'A cost SA cannot afford': Child mental health crisis at tipping point, shows report

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65% of young people with mental health issues do not seek help. (Getty Images)
65% of young people with mental health issues do not seek help. (Getty Images)
  • The South African Child Gauge report is an annual review of the state of SA's children.
  • The report shows how grim life is for most kids growing up in SA.
  • This year, the focus is on child and adolescent mental health and how "early exposure to adversity or deprivation" affects life-long mental health.

Child and adolescent mental health has reached a crisis point, shows the 2021-'22 South African Child Gauge report.

The report was compiled by UCT's Children's Institute, in collaboration with Unicef South Africa; the DSI-NRF Centre for Excellence in Human Development, University of the Witwatersrand; the Standard Bank Tutuwa Community Foundation; and the LEGO Foundation.

It sheds light on the ever-increasing societal factors burdening children and their long-term effects on mental health.

"These social determinants interact with genetic and biological risk factors across the life course – meaning that early exposure to adversity or deprivation in childhood has a significant impact on subsequent life-long mental health," the report reads.

The Child Gauge report shows that:

  • Nearly half of children in South Africa (42%) have experienced violence, including physical violence (35%) and sexual abuse (35%).
  • Two-thirds of children live in poverty.
  • 10-20% of children will develop a mental disorder, neurodevelopmental disability, or both.
  • 65% of children and adolescents with mental health issues do not seek help.
  • 50% of adult mental health disorders start in the teen years (typically by age 14). 
  • Only one in 10 children with diagnosable mental disorders can access treatment.

Also see: Children's mental health and the digital world: how to get the balance right

'A whole-of-society approach'

"Choosing to ignore the mental healthcare needs of children and adolescents comes at a cost South Africa cannot afford to pay," says one of the report's authors, Professor Mark Tomlinson from the psychology department at Stellenbosch University.

For Tomlinson, the solution to the issues our children face can only be achieved via a "whole-of-society approach" and must consider broader social issues impacting the youth.

"These solutions need to extend beyond medical treatment and the healthcare system and require a whole-of-society approach to address the social and environmental drivers of ill health, and create supportive environments that enable children to thrive."

A lack of child and adolescent psychiatrists is another shortfall in addressing the child mental health crisis in SA, says Dr Alicia Porter, a board member of the South African Society of Psychiatrists.

According to Porter, of the roughly 700 psychiatrists in South Africa, less than 100 specialise in child and adolescent psychiatry and are registered with the Health Professions Council of South Africa.

"Child and adolescent psychiatry is a sub-specialty of psychiatry, and it is not a very popular choice among psychiatrists due to the complexity of treating children and adolescents. It also requires additional two-year training in a recognised child and adolescent unit within the state sector," she says.

Making matters even worse is that these experts are only available in metropolitan areas like Gauteng, KwaZulu-Natal and the Western Cape, with the majority providing their services as part of a private practice, Porter says.

Also read: 'Talk about it like you talk about physical health': Five ways to protect teen mental health 

'Incorporated into the school curriculum'

"We need to aim for preventing mental health conditions and focusing on early screening and detection," Porter says of a potential way forward to addressing the current crisis. Porter adds that mental health skills should be included as part of schooling.

"Mental health needs to be incorporated into the school curriculum, where mental health promotion and coping skills are taught to all learners at schools and not just those identified as vulnerable. There also needs to be equipping and further training of teachers to recognise signs of mental health conditions."

Porter says teachers and parents should look out for the following mental health red flags:

In the home

Younger Children:

  • Irritability
  • Tantrums
  • Non-compliance, and
  • being oppositional or defiant


  • Grumpiness
  • Aggressive outbursts
  • Impulsiveness
  • Decline in academics or lack of motivation
  • May appear to be "lazy"
  • Seclusion
  • Rejection sensitivity
  • Poor personal hygiene
  • An "I don't care attitude"
  • Self-harm "cutting"
  • Substance abuse
  • Running away from home

In the classroom

  • Decline in academic performance (even in high achievers)
  • Change from a previous level of function
  • Isolating themselves and being withdrawn and quieter in the classroom
  • Trouble with friends
  • High absenteeism coupled with vague excuses like stomach aches, headaches, etc.
  • Self-harm – children will often wear jerseys constantly to conceal scars from cutting, or may refuse to participate in extracurricular activities.

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