow of chronic care, in clinics and other places where most people already seek help. And we are seeing the ripple effects: more young women accessing contraception, more men opening up in support groups, and more families recognizing that mental health care is not shameful, but a pathway to healing. But progress is fragile. Our data shows the challenge of keeping screening consistent, reducing the drop-offs between identifying a need and ensuring treatment, and the constant fight to retain skilled health workers in rural facilities. These challenges can be addressed if we keep investing in mental health, working together on policy, and building trust within our communities. This World Mental Health Day, our appeal is simple, let us reframe the conversation. Mental health in rural South Africa is not an add-on. It is the backbone of sustainable development, the foundation for healthier communities, and the catalyst for dignity and hope. We owe it to the young woman in Thabazimbi who, after losing a loved one and surviving gender-based violence, finds the courage to turn to the programme for support. We owe it to the elderly man in Kuruman who quietly shares his struggles with alcohol after decades of silence. And we owe it to every health worker on the frontlines, who carry the weight of a system that is only beginning to take mental health seriously.