Psychological distress in working South Africa

Mental health is a challenge that some 30% of people struggle with at some stage in their lives. The personal, family, business, and social costs are significant. Stigma, access to care, rates of trauma, and other challenges remain. Employers can do much to help and will help themselves in the process

Mental health is a complex consideration and it is not easily or simply defined. Sigmund Freud’s definition, ‘the capacity to work and to love’ remains simple and helpful.

The World Health Organisation (WHO) also offers a useful if rather idealistic definition: ‘subjective well-being, perceived self-efficacy, autonomy, competence, inter-generational dependence, and self-actualization of one’s intellectual and emotional potential, among others’.

These definitions create something of a dilemma in that very few people feel this ‘well’ consistently and so it’s not always clear what is realistic or possible. Given the challenges of modern life, some estimates suggest that as many of half of the world’s population experience sub-optimal mental health.

Psychological distress – or ‘mental health disorder’ as it is more clinically termed – is certainly common: in South Africa, some 30% of the adult population suffer from mental health disorders at some stage in their lives – in a one-year period some 17% have a recognisable mental health disorder.

Anxiety disorders16%
Mood disorders10%
Substance abuse15%
   Alcohol abuse11%
Drug abuse4%
Prevalence overlaps and is not neatly summed to arrive at the any-disorder prevalence

20% of employees in the workplace report being ‘very stressed’ or ‘highly stressed’. The most common mental health disorders are anxiety disorders (such as panic attacks, generalised anxiety, phobias, and post-traumatic stress disorder), mood disorders (depression), and substance abuse (including alcohol). Excluded are some of the more serious mental health conditions like psychosis (for example schizophrenia) and personality disorders, which are more complex but less common.


Mental well-being is a complex consideration. Cultural norms, social stigma, a fragmented and difficult national history, high levels of crime and violent crime, and a fluid and diverse society, create complexity.

The reality that access to quality healthcare is only available to those with the means to purchase it (mainly through medical scheme membership) creates yet more difficulty.


Mental health is linked to productivity.

Using the two most important measures of productivity, a clear link is seen between impaired mental health and reduced productivity.

Sanlam Health’s data, for instance, shows a clear link between self-reported stress and reduced productivity.

These findings support the intuitive sense that those who are unhappy, stressed, distracted, etc, are less productive at work.

FactorGood mental healthPoor mental health
Presenteeism probability10%50%
Absenteeism (days per annum)7,810,9


In most cases, mental health disorders can be treated with a combination of counselling and medication. Counselling may involve psychologists, social workers, psychiatrists, family doctors, leaders, community members, and more. There are many effective medications, although expert professional assessment and prescription is an imperative to optimise efficacy and to minimise side effects and dependency risks.

The treatment of most mental health disorders is effective and most patients do recover. There are challenges of course (for example, results with drug and alcohol dependency are mixed) but the reality for most people is that treatment works.


In the workplace, where productivity-impact is a real concern for all parties, all of the above have bearing. There are specific opportunities in the work environment:

  • Stigma can be reduced through careful policies and communications, with the role of senior leadership critical.
  • Targeted campaigns can be deployed (such as stress management skills, depression awareness, and alcohol abuse support).
  • Access to quality care can be provided. Examples include:
  • Making medical scheme membership compulsory and/or company-funded is really the only way to ensure access to comprehensive quality healthcare and, as such, is sound corporate policy.
  • Employee assistance programmes (EAPs) have become widespread and they do provide access to professional psychosocial counselling, which can be of great value.
  • Workplace clinics offer convenient and affordable (low cost or no-cost depending on specifics) access to primary healthcare, which can offer screening and support services.

Making wellness, and mental wellness, part of the ‘culture’ and fabric of a company is really the goal here. Specific policies and programmes and services help a great deal but the active support of business leadership is pivotal – with it a great deal can be achieved and without it, initiatives are likely to underperform.


Mental health matters and while much can be done, much is yet to be done.

References are available on request

Author: Dr Colin Burns is Health and Wellness Consultant at Sanlam Health