As part of their work, the SAFMH National Youth Advocacy and Advisory Forum are encouraged to take up advocacy initiatives that are meaningful to them. Mvelonhle Myeza (KZN) wrote the below research report as part of her advocacy for inclusive advocacy.
Mvelo said: “I chose this topic because I strongly believe that rural mental health remains an under-researched and underserved area in South Africa, despite the country’s stated commitment to community-based care. During the research, it became apparent that cultural and spiritual interpretations of mental illness significantly influenced help-seeking behaviour and access to treatment. What stood out mostly was the extent to which national advocacy efforts often overlook these local contexts, resulting in gaps between policy and lived experience. This points to the importance of advocacy strategies that are both culturally informed and practically inclusive.”
INTRODUCTION
Mental health advocacy in South Africa has gained momentum in recent years with growing public awareness, policy reform efforts, and an expanding rights-based discourse.[1] Although it is increasingly recognised as a public health priority, this recognition remains uneven.[2] Urban and peri-urban areas benefit from increased mental health awareness campaigns, clinics, and policy engagement, while rural communities, by contrast, remain largely excluded from both services and conversations.[3]
In rural contexts, where cultural traditions remain a vital part of everyday life, mental health conditions are seldom understood through biomedical frameworks.[4] For example, individuals presenting with symptoms of depression, psychosis, or schizophrenia are often regarded as having an ancestral calling.[5] These understandings reflect not ignorance, but a fundamentally different worldview in which health is defined not merely as the absence of disease, but as the spiritual, physical, mental, and communal well-being of a person.[6] Accordingly, amongst cultural-traditional believers, good health is not based merely on how it affects the living, but the harmony between self and ancestors, because it is of ‘paramount importance that the ancestors stay healthy so that they can protect the living.’[7]
Although African traditional religion is not inherently opposed to a Western medical way of treatment or healing, the World Health Organisation specifically states that health is not merely the absence of illness as well[1] – many of its followers believe that certain health conditions, particularly those perceived to have spiritual causes, cannot be effectively treated through conventional medicine alone.[2] A study found that traditional healing methods are often regarded as more effective for addressing mental health conditions believed to be rooted in spiritual or ancestral disturbance.[3] While this worldview is legitimate and meaningful to many, it can become harmful when spiritual interpretations replace, rather than complement, access to health care.[4]
In such cases, individuals in need of long-term psychotropic treatment may be advised to discontinue their medication or may be excluded from traditional rituals if they continue treatment. In support of this, a South African study involving 254 psychiatric patients in the Nelson Mandela Metropole provides empirical evidence of the influence traditional healers have on medical adherence. Among participants who had consulted traditional healers, 61% reported receiving no advice regarding their psychiatric medication, 29.5% were encouraged to continue treatment, while 5.1% were advised to stop taking their medication altogether, and 1.3% were instructed to stop and restart it at a later stage.
CONCLUSION
This report exposes a critical blind spot in South African mental health advocacy, namely the lack of culturally grounded, rural-responsive strategies. In communities where ancestral belief systems guide interpretations of mental health conditions, individuals are often forced to choose between clinical care and cultural belonging. SAFMH is uniquely positioned to lead a national shift toward equity and inclusion in mental health advocacy. By promoting a dual-system model, SAFMH can help dissolve the false divide between traditional and Western frameworks and ensure that no person is denied care because of where they live or what they believe in. If mental health is truly for all, then all must mean rural, cultural, and spiritual communities, too.
Read Mvelonhle’s full research report here.
References
[1] ‘Breaking the Stigma: Mental Health Advocacy Movement Gains Momentum’ available at Breaking the Stigma: Mental Health Advocacy Movement Gains Momentum | africamindsmatter.org accessed on 05 July 2025. [2] A major finding of this is that racial and ethnic minorities bear a greater burden from unmet mental health needs and thus suffer a greater loss to their overall health and productivity. See: ‘Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General’ available at Chapter 1. Introduction – Mental Health: Culture, Race, and Ethnicity – NCBI Bookshelf accessed on 25 July 2025 [3] R Vergunst ‘From global-to-local: rural mental health in South Africa’ 2018 Global Health Action (11) 1. [4] ‘Understanding Cultural Influences on Mental Health: Traditional Beliefs in Africa’ available at Understanding Cultural Influences on Mental Health: Traditional Beliefs in Africa | africamindsmatter.org accessed on 05 July 2025 – “In some cases, individuals with mental health issues may be ostracised or stigmatised by their communities due to these beliefs, which can further exacerbate their condition and prevent them from seeking professional help. Additionally, traditional healers may not always possess the necessary knowledge or training to effectively treat mental health disorders, leading to potentially harmful consequences for the individual.” [5] Ibid. [6] P White ‘The Concept of Diseases and Health Care in African Traditional Religion in Ghana’ (2015) HTS Theological Studies 71(3) 2. [7] Ibid. See also: P Iroegbu ‘Healing insanity: Skills and expert knowledge of Igbo healers’ (2005) African Development 30(3), 81. [8] World Health Organisation – Mental Health available at https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response accessed on 30 July 2026. [9] P White (note 6) 1. [10] S Maua & JP Egunjobi ‘Cultural-Spiritual Dimension to Management of Mental Illness in Sub Saharan Africa: A Narrative Review’ (2023) p 24 – 25, available at (PDF) Cultural-Spiritual Dimension to Management of Mental Illness in Sub-Saharan Africa: A Narrative Review accessed on 25 July 2025 [11] Ibid at 25. [12] Z Zingela; S Van Wyk; J Pietersen ‘Use of traditional and alternative healers by psychiatric patients: A descriptive study in urban South Africa’ (2018) available at https://pubmed.ncbi.nlm.nih.gov/30281411/ accessed on 25 July 2025 [13] See section 11 and section 27 of The South African Constitution, 1996. [14] Ibid at section 27(2). [15] See Article 4, 5 and 8 of The United Nations Convention on the Rights of Persons with Disabilities, 2006. [16] See reference 10.
