PHILA

Mental Health

You are not alone. You are not weak. Help is real.

IF YOU OR SOMEONE YOU LOVE NEEDS HELP RIGHT NOW

SADAG Suicide Crisis Line · 0800 567 567

SADAG Mental Health Line · 011 234 4837

Lifeline SA · 0861 322 322 · WhatsApp 065 989 9238

All free. All 24/7. All confidential.

DRAFT — Starter Edition

Contents

1. Welcome — and a word before we start

2. What mental health actually means

3. How to maintain your mental health

3.1 The everyday basics

3.2 Once-a-week practices

3.3 The five-minute reset

4. What to do when you’re struggling

4.1 Warning signs to listen to

4.2 First steps you can take today

4.3 When to get professional help

4.4 What to expect from a clinic

5. Foods that help with mental health

5.1 The gut-brain connection

5.2 Affordable mood foods

5.3 What to limit

6. The state of mental health in South Africa

6.1 The numbers

6.2 Why it’s hard to get help here

6.3 The cultural part — let’s name it

6.4 Why it is time for change

7. Crisis resources and getting help

1. Welcome — and a word before we start

Mental health is just health. The same way a body can be tired, or sick, or strong — a mind can be too. There’s nothing weak about needing help with it, and nothing weird about wanting to look after it before something goes wrong.

This is a starter guide. It does not replace a doctor, a psychologist, a nurse, or a friend. What it does is give you simple, honest tools you can start with today — and tell you exactly where to go when you need more.

If you are reading this for someone else, that’s okay too. Knowing what to look for and what to say is half the help.

Remember

If things feel too heavy, you don’t have to carry it alone.

SADAG Suicide Crisis Line: 0800 567 567 · Lifeline SA: 0861 322 322 · Free. 24/7.

2. What mental health actually means

Mental health is how you think, feel, behave, sleep, eat, and handle the things life throws at you. It changes day to day — like the weather. Good mental health doesn’t mean always happy. It means you can ride the bad days without falling apart, and you can enjoy the good ones.

A mental health PROBLEM is when those feelings or thoughts start to interfere with your life — your work, your relationships, your sleep, your ability to look after yourself. It might be sadness that won’t lift, fear that follows you everywhere, or thoughts that won’t quiet down.

Mental health problems are common. In South Africa, about one in three people will have a mental health problem at some point in their life. You probably know several people who have. They might just not be talking about it.

Three honest things

Mental illness is not a character flaw. It is not weakness, laziness, lack of faith, or punishment.

It is not something you can just “snap out of”. Telling someone to be strong does not make depression go away — just like telling someone with a broken leg to walk it off.

It is treatable. Most people get meaningfully better with the right support — therapy, medication, community, time, or a combination.

3. How to maintain your mental health

These are the things we know help most people most of the time. None of them are dramatic. All of them add up.

3.1 The everyday basics

• Sleep 7–9 hours a night, at roughly the same time each night. Poor sleep affects mood more than almost anything else.

• Move your body every day. A 20–30 minute walk is enough. Exercise is one of the most studied treatments for mild and moderate depression.

• Get sunlight on your skin within an hour of waking up. 10 minutes outside resets your body clock.

• Eat regularly. Skipping meals causes blood sugar dips that look exactly like anxiety.

• Drink water. Mild dehydration affects mood and concentration.

• Limit alcohol. It is a depressant. It might feel calming in the moment, but it makes anxiety and low mood worse the next day.

• Talk to someone — even briefly. A real conversation, every day, with a friend, family member, neighbour, colleague. Loneliness is a serious health risk.

3.2 Once-a-week practices

• Do something just for the joy of it. Music. Football. A long walk. Cooking something new. A book. Time with people who make you laugh.

• Spend an hour outside — a park, a stoep, a walk. Nature lowers stress measurably.

• Limit one thing that drains you. Less time on social media. Less time with a person who pulls you down. Less news.

• Help someone else. Volunteering, helping a neighbour, even small things — researchers find this lifts mood reliably.

• Check in with yourself: how am I sleeping? Eating? Drinking? What’s been weighing on me?

