Men's Mental Health: A Vital Yet Neglected Component Of Overall Wellbeing

The mental health landscape of South Africa is a growing concern. As a country, we have a low level of mental health literacy, yet Section 27 of the Constitution of South Africa guarantees all citizens the right to access health care services, including mental health care. Despite this legal framework, there is a general lack of awareness about what symptoms should alert us to mental disorders and what resources are available to support affected parties. Mental health services are often underfunded and inaccessible, especially in lower-income communities and more so in townships and rural settings. Even where services may exist, the health care resources tend to be redirected to diseases that are thought to be more of a priority, such as TB, HIV and AIDS, amongst others. This neglect of mental health has far-reaching consequences, with research showing that when mental health issues remain untreated, especially those that existed from childhood, they can lead to long-term emotional trauma, reliance on substance use, and reduced quality of life. 

This article focuses on the burden of mental health and related challenges as faced by men in South Africa. We need to normalise talking about these issues and seeking the much-needed interventions promptly.  

Burden and Risk factors of Mental Illness in Men 

South African data confirms a significant gender divide in both treatment and outcomes. The South African Stress and Health (SASH) survey found that while around 25% of adults with a 12-month mental disorder received any treatment, only 6.6% of men with a mood disorder accessed care compared to 18.5% of women. This shows men are far less likely to seek or receive support, despite comparable or greater levels of need. 

The same gender divide is starkly visible in suicide statistics. According to the World Health Organization’s 2019 estimates, the suicide rate for South African men is 37.6 per 100,000, compared to 9.8 per 100,000 for women—nearly a 4:1 ratio. Local surveillance by the South African Medical Research Council (SAMRC) also confirms that men account for approximately 77% of suicides nationally. Recent insurance-based data reinforces this picture: the Discovery Life 2024 report found that suicide was the leading cause of unnatural death among policyholders, disproportionately affecting middle-aged and older men. 

This scenario also appears to play out in South Africa more broadly. In addition to low literacy levels and the stigma attached to mental health, studies have reported that a preference for self-reliance and believing that the condition will resolve on its own are among the reasons why men do not seek help for mental illness. 

The societal factors propelling avoidance behaviour includes the stigma of mental illness being more pronounced amongst men, making it difficult for men to admit to having mental health problems and seeking the necessary help.  Traditionally, expectations placed on males (even whilst growing up) are that men are strong and self-reliant and are often considered to be the breadwinners for their families in adulthood. Cultural norms discourage men from expressing their emotions and they are labelled or perceived as weak when displaying vulnerability. We have all encountered instances when the following are uttered to male figures in boyhood or in adulthood, “Man up,” or “Men (boys) don’t cry”. Failure to meet these societal expectations or manage these stereotypes by standing one’s ground, can lead to feelings of inadequacy and isolation. This often perpetuates non-disclosure and compels men to suffer in silence, both in our communities and workplaces.  

In South Africa, added to the day-to-day life stressors, are factors emanating from our complex socioeconomic environment, which include, amongst others, the disparities in our quality of life, absent fathers, the high levels of crime, unemployment, violence and substance abuse. These may worsen the mental health challenges faced by men, leading to depression and anxiety if not addressed, especially when impacting their ability to provide for their families.  

For those fortunate enough to be employed, the demands of employment, workplace bullying and income insecurity are often identified as stressors. Men in workspaces often conceal their emotions to maintain their status, in keeping with cultural norms and expectations. There is also fear that a mental health diagnosis may lead to discriminatory practices at work. This is despite Section 9 of the Constitution prohibiting unfair discrimination, including discrimination of employees based on disability, including mental health conditions. Proactive management of employee’s mental health is beneficial for both the employer and employee. 

Mental Health Challenges faced by Men 

Both men and women face similar mental health challenges. In this article, we focus on men and how they are affected by more common mental health conditions, discussed below.  

