The Need for and Accessibility of Mental Healthcare in South Africa
South Africa is a country where, in a population of 52 million, 53% live below the poverty line; 24% are unemployed; and 11% live with HIV/AIDS. According to the World Health Organization’s (WHO) 2015 country profile, the average life expectancy is 59 years; the average healthy life expectancy is 51 years; and HIV is the leading cause of death by far, accounting for over 33% of deaths in 2012. For reference, contrast this to the profiles of Britain or the United States, where the average total and healthy life expectancies are 20 years longer, and the leading cause of death in 2012 (ischaemic heart disease in both countries) accounting for only 15% of deaths at most. These statistics suggest a country rife with mental health problems. 
Certainly, there is very probably a need for mental healthcare among these adults in poverty, unemployment or living with HIV. Less obvious is that a great many children are also in need of such care. Thousands of children are being orphaned every year, many live in unstable homes, and child abuse is far too common. The South African Police Service sees over 45,000 reported cases of child abuse per year, a number that may be several times higher when considering the unreported cases. HIV/AIDS are the leading cause of death even in infants under the age of 5, according to WHO. The consequence is that there is a great need for mental healthcare among children and adolescents in South Africa that is not being met. 
A study in 2014 analyzed the mental health of adolescents in five cities around the world: Baltimore, New Delhi, Ibadan, Johannesburg, and Shanghai. In analyzing the mental health of adolescents of ages 15 through 19 living in each these cities, this study found that the adolescents living in Johannesburg were most likely to show depressive symptoms (41% of males and 45% of females), most likely to exhibit symptoms of posttraumatic stress disorder (PTSD, 54% of males and 67% of females) and most likely to have harboured suicidal thoughts or plans in the last 12 months (33% of males and 40% of females). All of these were significantly higher than the percentage of adolescents with such symptoms in any of the other four cities. 
The need for mental healthcare is widespread, and this has not gone unnoticed. A mental health policy was instated in 1997. A plan exists to improve the country’s mental healthcare system and has been revised several times; but inclusive, accessible mental healthcare for all is still unrealised. WHO’s 2011 mental health atlas showed that out of the 3460 mental health outpatient facilities throughout the country (6.85 per 100,000 population), only 48 are reserved for children and adolescents; and of the 1362 psychiatric beds in general hospitals (2.7 per 100,000 population), only 52 are reserved for children and adolescents. According to that same report, per 1 million members of the population, there were 2.7 psychiatrists, 3.1 psychologists, 1.2 occupational therapists, and 97.2 nurses working in the mental health sector. In a country with such a prevalence of mental health problems, there is a glaring deficit in both workers and facilities.
There is also a geographical component to the difficulty. Dr. de Kock and Dr. Pillay published a study last month addressing the “human resource crisis” in the field of mental health. 40% of South Africa’s population lives in rural areas, yet the study showed that there were only 116 nurses to serve over 17 million people: a rate of 6.7 nurses per 1 million people, which is far lower than the rate nationwide. In these areas, furthermore, psychiatrists are found at a rate of 0.3 per 1 million people: thus mental health patients in rural areas are often prescribed psychotropic medication by nurses, primary care doctors, or clinical associates. Drs. de Kock and Pillay make the recommendation that more nurses specializing in mental health be assigned to rural areas and that non-medical personnel working in the mental health sector be given the authority to prescribe psychotropic medication when necessary.
The need for mental healthcare goes beyond merely access to medications and should not necessarily be medicated, a fact recognised and acknowledged by Drs. de Kock and Pillay. Ideally, there should be awareness about the issues and various diagnoses, community support, the opportunity for counseling and therapy sessions and more. 
There is awareness, in the government, the media, academia and the general public, of the problems with the current state of mental healthcare and the need for improvement. However, the awareness is not widespread enough and improvement cannot arrive fast enough. What is clear is that more than half of children and adolescents are certainly in need of mental healthcare, but many have little or no access to a mental healthcare professional.
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 [Statistics from WHO and http://www.ncbi.nlm.nih.gov/pubmed/27430669]
 [http:// www.saps.gov.za/newsroom/msspeechdetail.php?nid=4936]
 [http:// www.ncbi.nlm.nih.gov/pubmed/27430669]