Heeding the call: Advancing adolescent mental health in South Africa


Theodoros Chronopoulos


The mental health of young people is in crisis around the world. It was dire before COVID, which only exacerbated the situation–straining and severing connections to school, community, and health systems, dimming economic prospects, and intensifying burdens and pressures at home. And the effects are long-lasting and won’t go away even as the pandemic fades. In South Africa, where the ramifications of Apartheid are still very much felt by underserved young people, the crisis is acute.

For several years, EMpower has been supporting local organisations in the country that build young people’s resilience and wellbeing. Increasingly, these community-based and -led efforts are filling the gap where the government has fallen severely short. And there is much to learn from their work.

Even though mental health problems are the leading cause of health disability amongst adolescents, only 4% of the total health budget in South Africa is allocated to mental health services. This gross underinvestment, combined with a steep shortage of mental health providers, significantly limits the care available to young people. As a result, community-based organisations are increasingly compelled to respond, leading initiatives to enhance young people’s capacity to endure and rebound from stresses and traumas.

Over the last several years, EMpower has been on a learning journey with many of these organisations, our grantee partners, to better understand and support adolescent mental health. This week we’re releasing a new report, which brings together key findings and recommendations for funders and other organisations, with the goal of increasing action, resources, and practicable strategies to ensure young people’s mental health in South Africa, and beyond.

We are glad that the South African government has finally published its National Mental Health Policy Framework and Strategic Plan 2023-2030. It acknowledges that “services for children and adolescent mental health are severely lacking” and makes a number of commitments. We hope the government will match the policy with the investment required to make a real difference. The philanthropic sector should also play a major role to further this work. Based on the collective experience of our grantee partners, young people themselves, and others, we have identified 10 guiding questions that funders and organisations should consider when entering this field. While this guidance emerged out of our experience in South Africa, much of it is applicable to other contexts. 

Guiding Questions When Investing in Adolescent Mental Health

  1. Does the programme meet young people’s basic needs? Young people need consistent, safe spaces where they can have their emotional and physical needs met. They need access to food, as they can’t explore mental health or personal development issues when they are worried about where they are getting their next meal.
  2. Do young people have at least one caring adult that they can turn to? Every young person should have a relationship with at least one consistent and caring adult, someone they can trust and turn to when they are struggling. This can be someone in their family or community, or a staff member from an organisation.
  3. Are organisations listening to and embedding youth voices in their programming? It is important that approaches, programme components, indicators, and curriculum be based on needs identified by young people. They should be included when an organisation is developing a programme to ensure it is developed in a way that values their lived experiences, recognises their real felt needs and coping strategies, and makes their resilience and strengths more visible.
  4. Does the organisation invest in positive role models from the young people’s own communities? Youth need positive role models and facilitators from their own communities. They need access to staff and mentors from a similar background, who understand the cultural practices that shape their lives, have faced similar challenges, and can guide and support them in ways that make sense to them.
  5. Does the programme provide youth with access to practical tools? Youth should have access to practical tools that support their emotional regulation, reflection, and self-expression. They should have access to tools that help them speak about and process what they are feeling and that they can use to manage difficult feelings and experiences when they are at home, at school, or at work.
  6. Does the programme provide youth with access to meaningful opportunities? Young people need access to a range of meaningful opportunities that develop their skills and offer exposure to different spaces. This can include training, internships, and job placements as well as exchange programmes and volunteer opportunities. It is important that young people have the chance to spend time in new spaces that broaden their perspectives about the world and take them out of their comfort zones.
  7. Is the programme trauma-informed? Staff working with young people should have an understanding of the impact of trauma on their mental health and be able to work in ways that are trauma-informed. Trauma training should be provided for staff, along with emotional/psychological support for them to work through their own trauma-related issues if they arise.
  8. Is the programme working in ways that intentionally challenge harmful gender norms? Organisations must acknowledge how gender impacts mental health. Programmes should be designed, implemented, and facilitated in a way that makes all young people, especially girls and young women, feel emotionally and physically safe. Understanding the specific mental health vulnerabilities and risks of adolescent boys/young men, adolescent girls/young women, and gender expansive young people will result in more impactful mental health programmes.
  9. Is the organisation connected to a mental health professional who can assist with referrals? Strengthening relationships between community-based organisations and clinical care institutions can help close the treatment gap. Organisations should prioritise creating stronger referral systems that can funnel youth to professional services when needed.
  10. Does the organisation amplify youth voices around the issues that affect them?Policymakers should acknowledge young people’s unique needs and challenges. For this reason, organisations should help them discover their own voices, articulate their needs, build their leadership, and facilitate access to advocacy platforms that aim to expand and improve services and opportunities for them.

Local organisations in South Africa are working creatively to support young people, establishing safe spaces for them to process their emotions and experiences, and building their resilience during extremely challenging times. They are forging new communities of care that provide crucial services to young people. In many cases, they are the only source for such support. At EMpower, we have seen this play out in the other 14 countries where we work as well; most of our grantee partner organisations are now addressing young people’s mental health needs in some way. Together, we have much to learn from each other. To boost our efforts, we need commitment from governments and donors to invest more in young people—in their well-being and their future.

Theodoros Chronopoulos is the Senior Programme Officer for Africa and Russia and Lead of Child and Youth Safeguarding at EMpower. For more than 20 years, he has worked with activists and NGO leaders in Africa and Europe, facilitating communities of practice, co-designing and implementing research, learning, and reflection projects, and collaboratively developing strategies to strengthen social and economic rights.

To mark Mental Health Awareness Week 2023, Alliance magazine has made the March 2022 special feature on ‘Mental Health Philanthropy’ available to download for free until 21 May 2023.

Download the issue for free here 

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