Access Denied: The Affordability of Counselling Services in South Africa

No medical aid but feel like you’re having another overwhelming episode of anxiety? Unsupportive parents yet experiencing suicidal thoughts? On a tight student budget but struggling to cope with very recent grief? Well, if you don’t have a quick, disposable R1000, that’s most likely the end of the road of you receiving professional help. 

The South African Depression and Anxiety Group (SADAG) reports that as many as one in six South Africans suffer from anxiety, depression or substance abuse; however, as little as 16% actually receive treatment. While not the only contributing factor, a lack of accessibility and the high affordability of mental health services has left many South Africans isolated and without professional care to deal with their personal traumas, illnesses, and struggles. 

Psychologist, Shifra Jacobson, a specialist in psycho-education, explains that South Africans, in particular, hold years of untreated trauma because of the country’s violent past. Jacobson explains, “There hasn’t been adequate reparations after Apartheid and there hasn’t been real reconciliation. People’s minds, bodies, and spirits are still very broken." However, it’s not only the past that has affected our nation. Jacobson points out that it’s also the present political, social, and economic landscape Apartheid left behind, adding, “Suicide is a big threat currently because of the climate catastrophe, horrendous racism, and the insecurity of the country. We’re seeing an increase and normalisation that just about anyone feels stressed, anxious or depressed. It’s like a common cold."


Psychologist, Shifra Jacobson, at low-cost mental health centre, The Counselling Hub, in Woodstock. Image by Caroline Petersen.


Since sessions with a psychologist start around R700, and a psychiatrist starting from around R1500, the idea that the average South African could access these services is almost unthinkable. As Jacobson explains, “Mental health access is seen as a luxury good. A luxury item that only certain consumers can have access to. In many ways, it’s true. But the idea has created a mythology and a stigma in a lot of communities”. Without professional help, people are left undiagnosed, feeling isolated and confused, and may even resort to unhealthy or unsustainable coping mechanisms.


As an alternative to pricey counselling, Jacobson suggests other reflective models such as colour therapy, meditation, mindfulness, yoga and movement. Image by Caroline Petersen.


This is where Jacobson, along with Kentse Radebe from the South African College of Applied Psycholgy (SACAP), and Romi Kaplan from the Kaplan-Kushlick Foundation, saw a gap. In the attempt to offer mental health services that were actually affordable and accessible to those in the Western Cape, the trio co-created The Counselling Hub: a low-cost mental health service based in Woodstock offering individuals counselling sessions for just R50. Jacobson, who acts as the Coordinator of The Counselling Hub, comments, “The need for quality mental health services is widespread and intense in low-income communities where high rates of poverty and unemployment; crime and violence; domestic abuse and addiction take an immense toll on people’s mental wellbeing”. So for Jacobson, Radebe and Kaplan, “We see it as a social justice issue.” 

In their attempts to defy the stereotypes and demystify the stigma attached to mental health, as of the 30th of July, The Counselling Hub has successfully seen over 200 clients and has facilitated almost 500 counselling sessions. The organisation is supported by professional volunteers who are certified and registered in clinical psychology; as well as student interns from SACAP who are completing the counselling aspect of their degree while under Jacobson’s supervision. The Counselling Hub is truly a centre of hubbub, as Jacobson explains, their offices are full almost every day with clients coming from as far as Atlantis, Khayelitsha, and even up the West Coast.


The Counselling Hub’s waiting room table. Clients are encouraged to draw doodles, add affirmations, and decorate the table cloth as a form of art therapy while waiting for their session to begin. Image by Caroline Petersen.


Centres like The Counselling Hub proves that, when mental health services are affordable and accessible, people will jump at the opportunity to process and heal. Other centres such as Rape Crisis offer twelve free counselling sessions to rape and sexual assault survivors. As Rape Crisis reports on their website, “Counselling gives rape survivors a space to find the words that will help them heal. Through counselling they find their own coping strategies and learn how to deal with all these difficulties in their own way”. Based on volunteers’ donations, Rape Crisis can support these counselling services for survivors. 

In an ideal world, no one would need to donate to Rape Crisis and centres like The Counselling Hub wouldn’t have to charge a dime. Unfortunately, the cost of upholding centres offering mental health care go far beyond paying the practitioner for their time (which is also a factor to consider). Jacobson explained that there’s operating costs, such as rent, water, and the electricity of the space you may find yourself in. “At a push, it would actually cost us R400 to R500 per session” says Jacobson. 


A drawing and reflection on The Counselling Hub’s waiting room table cloth. Image by Caroline Petersen.


Ultimately, the goal of mental health practitioners is for places offering low-cost counselling to start sprouting up everywhere. This would be the “common cold” that would be a joy to spread. However, against the backdrop of a scarce mental health infrastructure in South Africa, these dreams may remain as simply that. Due to South African public health services believing mental health issues are not public health issues at all, centres would need to be operated off fundraising, private donations, and funds from organisations such as SACAP. While few in number, zero to low-cost mental health care has a high impact. In Jacobson’s words, “If we can just alleviate some stress, some anxiety, some depression so that people who go through our walls and doors can just feel better about themselves – that’s it – that’s the small something we want to do."