Across southern Africa, men seek mental health care less often than women, which can have significant impact on their health and longevity. Grassroots, community-led initiatives are helping men to open up and receive support.
Men in southern Africa seek mental health care less often than women, which can have a significant impact on their health and longevity. Photo: SA Federation for Mental Health
“A man is a black iron,” proclaims an old Sesotho proverb, implying that men must be strong and endure suffering without complaint. In many African countries, men subscribe to traditional masculine norms that emphasise strength, control, and decisiveness. But in trying to fulfil these societal expectations, their mental health can suffer.
The situation is compounded by a persistent belief that depression is uncommon among African men and women, and that mental health challenges are not prevalent in these populations. Historically, depression among Black people is heavily stigmatised and viewed as a sign of emotional fragility; symptoms like feelings of helplessness, worthlessness, and hopelessness are considered cowardice.
Amid the growing burden experienced by men in southern Africa, destigmatising mental illness increasingly depends on grassroots, community-led support.
Gender norms drive fear of appearing weak
Men learn from an early age that talking about worries, fears, and problems may be a sign of weakness—this makes them much less likely than women to seek help for mental health difficulties like anxiety, depression, and substance use. Research suggests that internalising social masculinity norms makes African men more susceptible to poor mental health.
In Africa, the male suicide rate is the highest in the world, and South Africa, Botswana, and Zimbabwe are among the worst-affected countries.
“I come from a typically conservative Afrikaner family where gender roles are strongly defined. Men are raised to be tough and stoic and not talk about their feelings,” says Leon de Beer, deputy director at the South African Federation for Mental Health, of the predicament of men living in traditional South African societies and experiencing mental health challenges.
De Beer is an educated man with a loving family and a good job working in the field of mental health, but it still took him a long time to acknowledge that he had a mental health problem of his own. “It’s not an easy process, having to open up to people,” he says.
South African construction worker Akona Mzamane had a similar experience. He says his Xhosa upbringing made it difficult for him to talk about the pain of losing his daughter. He resorted to drinking and, in the process, became violent.
“I went from being a calm, respected man to a violent drunk. While my wife could openly grieve, crying and expressing sadness, I had to suppress my emotions. With no outlet, I turned to alcohol to numb my grief,” he says.
Mzamane says he despised himself for feeling grief, seeing it as a sign of weakness and a disappointment to his family. “During my initiation, we were circumcised with a blunt knife. I didn’t cry like the other boys. I stood strong. How could I now be this vulnerable?” he says.
Mental health conditions are a significant risk factor for suicide—the rate of which is much higher among men than women. In Africa, the male suicide rate is the highest in the world, and South Africa, Botswana, and Zimbabwe are among the worst-affected countries.
According to WHO data, South Africa reports the tenth highest rate of suicide globally, with 23.5 suicides per 100,000 people. There were 13,774 suicides reported in 2019, out of which 10,861 were by men.
Taking the first steps to mental health care
In line with many African traditions, Mzamane’s family believed he was cursed and brought in a traditional healer to cure him. He found it easier to confide in the healer, as it made his situation feel “less unusual”.
“The community approved so [I felt] no stigma,” Mzamane says. “Traditional healers are seen as dealing with supernatural issues, so you believe your problem isn’t just ordinary—it’s divine, which makes your challenges seem elevated.”
“Acknowledging you have a problem is half the battle—the other half is the practical issue of finding a therapist.”
While the traditional healer did not cure Mzamane, over the course of one year he at least had someone to talk to, which led him to then seek help from a mental health professional.
“The healer helped by being a listening board and nudged me to take professional help,” Mzamane says. “I think they have a role in managing the effects of mental illness in men as a first line because of their place in society.”
Traditional healers are also cheaper than more formal modes of care. For the year that Mzamane consulted the healer, he paid the equivalent of one goat (US$24). He was also fortunate to live close to an NGO that provided free basic counselling when he sought professional support. For many men, high costs mean it can be extremely difficult to access care—not to mention the severe shortage of mental health workers across Africa, which serves as another barrier for men.
De Beer was able to access mental health support through medical aid, a type of health insurance that covers outpatient services. But, he says, not many South Africans have medical aid, and even when they do, some mental health services are not covered.
“Acknowledging you have a problem is half the battle—the other half is the practical issue of finding a therapist,” de Beer says. Plus, he says it can take time to develop a trusting rapport with a mental health worker. “It can be demotivating trying to find someone you can work with.”
His views are backed by a 2023 study that examined the current state of mental health care in South Africa. It estimated that about 75% of South Africans with common mental health conditions like depression, anxiety, and substance abuse do not get treatment. Those who do receive treatment often do not stay in care and experience inconsistent and ineffective access to quality services.
Long distances and high costs impede care
In neighbouring Botswana, a 2022 report found that 52% of men are diagnosed with mental illness compared to 48% of women—but outcomes for men are improving, albeit slowly.
Charity Kennedy, who founded the Botswana Network for Mental Health after being diagnosed with depression in 2010, says gender stereotyping and stigma limit Botswanan men from seeking mental health support.
