Suicide in South African Boys and Men

A review of what we know — and what we keep failing to measure — about a crisis that disproportionately kills young men, and the discipline that was meant to respond to it.

This article reviews what is currently known about suicide in South Africa, with particular attention to the disproportionate burden carried by boys and men. It compares the South African suicide rate against global trends, we survey the peer-reviewed evidence on prevalence, profile and intervention, and lays the foundation of a critique of South African Psychology as an applied science.

An Overview

The numbers, in brief:

Introduction

Why suicide in boys and men, and why now?

Approximately 1 in 5 South African learners will attempt suicide before reaching tertiary education (Shilubane et al., 2015). Men account for roughly 80% of completed suicides in South Africa: of an estimated 14,000 annual suicides, men make up about 11,200 of those deaths (Kootbodien et al., 2020; Robinson et al., 2024). Over the past two decades, the South African suicide rate has continued to climb, even as the global rate has declined (Bertolote & Fleischmann, 2009; Robinson et al., 2024).

This article advances three claims.

1. The available evidence shows that fatal suicide in South Africa is concentrated in boys and young men, despite women presenting more often for non-fatal suicidal behaviour.
2. The country’s mental health services are not configured to reach the population most at risk: practitioners are too few and demographically unrepresentative of the South African population.
3. The academic literature itself lacks rigour — statistics conflict, reporting is inconsistent, and the crisis remains a low public health priority.

The Problem Statement

What, precisely, is the issue?

The problem this article addresses can be stated in three connected parts.

1. The crisis disproportionately affects boys and men.

• The South African suicide rate continues to grow at an alarming rate, against the global trend of decline.
• Although estimates vary across sources, suicide rates in South African men are approximately five times higher than in women.

2. The academic record is fragmented and conflicting.

• Reliable national figures are difficult to obtain. Suicides are often inferred from records of unnatural death, and published estimates conflict, ranging from 1.8 to 19.2 per 100,000 over similar timeframes (Du Toit et al., 2008; Onoya, Makwakwa & Motloba, 2021) a substantial incongruence in statistical reporting.

3. Existing South African interventions are not addressing this crisis adequately.

• Successive policy frameworks — the Mental Health Care Act (2002), the National Mental Health Policy Framework 2013–2020 (2013), and the 2023–2030 (2023) framework — have not arrested the rise in suicide deaths.
• The mental health workforce remains demographically unrepresentative of the population it serves, particularly with respect to men and to Black South Africans.

Literature Review

To present a thorough critique of South African Psychology, this review synthesises peer-reviewed work on three questions:

1. The prevalence of suicide in South Africa
2. The barriers to existing intervention strategy
3. Feasible courses of action.

Prevalence

It is well documented that around 700,000 to 800,000 people die by suicide every year globally (Kootbodien et al., 2020; Lovero et al., 2023; Onoya, Makwakwa & Motloba, 2021; Robinson et al., 2024), with a global suicide rate of approximately 10 per 100,000. WHO estimations in the early 2000s projected that annual suicides would double by 2020, surpassing the millions (Bertolote & Fleischmann, 2009; Du Toit et al., 2008; Schlebusch, 2012). The global rate has since fallen short of those projections; in South Africa, however, peer-reviewed work agrees that fatal suicides have continued to rise over the same period (Robinson et al., 2024). Reliable national numbers remain elusive: estimates over similar timeframes range from 1.8 to 19.2 suicides per 100,000 (Du Toit et al., 2008; Onoya, Makwakwa & Motloba, 2021). A plausible explanation is structural: although about 75% of global suicides occur in LMICs like South Africa, less than 15% of suicide-related research is conducted in LMIC contexts (Alabi, 2022; Jordans et al., 2017). The general consensus places the South African suicide mortality rate at more than double the global average — about 23.5 per 100,000 — though this figure is contested. The finding that men, and especially young men, commit the majority of suicides is consistent across South African work (Kootbodien et al., 2020; Robinson et al., 2024). The crisis, nonetheless, remains a low public health priority and reliable data are largely unavailable.

Barriers to South African intervention strategy

The composition of the mental health workforce — in terms of size, demographics and distribution — does not reflect the political and contextual antecedents of suicidal behaviour in South Africa (Janse van Rensburg et al., 2022). The dichotomy between the average mental health worker and the average person seeking care highlights a need for representation: the principle that, for equitable transformation to take place, the composition of an institution at every level should reflect the population it serves. When that principle is breached, those most in need of care become vulnerable to human rights violations.

Although women experience higher rates of depression and anxiety than men — commonly attributed to greater male stigma around help-seeking — the disparity is complicated by the under-representation of men in the mental health workforce. Data from South African hospitals show that men typically constitute the majority of inpatients in psychiatric care, ranging from 55% (Thomas et al., 2015) to 67% (Franken et al., 2019; Shozi, Saloojee & Mashaphu, 2023). By contrast, men comprise only 24% of registered psychologists in South Africa, with African men representing just under 4% (HPCSA, 2021, as cited in Padmanabhanunni et al., 2022); 10.4% of practising nurses (Shakwane, 2022); and 5% of occupational therapists (Ned et al., 2020). A recent profile of the psychiatrist workforce (Janse van Rensburg et al., 2022) estimates 0.35 psychiatrists per 100,000 in the public sector, underscoring the inaccessibility of mental health care.

Suggestions for intervention

South Africa first formalised mental health policy in the Mental Health Care Act of 2002. A strategic plan followed in the National Mental Health Policy Framework 2013–2020, and a 2023–2030 update is now in force. These instruments have had little effect on institutional transformation or on the suicide crisis itself, which has worsened in tandem with each iteration of the policy.

A central facet of national mental health planning is research. The National Health Research Summit Report (National Health Research Committee, 2021) sets out priorities including the social determinants of health, capacity building among health research personnel under the country’s transformation mandate, funding flows, and improved access to research infrastructure. These are general health-sector priorities; focused on suicide specifically, Schlebusch (2012) argues for broadening public awareness, enhancing population-based and clinical services, strengthening policy guidelines, and improving monitoring systems.

At the level of practice, Shilubane et al. (2015) found that teachers in Limpopo lacked the skills both to identify suicidal ideation in learners and to manage the aftermath of a suicide. Their recommendation — that school-based suicide prevention programmes be developed — is echoed by work on mental health literacy in primary care, which urges that literacy be integrated into professional training (Smit & Marais, 2025).

Discussion

What does the literature review tell us?

01Representivity 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 community it serves. In South African mental health, the principle is conspicuously breached. The population most at risk of commiting suicide are — young black men — who are also 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, a minority of them are black ( Franken et asl., 2019; Shozi, Saloojee & Mashaphu, 2023; Thomas et al., 2015 ).

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

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, substance abuse, and the legacy of apartheid spatial planning — are less emphasized in research and in policy implementation (Goldstone, Bantjes & Dannet, 2018; Jordans et al., 2022).

02The evidence gap as a research-priority failure

Most suicide statistics are inferred from records of unnatural death, and there is no standardised national surveillance system. The result is the complaceny of the sectors mandated to respond to the suicide crisis.

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 are maintained 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 — for the broadening of public awareness, enhancing population and clinical services, strengthening policy, and effective monitoring — of suicides and other mental health symptoms remains aspirational at best.

03Policy 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. A short companion piece sets out the timeline, scale and context of the tragedy in full.

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.