1. Depression  

Is a mood disorder that has a negative impact on the way a person thinks, feels and acts. According to the Diagnostic and statistical manual of mental disorders (5th ed., text rev.)  (DSM-5-TR), depression is a mental health condition characterised by at least five of the following symptoms: 

• Persistent sadness, tearfulness, feeling empty or hopeless  

• Loss of interest in activities (that were once enjoyable) 

• Fatigue or loss of energy 

• Changes in sleep patterns  

• Changes in appetite 

• Feelings of worthlessness 

• Psychomotor agitation (restless symptoms, inability to sit still, pacing up and down, wringing of hands) or psychomotor retardation (slowing down of thoughts, actions or speech) 

• Difficulty in concentrating, thinking or making decisions 

• Recurring suicidal thoughts or attempted suicide 

The five or more symptoms should be present at the same time, having been present for at least two weeks, and cause significant impairment in daily functioning at home and work. The symptoms may be identified through self-observation or may have been noticed by those around you. 

In men, depression is often not recognised because the symptoms of depression present differently than they do in women. Rather than appearing sad or withdrawn, men living with depression may seem irritable, angry, and engage in risk-taking behaviour. Men may also mask depression with substance use, overworking or emotional withdrawal.   

Questionnaire 

Do You want to check your Mental Health? If you think you may have Depression, please take this Self rating questionnaire provided by the South African Depression and Anxiety Group (SADAG) through the link below. and discuss the Findings with your Mental Health practitioner. Click here 

2. Anxiety Disorder  

Anxiety is a normal response to stress, and may even be beneficial in some situations, such as increasing attention and focus on tasks. By contrast, DSM-5-TR defines an anxiety disorder or Generalized Anxiety Disorder (GAD), as excessive anxiety and worry about various events or activities, occurring more days than not for at least six months. The disorder interferes with normal daily functioning to a marked degree. Anxiety is difficult to control and is accompanied by at least three of the following symptoms: 

• Restlessness     

• Fatigue 

• Difficulty with concentrating 

• Irritability 

• Muscle tension 

• Sleep disturbance 

The anxiety, worry, or physical symptoms must cause clinically significant distress or impairment in social, work-related, or other important areas of functioning. A growing but under-recognised issue which can worsen depression and anxiety, is loneliness and isolation. Compounding the isolation over recent years, is the rising obsession with the use of digital technology and social media, to the extent that they stifle and often replace meaningful human conversations. Disrupted sleep patterns and feelings of inadequacy as one constantly compares oneself to the outside world, are some of the detrimental effects of excessive social media use.   

3. Substance Abuse leading to a substance use disorder (SUD)  

Men are more likely than women to use alcohol and recreational drugs as stress relief or as a coping mechanism. However, excessive use can lead to a substance use disorder, which may trigger violent and aggressive behaviour, and often coexists with depression and anxiety. 

A person with a substance use disorder has difficulty controlling their use of alcohol, drugs, or other addictive substances despite wanting or trying to reduce it.  They continue despite the excessive use of the substance, affecting their life negatively both socially and at work.

Continued use of the substance may lead to a breakdown of relationships, emotional instability and risky behaviour that may bring the person into conflict with the law.  They even continue to use the substance to the detriment of their own health, knowing it may cause or worsen physical or psychological problems. The person may be so dependent on the substance that they experience withdrawal symptoms when not using it. 

Studies show that men are more likely than women to develop a SUD and are less likely to seek treatment. 

4. Suicidal Ideation and Suicide  

For some people who feel that they are unable to cope with life’s challenges or mental illness, resorting to suicide may be seen as a permanent end to their struggle.  

The rates of suicide in South Africa are highest for men. The gender paradox in suicidal behaviour has long been established, even though more women attempt suicide. Men are more likely to complete suicide attempts.  Men are also more likely to use methods that are more likely to have lethal consequences, such as using a firearm or jumping from a height, whilst women may pursue less reliable and less lethal means, such as medication overdoses or cutting of wrists.  

Suicidal warning signs include withdrawal, hopelessness, and sudden mood changes. Thoughts of committing suicide are often not triggered by a single cause but occur due to a combination of different life events, thoughts, and feelings. Major depressive disorder, bipolar disorder, anxiety disorders, and substance use disorders (especially alcohol abuse), are amongst the mental illnesses are associated with at risk of suicidal behaviour. The risk of suicide in South Africa is further worsened by the tough economic situation, unemployment, and traumatic life events, especially in marginalised communities. 