3.3 The five-minute reset

For when stress, anxiety, or anger is rising and you need something fast. Pick one:

• Slow breathing — breathe in for 4 seconds, hold for 4, out for 6. Repeat for 2 minutes. Slows the heart, calms the body.

• Step outside for 5 minutes. Look at something more than 20 metres away — sky, trees, a building far off. This relaxes the nervous system.

• Walk for 5 minutes. Anywhere. Briskly. It clears the head and burns off stress chemicals.

• Drink a glass of cold water slowly.

• Phone or text one person to say hello — no agenda, just to connect.

• Write down three things on your mind. You don’t have to do anything with them. Getting them out of your head and onto paper helps.

Remember

If things feel too heavy, you don’t have to carry it alone.

SADAG Suicide Crisis Line: 0800 567 567 · Lifeline SA: 0861 322 322 · Free. 24/7.

4. What to do when you’re struggling

4.1 Warning signs to listen to

Some signs are normal reactions to a hard week. When they last two weeks or longer, or they’re getting worse, that’s when it’s time to pay attention.

• Sadness, emptiness, or hopelessness that won’t lift

• Losing interest in things you used to enjoy

• Sleep changes — sleeping too much, or not being able to sleep

• Big appetite changes — eating much more or much less than usual

• Feeling tired all the time, even after rest

• Trouble concentrating or making simple decisions

• Constant worry, racing thoughts, or feeling on edge for no clear reason

• Pulling away from family and friends

• Drinking more or using drugs to cope

• Feeling worthless, or like you’re a burden to others

• Thoughts of harming yourself, or that everyone would be better off without you

If you’re having thoughts of harming yourself

Please call the SADAG Suicide Crisis Line right now: 0800 567 567.

They are trained to help. You will not be judged. You don’t have to know what to say — they will guide the conversation.

If you can’t call, ask someone you trust to be with you, or go to your nearest clinic or hospital emergency department.

4.2 First steps you can take today

• Tell one person. The hardest sentence in mental health is the first one. “I’ve been struggling.” Anyone you trust — a friend, family member, faith leader, nurse, teacher.

• Go back to the basics in section 3 for a few days. Sleep. Walk. Eat. Water. Sunlight. They will not cure depression, but they will give your body something to work with.

• Cut the worst inputs. The news. The person who makes you feel small. The scroll that leaves you feeling worse.

• Write down what’s hurting. Not for anyone else — just for you. Often you discover what the real problem is once it’s on the page.

• Be patient with yourself. Healing is not a straight line.

4.3 When to get professional help

There’s no “bad enough” threshold. If you are struggling and the everyday tools aren’t helping, that is reason enough.

Get professional help sooner rather than later if:

• You have warning signs from 4.1 that have lasted longer than two weeks.

• Your work, relationships, or daily life are being affected.

• You are having thoughts of harming yourself or others — get help immediately.

• You are using alcohol or drugs to cope.

• Someone who loves you has expressed concern about you more than once.

• You’ve been through trauma — abuse, assault, loss, witnessing something terrible — and you can’t shake it.

4.4 What to expect from a clinic

Many people are nervous about going for the first time. Here is what usually happens at a public clinic:

• You see a nurse first. They will ask what’s been going on and how long you’ve felt this way.

• If you have a serious concern, you may be referred to a doctor at the clinic, or to a psychiatric nurse, social worker, or psychologist.

• If medication is recommended, it usually takes 2–6 weeks to start working properly. Stick with it. Don’t stop suddenly without talking to the clinic.

• Therapy is also often free at public clinics — ask. It can be one-on-one or in a group.

• You can ask for someone who speaks your home language. You can ask for a different person if the first one doesn’t feel right.

• Everything you tell the clinic is treated as medical information. They cannot share it without your consent except in very specific cases (such as serious risk to yourself or others).

If you can’t face the clinic yet

Call SADAG first: 011 234 4837. They can talk you through what to expect and refer you to local services.

Many people find a phone call easier than walking in. Both are valid first steps.

