A Critique of South African Psychology

The South African suicide crisis in boys and men is not only a public health failure — it is a transformation failure. A discussion of the discipline meant to respond to it.

This discussion follows from the companion review, Suicide in South African Boys and Men. It takes the patterns documented there — the disproportionate burden on boys and men, the conflicting evidence base, and the limited reach of existing interventions — and uses them to evaluate the strengths, failures and overall merit of psychology, as an applied science, in fulfilling its stated mission to enhance human well-being and promote social justice (PsySSA).

01The argument in summary

The literature reviewed in the companion article supports four claims, taken together as the basis of this critique:

• The crisis is gendered. Men account for the overwhelming majority of completed suicides in South Africa, while women account for the majority of recorded attempts. Despite this, the lived experience of distress in men is comparatively under-studied (Kootbodien et al., 2020; Robinson et al., 2024).
• The evidence base is fragmented. Reported suicide rates for South Africa range from 1.8 to 19.2 per 100,000 over similar timeframes. Less than 15% of global suicide research is conducted in LMICs, despite LMICs accounting for roughly 75% of suicide deaths (Alabi, 2022; Jordans et al., 2017).
• The workforce is unrepresentative. Men make up the majority of psychiatric inpatients but only 24% of registered psychologists, with African men under 4% (HPCSA, 2021, as cited in Padmanabhanunni et al., 2022). Public-sector psychiatrist density is approximately 0.35 per 100,000 (Janse van Rensburg et al., 2022).
• Policy has not translated into practice. Three successive national frameworks (2002, 2013–2020, 2023–2030) have not arrested the rise in fatal suicide.

02Representivity as a transformation problem

Representivity is the principle that, for equitable transformation to occur, the composition of an institution at every level should reflect the population it serves. In South African mental health, the principle is conspicuously breached. The population most likely to die by suicide — young, Black, unemployed men — is the population least likely to encounter a clinician who shares their socio-demographic profile. African men comprise an estimated 4% of registered psychologists, while a majority of psychiatric admissions are men, many of whom are Black (Franken et al., 2019; Shozi, Saloojee & Mashaphu, 2023; Thomas et al., 2015).

The help-seeking gap and the workforce gap are reinforcing each other.

This mismatch matters for two reasons. Clinically, the stigma cited as a reason men do not seek help cannot be addressed by a workforce that does not look or sound like the men in question. Politically, when the people responsible for defining mental health priorities are demographically removed from those most affected, the antecedents of suicidal behaviour — unemployment, structural violence, alcohol use, and the legacy of apartheid spatial planning — become easier to underweight in research and in service design (Goldstone, Bantjes & Dannet, 2018; Jordans et al., 2022).

03The evidence gap as a research-priority failure

The 10-fold spread in published South African suicide rates is not a curiosity of measurement; it is a symptom. Most suicide statistics are inferred from records of unnatural death, and there is no standardised national surveillance system. The result is that the crisis is, almost literally, not being seen by the institutions mandated to respond to it.

The National Health Research Committee’s (2021) priorities — social determinants of health, transformation-aligned capacity building, improved funding flows, and integrated research infrastructure — map well onto what suicide research in South Africa needs. The gap is at implementation: priorities recur from one strategic document to the next without translating into a durable monitoring system, an LMIC-led research programme, or sustained data investment. Schlebusch’s (2012) recommendations — broadening public awareness, enhancing population and clinical services, strengthening policy, and effective monitoring — were made well over a decade ago and remain largely aspirational.

04Policy without practice: the Life Esidimeni warning

The argument that policy has not translated into practice is not abstract. The Life Esidimeni tragedy illustrates what happens when mental health policy is implemented without the institutional and human resource capacity to deliver it. Between October 2015 and June 2016, approximately 1,711 mental health care users were relocated from a long-term provider in Gauteng to NGOs that were unlicensed and unprepared. At least 144 patients died; 1,418 survivors were exposed to torture, neglect and trauma. The Health Ombud’s 2017 report and the 2024 inquest judgment found that senior officials negligently caused the deaths.

05Funding and the human-rights frame

Mental health receives approximately 5% of South African government health spending, against a population-level mental health burden estimated at over 16%. The discrepancy is not a technical oversight; it reflects the discipline’s political weight. Read alongside the workforce data, the funding picture suggests that the population most likely to need care is also the population least likely to find a clinician, in the cheapest part of an already-underfunded sector. When framed in the terms PsySSA itself uses — well-being, social justice — this is a human rights matter, not merely a service-delivery one.

06Strengths worth preserving

An honest critique should also note what the discipline has done well. South African research on suicide has produced careful profile work in specific provinces and hospitals (Du Toit et al., 2008; Onoya, Makwakwa & Motloba, 2021; Robinson et al., 2024; Wassenaar et al., 2000) and has built a tradition of qualitative work that engages directly with people who have attempted suicide (Goldstone, Bantjes & Dannet, 2018). School-based and university-based prevention scholarship is growing (Shilubane et al., 2015; Smit & Marais, 2025). National policy has, at least formally, integrated mental health into general health planning since 2002. The strengths are real; what is missing is integration, scale and demographic reach.

07Recommendations

Four recommendations follow from the argument above. They are pitched at the level of the discipline rather than the individual clinician.

• Build a national suicide surveillance system. Without a standardised, routinely updated national dataset, the 10-fold variance in published rates will continue. A surveillance system should be co-located with mortality registration and integrated with primary care records.
• Treat workforce demography as a clinical variable. Recruitment, training pipelines and bursary allocation in psychology, psychiatry and allied professions should explicitly target the under-representation of men — particularly Black South African men — with measurable five- and ten-year targets.
• Resource school- and primary-care-based detection. Teachers and primary-care nurses are the people most likely to encounter a young man at risk. Mental health literacy should be a core component of pre-service training (Shilubane et al., 2015; Smit & Marais, 2025), not an optional add-on.
• Centre LMIC-led research. Since 75% of global suicide deaths occur in LMICs and less than 15% of suicide research is conducted there, South African funders should preferentially resource locally-led, longitudinal, men-focused research, rather than importing frameworks designed for high-income contexts.

08Limitations of this critique

This article rests on a narrative review rather than a systematic one; the studies cited are not exhaustive, and inclusion was driven by relevance to the South African case rather than by formal selection criteria. The estimates of suicide prevalence are themselves contested, and the workforce statistics draw on registry data (HPCSA, professional councils) that may under-count practitioners working in informal or non-registered settings. The argument also holds gender as a primary axis of analysis; intersecting axes — race, class, sexuality, disability, geography — shape the crisis in ways this article does not fully unpack. Future work should triangulate registry data with hospital records, mortality surveillance, and qualitative accounts from men who have attempted suicide.

09Conclusion

The suicide crisis in South African boys and men is, at this point, uncontroversial as a fact. What is harder to admit, and what this discussion has tried to set out, is that the crisis indicts the discipline meant to respond to it. Psychology in South Africa has the formal mandate, the policy frameworks and the research base to address suicide; what it lacks — demographically, geographically, and politically — is the institutional alignment to make that mandate matter. Until the workforce, the evidence base and the funding posture are brought into line with the population most at risk, every successive policy framework is likely to repeat the pattern of its predecessors: published, cited, and out-paced by the suicide rate it was written to bring down.