Other risk factors include:  

• A family history of suicide, substance use, or mental disorders 

• A personal history of suicide attempts Exposure to violence, including sexual or physical abuse 

• Having a substance use disorder 

• Chronic pain  

• Recent release from prison 

• Direct or indirect exposure to others’ suicidal behaviour 

5. Post-Traumatic Stress Disorder (PTSD)  

Post-traumatic stress disorder (PTSD) is a mental health condition triggered by exposure to traumatic events such as death, serious injury or sexual violence. According to the DSM-5-TR, in addition to the direct or indirect exposure to trauma, a diagnosis of PTSD also requires that the affected person experiences the presence of symptoms from four distinct clusters as follows: 

• Intrusive symptoms like flashbacks, nightmares, or distressing memories 

• Avoidance of trauma-related thoughts or reminders 

• Negative changes in mood or thinking (e.g. feelings of guilt, isolation, loss of interest) 

• Heightened state of arousal (e.g., irritability, sleep issues, hypervigilance) 

The symptoms must be present for over a month and must be considered to cause functional and social impairment and must not be attributed to other causes. It may, however, co-exist with other mental disorders. 

In South Africa, PTSD is especially prevalent due to high rates of violent crime, domestic abuse, and the brutality that was sometimes associated with the country’s history of apartheid and political unrest. In men, stigma and underdiagnosis are major barriers to treatment. 

6. Attention-Deficit/Hyperactivity Disorder (ADHD)  

Often associated with childhood, ADHD has been found to persist into adulthood. In the US, an estimated 4.4% of adults live with ADHD, with men being affected twice more than women. ADHD may sometimes go unrecognised or be misdiagnosed in men, particularly in South Africa, where mental health literacy is limited. 

Adults with ADHD may experience the following symptoms: 

• Inattention: Difficulty paying attention, staying on task, or being organised 

• Hyperactivity: Excessive activity or restlessness, even at inappropriate times, and difficulty engaging in quiet activities 

• Impulsivity: Acting without thinking or having trouble with self-control 

According to the DSM-5-TR, a diagnosis of adult ADHD requires that symptoms persist for at least six months, cause functional impairment, and appear in multiple settings such as work, home, or social environments. Adult men with ADHD may often find it challenging to stay organised, stick to a job, keep appointments, perform at work and maintain relationships. 

A Call to Action 

To effectively address the challenges surrounding men's mental health, the following key actions are recommended at individual, societal, and workplace levels: 

1. Practice self-care: Be alert and be aware when all is not well. Engage in activities that men enjoy, set boundaries, and prioritise self-care. Encourage other men to engage in self-reflection to understand their triggers and reactions, helping them to better manage their own mental health.  

2. Healthy Coping Mechanisms: Promote activities like exercise, mindfulness, and healthy hobbies to help men manage stress and improve their mental well-being. 

3. Societal Norms: Challenge societal norms that discourage men from expressing their emotions and promote the idea that vulnerability is not a sign of weakness but is a sign of strength. 

4. Safe Spaces: Create platforms where men can express their emotions without fear of judgment. Encourage participation in support groups and counselling sessions. 

5. Mental Health Literacy: Increase awareness about mental health symptoms and available resources through educational programmes, advocacy, and community-based awareness campaigns. 

6. Inclusivity: Avoid discrimination. De-stigmatise language used in relation to mental health campaigns to normalise conversations and encourage help-seeking behaviour. 

7. Accessibility: Advocate for more resources and accessibility of mental health services, especially in lower-income, and rural communities. 

8. Role Models: Encourage leaders and public figures to openly discuss their mental health struggles, setting a positive example for others. This reduces stigma. 

9. Workplace Support: Ensure workplaces have policies and programmes to support employees' mental health, including access to counselling services and stress management programmes. Ensure workplaces do not discriminate against those affected by mental health issues. 

10. Immediate Help: Encourage a speak-up culture. Ensure access to resources are available when immediate help is needed, e.g. helpline, counsellor, psychologist, GP, or other health care professional. 

By implementing these actions, men can be actively supported to speak up, address their mental health challenges and seek the help they need. These actions help to prioritise mental health as a fundamental human right, making it possible to gain inroads in delivering impactful solutions that contribute towards sustainable changes for men and those within their reach. Let us empower South African men to better manage their mental well-being so they can lead meaningful and fulfilling lives, in the different roles that they play. 