5. Foods that help with mental health

Food alone cannot cure depression or anxiety — please don’t let anyone tell you it can. But what you eat does affect how your brain works, and there is growing evidence that some patterns of eating support mental wellbeing more than others.

5.1 The gut-brain connection

Your gut and your brain talk to each other constantly through nerves, hormones, and the bacteria living in your digestive system. When your gut is unhealthy — too much sugar, too little fibre, too much processed food — it can affect mood, energy, and stress.

The single biggest food pattern with evidence for mental health is the Mediterranean style: lots of vegetables, beans, lentils, fish, olive oil, nuts, some fruit, and not much processed food. Most of those ingredients are affordable in South Africa.

5.2 Affordable mood foods

Foods that local research and international studies link to better mood, lower depression risk, and lower anxiety:

Food group Examples in SA Why it helps

Oily fish (omega-3) Tinned pilchards, tinned sardines, mackerel Omega-3 fats reduce inflammation in the brain. Tinned pilchards are one of the cheapest sources of omega-3 in the world. Fermented foods Maas (amasi), plain yoghurt, fermented vegetables Feed good gut bacteria, which support mood. Maas is local, cheap, and ideal. Leafy greens Morogo, spinach, cabbage, beetroot leaves Rich in folate. Low folate is linked to depression. Beans and lentils Sugar beans, lentils, samp & beans, soya Protein + slow carbs = stable blood sugar = stable mood. Eggs Whole eggs, boiled or scrambled Choline and B12 — both essential for brain function. Nuts and seeds Peanuts (raw or roasted), sunflower seeds, pumpkin seeds Magnesium and healthy fats. Magnesium is the “anti-stress” mineral. Whole grains Oats, brown rice, brown bread, brown pap Slow energy release. Sudden blood sugar crashes feel like anxiety. Fruit Bananas, apples, oranges, pawpaw, naartjies Vitamins, fibre, and natural sugars. Bananas have tryptophan, which the body uses to make serotonin. Water Tap, filtered, or boiled Even mild dehydration affects mood, concentration, and energy.

5.3 What to limit

• Sugary cold drinks and energy drinks. They cause blood sugar spikes and crashes that mimic anxiety.

• Highly processed snacks (chips, sweets, biscuits) most days. Linked to higher depression rates in several studies.

• Excess caffeine — more than 3 cups of strong coffee or energy drinks a day can worsen anxiety and sleep.

• Alcohol — it’s a depressant. Even moderate drinking affects sleep and mood the next day.

The simplest food rule for mental health

Eat mostly real food. Mostly plants. Include some fish or beans. Include something fermented (maas works perfectly). Drink water.

You don’t have to do this perfectly. Even small shifts — one less cold drink a day, one more vegetable per meal — make a measurable difference over weeks.

6. The state of mental health in South Africa

6.1 The numbers

South Africans are not okay. The data has been clear for years.

What we know The number

South Africans who will have a mental illness in their lifetime About 1 in 3 Adults with probable depression (national survey) Around 25.7% Adults with probable anxiety (national survey) Around 17.8% South Africans with a diagnosable mental illness who get NO treatment Around 9 in 10 University students with anxiety symptoms in the past 30 days Around 37% SA’s ranking out of 64 countries on the Mental Health Quotient 63rd (second-lowest)

These numbers come from national surveys, SADAG, and international ranking studies. The pattern is the same across every reliable source: high need, low access, getting worse.

6.2 Why it’s hard to get help here

• Cost. Private psychologists and psychiatrists cost R800–R2 500 per session. Few people can afford that, especially weekly.

• Public services are stretched thin. There are fewer than two psychiatrists per 100 000 people in South Africa. The wait for a public appointment can be weeks or months.

• Geography. If you’re rural, the nearest psychologist may be 100 km away. Many districts have no specialist services at all.

• Medical aid doesn’t always cover what you need. Most basic plans cap mental health sessions or only cover certain diagnoses.

• Language. Therapy in a language that isn’t your first language is harder. Not enough therapists work in isiZulu, isiXhosa, Sesotho, Setswana, Afrikaans, or other home languages.