“The perspective on men’s mental health is gradually changing, though not at the same rate as the perspective on women’s mental health,” she says. “Our organisation’s interventions and efforts to address barriers to help-seeking behavior are showing positive results. We have observed a yearly increase in men seeking help for their mental health.”
However, she says, men over the age of 36 are more difficult to reach than younger men. “We need to be more intentional with that demographic,” Kennedy says.
Botswana Network for Mental Health has ramped up general mental health education that targets men, running educational sessions in social clubs and leveraging commemorative days. What remains a challenge is access to mental health services.
Botswana is about the size of France or the state of Texas and is thinly populated, which poses a challenge in providing health services in general and psychiatric services in particular. There are three national referral hospitals, one of which is a psychiatric hospital. As of 2022, there were 11 psychiatrists in the country: five are academics, three are in private practice, and the rest work in public hospitals and clinics.
Long distances to health facilities and an unsupportive boss stopped Komotso Katlego from getting the mental health treatment he needed. He became suicidal after DNA results showed he was not the biological father of his two children, he explains, speaking through his brother who takes care of him.
Katlego lives about 15 kilometres from the nearest health facility. He walked there once, but it was too hectic for repeat visits. His boss also refused to give him the day off, saying his ‘issue’ was not serious.
Katlego would like to go to a private facility in the capital city Gaborone, but sessions are prohibitively expensive, costing between US$30 and US$80 each. He would need multiple visits and his family cannot afford it. Community and church members visit and encourage him, which makes him feel better for a couple of days, before the darkness returns. “It’s kind of a roller coaster, but we hope the good days will last longer with time,” Katlego’s brother says.
Community-led initiatives reducing mental health stigma
Kennedy believes greater and more formal provision of community support will change the trajectory of mental health services in Botswana, especially for men, offering a dual benefit: improved access to care and a reduced stigma around mental health problems.
Provision of community support can change the trajectory of mental health services. Photo: SA Federation for Mental Health
“We should shift from strengthening institutions to strengthening community-based mental health services, where community members help resolve and bring awareness to mental health issues. This will remove stigma and encourage positive health-seeking behaviors,” she says.
Angelica Mkorongo, a mental health advocate in Zimbabwe, where similar social norms prevent men from speaking openly about mental health problems, agrees that communities play a crucial role in raising awareness about men’s mental health.
Mkorongo suffered from obsessive compulsive disorder (OCD) for more than 30 years. Her community had little awareness and offered little support, so in 2018 she founded the Zimbabwe OCD Trust, an NGO dedicated to raising awareness of OCD and anxiety disorders among Zimbabwean communities.
Mkorongo says Zimbabwe now has several services focused on men’s mental health, including men’s support groups, where mental health issues are discussed in a supportive environment, and Friendship Bench, a popular program where trained community members provide basic mental health support in accessible public spaces.
“Men need to be educated to recognise signs of mental health issues, so they should be encouraged to participate and attend community events,” Mkorongo says.
Changing the mental health conversation
In South Africa, there has been an increase in the number of organisations focused on men’s mental health. These organisations aim to facilitate help-seeking behaviour. Public-private partnerships and increased funding for NGOs are also proving effective in addressing issues associated with men’s mental health.
“Talking to men in camps, churches, and religious places, where they congregate—with messaging specifically for them as the target audience—is more effective than having generic campaigns with slogans like ‘real men cry too’.”
Mzamane suggests that cultural practices such as initiations and coming-of-age ceremonies should be used to raise awareness of mental health issues in boys and young men. Traditional gender roles could be examined in a manner that does not place excessive burden on men as ‘emotionless’ providers and breadwinners.
Roy Phiri, a Zimbabwean media marketer who has depression, agrees that specifically targeting boys and men within existing social circles is an effective way of raising awareness of mental health issues.
“Talking to men in camps, churches, and religious places, where they congregate—with messaging specifically for them as the target audience—is more effective than having generic campaigns with slogans like ‘real men cry too’,” he says.
“It took me a while to realise I had a problem, and even longer to seek help. I feared being labelled mad or people doubting my capacity at work.”
Eventually, Phiri went to a men’s boot camp where there was a discussion on mental health. He was encouraged to seek treatment and says his depressive episodes are now fewer and that he is getting better at identifying triggers.
Changing the conversation about mental health at a broader public health level is important, too. Phiri has worked on several mental health campaigns and believes men are not as likely as women to listen to expert advice, which means they must be targeted differently. He says helping men feel comfortable talking about their feelings is crucial in building an understanding that mental health challenges can happen to anyone, regardless of their gender, stature in society, or affiliation.
Reducing the influence of African proverbs that reinforce and perpetuate traditional gender norms is another important step. “If [these proverbs are] drilled into people’s heads when they are children, it’s what they internalise and become,” Phiri says, recommending creating alternative proverbs that promote gender equality and challenge conventional gender roles. “We need to start conversations about this as citizens.”
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