You might be surprised to know that the leading cause of disability worldwide isn’t a communicable disease, heart disease or back pain: it’s depression.

Depression is extremely common, in both rich countries and poor countries (no, it’s not just a boujie rich person disease), with an estimated 322 million people worldwide living with it, and with low- and middle- income countries reporting the most dramatic increases over the past decade. Which means that one of the most urgent health crises faced by the world today is how to make mental health care more accessible, especially in under-resourced countries. For instance, Zimbabwe — a country of 16 million people — has only 10 working psychiatrists.

In South Africa, it’s estimated that only one in four people suffering from a mental illness will receive some form of care. The barriers to access include long waiting times at clinics, a lack of trained mental health professionals, and the high cost of private support, not to mention the stigma of admitting that you aren’t coping.

Kentse Radebe, executive director of the South African College of Applied Psychology Foundation, knows all about these challenges. This year, her organisation launched the Counselling Hub, a low-cost service based in Cape Town where people can access counselling for R50 a session. She says that South Africa urgently needs to experiment with alternative ways of getting help to more people who need it.

“Oftentimes when we’re introduced to mental health, especially in popular media, we think of a psychiatrist or psychologist as being the only person who can assist you. A lot of research has shown that there are other ways to provide basic mental health care services that still meet the minimum needs and requirements of our population.”

She points to examples like Zimbabwe’s friendship bench project as inspiration, where grandmothers are trained to provide basic counselling services on simple benches placed outside public clinics.

“In South Africa, a few years ago, we introduced the registered counsellor profession, which is somebody who has a four-year training in basic mental health care. We need individuals who aren’t necessarily as skilled or a specialised psychiatrist and psychologist, but individuals who have mental health care training who can implement — at a community level — the kinds of interventions and programmes that promote mental health care. Obviously, if it’s a serious mental health illness like schizophrenia or bipolar disorder, then you definitely need to be referred on to a specialist. But at the base level we’re looking at prevention and promotion of basic mental health care.”

There’s a useful analogy here to other types of health issues. If you’re having a heart attack, you need to go see a doctor! But it’s also important that we teach people how to keep themselves healthy through their everyday habits like eating well and exercising. Health can be something that’s supported by a whole society along the whole spectrum of care, and mental health care is no different.

Expensive, private psychotherapy isn’t the only option. If you need help, Kentse recommends getting in touch with one of these NGOs:

• The South African Depression and Anxiety Group 24-hour toll-free helpline: 0800 456 789
• The Lifeline 24-hour toll-free national counselling helpline: 0861 322 322 (there are also special hotlines to support survivors of gender-based violence and people affected by HIV/AIDS, as well as in-person counselling centres all around the country)
• The Counselling Hub low-cost counselling centre in Cape Town: 021 462 3902

For more advice about living with depression or anxiety, or for supporting someone around you who’s struggling, take a listen to the final Season One episode of the Like a F-cking Grownup podcast. ML

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