6.3 The cultural part — let’s name it

There are also barriers that don’t show up in the statistics. They are real, and they matter.

• The “strong African” / “strong man” expectation. The idea that you must endure quietly, that complaining is weak, that men especially shouldn’t cry or ask for help. This kills people. Asking for help is the strongest thing a person can do.

• The fear of being called “mad” or “crazy”. Mental illness is often confused with severe psychosis in public conversation, when in fact most mental illness looks like ordinary people getting quietly overwhelmed. Depression doesn’t make you mad. Anxiety doesn’t make you mad.

• The spiritual framing. In many communities, depression or anxiety is read as a curse, a calling, ancestral displeasure, or a spiritual battle. Phila does not dismiss spiritual life — for many people it is a real source of strength. But spiritual support and medical support are not opposites. You can pray AND go to the clinic. You can see a healer AND take medication. The two are not in competition.

• Distrust of clinics and Western medicine. Sometimes earned, sometimes inherited. The answer isn’t to lecture people — it is to make services more welcoming, more local, in more languages, with more dignity.

• Silence at home. Many families have someone struggling that nobody talks about. The silence helps no one. Starting the conversation gently — not interrogating, not fixing — can change everything.

6.4 Why it is time for change

Mental health is not a luxury problem. It affects how children learn, how parents raise, how workers earn, how communities function, how the country runs.

Untreated depression and anxiety cost South Africa billions every year in lost productivity, absenteeism, and avoidable hospitalisations. Each suicide is a family, a neighbourhood, and a future broken.

Things that need to change, and that you can advocate for:

• More mental health professionals in public clinics, in more languages.

• Mental health funding that matches the size of the problem — currently the National Health budget allocates a tiny percentage to mental health.

• Mental health education in schools, so the next generation can name what they are feeling and ask for help without shame.

• Workplace mental health support — every large employer should offer free, confidential counselling.

• Public conversations led by people who have lived through it. The biggest dent in stigma comes from ordinary people saying, “me too — and I got better”.

What you can do, even from where you are

Talk about mental health like you would talk about diabetes or blood pressure — as a real, manageable health issue.

Check on the people in your life who are usually “fine”. Especially the strong ones.

Share resources like this guide. The first time someone hears that help exists may be the day they reach out.

If you’re an employer, an educator, a faith leader, or a community leader — make it safe to bring this up.

Vote and advocate for better public mental health services.

7. Crisis resources and getting help

IF YOU OR SOMEONE YOU LOVE NEEDS HELP RIGHT NOW

SADAG Suicide Crisis Line · 0800 567 567

SADAG Mental Health Line · 011 234 4837

Lifeline SA · 0861 322 322 · WhatsApp 065 989 9238

All free. All 24/7. All confidential.

Other helplines and services

• South African Federation for Mental Health — 011 781 1852 (information, referrals, advocacy)

• Cipla 24hr Mental Health Helpline — 0800 456 789 (run with Lifeline)

• AKESO Crisis Line (in-patient psychiatric facilities) — 0861 435 787

• Childline (for children and young people) — 116 (free from any phone)

• GBV (gender-based violence) Command Centre — 0800 428 428

• Adcock Ingram Depression and Anxiety Helpline — 0800 70 80 90

Online and WhatsApp

• SADAG website with self-help tools and local support groups — sadag.org

• Lifeline SA WhatsApp — 065 989 9238

• Find a Helpline (international directory, includes SA) — findahelpline.com

If you are supporting someone else

• Listen more than you speak. You don’t have to have answers.

• Don’t say “snap out of it”, “others have it worse”, or “just be strong”. They might be trying very hard already.

• Do say: “I’m glad you told me”, “you’re not alone”, “let’s figure out the next step together”.

• Help them make the call or go to the clinic. Sometimes the act of just sitting next to someone while they dial is what it takes.

• Look after yourself too. Supporting someone in distress is heavy. You also deserve support.

One last thing

If you only remember one thing from this guide, let it be this: reaching out is the strongest move, not the weakest.

The first call is the hardest. After that, it gets easier.

0800 567 567. Save it in your phone. Today.