Here below are contact details for some of the resources available in South Africa:  

1. SADAG Office: (+27) 11 234 4837 

2. SADAG Suicide Crisis Helpline: 0800 567 567 

3. LifeLine South Africa:        0861 322 322                                   

4. Stop Gender Violence Helpline:  0800 150 150 

5. Department of Social Development Substance Abuse Line: 0800 12 13 14 

6. ADHD Helpline: 0800 55 44 33 

Available resources extend beyond this list. You may be directed to more resources through your clinic, workplace or healthcare practitioner. 

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References: 

1. Africa Minds Matter. 2024. Mental Health Inequality: The Struggle for Access in South Africa. https://africamindsmatter.org/mental-health-inequality-the-struggle-for-access-in-south-africa/ 

2. American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Publishing. 

3. Andersson, L. M. C., Schierenbeck, I., Strumpher, J., Krantz, G., Topper, K., Backman, G., Ricks, E., & van Rooyen, D. 2013. “Help-Seeking Behaviour, Barriers to Care and Experiences of Care among Persons with Depression in Eastern Cape, South Africa.” Journal of Affective Disorders, 151(2), 439–448. 

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5. Clinical Partners. 2025. Mental Health in Men: Evidence-Based Approaches for 2025. Clinical Partners. 

6. Discovery Life. 2024. Claims Experience Report: Suicide-Related Deaths. Johannesburg: Discovery Life. (summarised in Citizen, Moonstone, and MedEd reports). 

7. Epicentre. 2025. “Raising Awareness for Men’s Mental Health.” https://epicentre.org.za/2025/06/10/men-mental-health/ 

8. Goldfield, Gary. 2025. “Social Media and Loneliness: A Dangerous Pair.” Psychology Today, January 26. https://www.psychologytoday.com/us/blog/no-more-fomo/202501/social-media-and-loneliness-a-dangerous-pair 

9. Hamman, Dedri. 2022. “Breaking the Silence: A Closer Look at Men’s Mental Health.” https://edpsych.education/breaking-the-silence-a-closer-look-at-mens-mental-health/ 

10. Harmer, Bonnie, Sarah Lee, Abid Rizvi, and Abdolreza Saadabadi. 2024. “Suicidal Ideation.” StatPearls. Treasure Island, FL: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK565877/ 

11. Luzan. 2024. “Mental Health in the Workplace: What the Law Says for Employers.” https://www.luzan.co.za/mental-health-in-the-workplace-what-the-law-says-for-employers/ 

12. Psychologs World. 2024. “Long-Term Effects of Childhood Neglect on Adult Mental Health.” https://www.psychologs.com/long-term-effects-of-childhood-neglect-on-adult-mental-health/ 

13. Schrijvers, Didier, Rudi Bollen, and Bernard Sabbe. 2012. “The Gender Paradox in Suicidal Behaviour and Its Impact on the Suicidal Process.” Journal of Affective Disorders, 138(1–2), 19–26. 

14. Seedat, S., Williams, D. R., Herman, A. A., Moomal, H., Williams, S. L., Jackson, P. B., Myer, L., & Stein, D. J. 2009. “Mental Health Service Use among South Africans for Mood, Anxiety and Substance Use Disorders.” South African Medical Journal, 99(5 Pt 2), 346–352. 

15. Sorsdahl, Katherine, Dan J. Stein, and Bronwyn Myers. 2012. “Negative Attributions towards People with Substance Use Disorders in South Africa: Variation across Substances and by Gender.” BMC Psychiatry, 12(101). https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-12-101 

16. South African Government. 1996. Constitution of the Republic of South Africa, Chapter 2: Bill of Rights. https://www.gov.za/documents/constitution/chapter-2-bill-rights 

17. World Health Organization (WHO). 2021. Suicide Worldwide in 2019: Global Health Estimates. Geneva: World Health Organization. https://www.who.int/publications/i/item/9789240026643 

18. World Health Organization (WHO). 2024. “Post-Traumatic Stress Disorder.” https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder