How to access public mental health services

If you feel that you need help, reach out

By Enzo Sinisi

14 July 2020

Photo: Mental Health - The Noun Project (CC0 1.0)

If you have reached the point where you know you need help, but you cannot access private health care and you aren’t sure where to turn next, then this article is for you. We will look at:

Here are a few of the most common reasons a person decides to reach out (your reason might not be listed):

The first question to ask yourself is what do you need. Are you in a state of intense emotional distress and need to speak to someone right now? Has a doctor or loved one suggested that you see a counsellor or therapist? Do you feel ready (or able) to start meeting with a counsellor or therapist?

Therapy works best in the context of a relationship, such as when you meet with the same therapist over a period of time. But there are times when this is not possible. For example, you might feel too ashamed to start seeing (or be regularly seen by) another person. Or perhaps you need to speak to someone this second. Or maybe you have something you feel is too risky to share in person.

A phone-call away

If this sounds like you then a good first step would be to reach for the phone and to call one of the many valuable crisis lines, helplines, and suicide hotlines.

These lines are enormously helpful and usually offer a free 24/7 service that is entirely confidential. Trained counsellors answer the calls, and while they listen and may advise you, they will accept what you say without judgement and will not tell you what to do. Many also have access to a range of referral resources and so can connect you to other services if necessary.

Make the call; you have nothing to lose.

The South African Depression and Anxiety Group (SADAG) is an excellent choice. You can find their numbers listed here:

Other quality services are also available. Click here for a list of suicide lines and hotlines.

I’m ready to see someone, now what?

Telephone, text and email support are all valuable and even lifesaving. However, there are advantages to meeting with and potentially starting an ongoing journey with a mental health professional. Regular meetings with the same professional offers both of you a chance to get to know each other and make it easier for the professional to assess and help you.

Thanks to South Africa’s community service program, it is now far easier to access medical doctors and psychologists than before, especially around cities. However, to maximise your chances, it is essential to understand how the public health system works and to follow the procedures carefully.

The South African health system prioritises community-based care.

Unless you face an emergency, your health care journey starts with a visit to the community clinic nearest to your home. Hospitals do not offer superior care to our clinics; instead, they aim to address more specific problems and then refer to community clinics.

Most people in need of counselling, or other mental health services, are not facing an emergency. They are ordinary people (like you and me) having a difficult time.

Life throws up challenges. Some we manage on our own, others with help from loved ones (if we are lucky enough to have some). Then some problems require expert hands, either because special skills are needed or because they can overburden our relationships.

How to find clinics and services

The internet is an excellent tool when it comes to locating clinics and other services. Unfortunately, many sites (including Google) hold outdated clinic contact details. These two websites are better than most.

What if the phone rings or the number is wrong?

If you can’t get through by phone, visit the clinic and talk to the staff. Prepare by asking yourself the following questions…

If you do get to see someone, it will most likely be a medical officer or a nurse. They will assess your situation and most likely either give an appointment, put you on a waiting list, or refer you to another clinic or hospital.

Clinics are medical spaces

The person assessing you will likely prioritise ruling out medical conditions. It is possible that counselling is not on top of their mind. If you are aware of an emotional need and would like to see a counsellor, you should ask to see one. Be polite and direct, for example: “I would like a chance to speak with a psychologist or counsellor. Please can you refer me to one?”

If possible, it can help to arrive with a letter from a private GP supporting the need for counselling.

Treating professionals will use their expertise to decide how best to proceed. They might decide that counselling is unnecessary, or that they do not have access to enough resources to provide it. Still, there is no harm in asking. It is also worth asking if another clinic (or NGO) could help.

How to get the most from counselling:

How to access a hospital

Public mental health hospitals are considered secondary level facilities, which means one needs to be referred to them by a primary level facility.

New patients are required to bring a referral letter. Your community clinic, local GP or psychiatrist, will assist with this.

If you are a known patient of the facility, you may call your treating team and they will explain the steps to take.

Remember: Hospitals do not provide better care than clinics, they address specialised problems. There is no need to attend a hospital unless your situation requires it.

What if it is an emergency?

Emergencies are situations that require immediate intervention to reduce imminent harm or risk. In mental health terms, risk can include risk to someone’s personal or professional reputation.

If you (or someone) are experiencing an emergency, visit a nearby casualty/emergency department (preferably near your home). Ask a friend or family member to accompany you.

Answering yes to the following questions suggests risk.

Answering yes to the following implies a lower risk.

What to do if someone needs to go to the hospital refuses?

I am sorry if it applies to you since this is an experience that can be upsetting, difficult and scary. Fortunately, there are systems in place, and help is available.

If someone has a mental illness or suspected mental illness, they are a risk to themselves or others, and they refuse to go to the hospital – you can call the South African Police Services (SAPS). The Mental Healthcare Act 2002 (Section 40) obliges SAPS to assist in bringing the person to a nearby hospital or clinic that offers emergency services.

It is sometimes necessary to call the local station commander and remind them of their responsibility. Be polite; they do not do this every day.

What else can you do to help?

Does the person have a psychologist or a doctor? If so, an accompanying referral letter from them can help improve the chances of being seen quickly. If necessary, can help you find a private mental healthcare professional.

Ask the psychologist or doctor to call the emergency room, ahead of the patient, to discuss the case with the on-call doctor. If they do this, ask them to address the referral letter directly to that doctor.

Sometimes it helps to complete the paperwork beforehand. A family member or associate is required to complete a Form 4 (download here) before involuntarily admitting a patient. You can download the form here:.

The admitting doctor is required to complete a Form 5 (download here).

For more advice, contact the Mental Health Help Line on 0800 12 13 14.

Enzo Sinisi is a clinical psychologist and practising psychoanalyst in Cape Town.