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that it is one’s own.

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3. This essay/report/project is my own work.

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Signature: Yandisa

Date: 10/9/2018
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The profession of psychology is often criticised for not attending to the mental health needs
of most South Africans

Yandisa Maqenukana
MQNYAN003
Department of Psychology
University of Cape Town

Group 7
Word Count: 3539
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Apartheid was abolished in South Africa in 1994. Following this transformation in the
country many things changed including the discipline of psychology (Geffen, 2013). This was
because it was seen as being directly complicit in the phenomenon of Apartheid. It was used to
justify the marginalisation as well as the oppression of Black people in the country, by
justifying why White people in the country were more deserving of the country’s resources
than Black people, who were the majority (Geffen, 2013, p. 4). Ahmed (2004) highlights that
the construction of the profession in South Africa during those times was tailored to deal with
the mental health needs of the minority White South Africans, while it completely neglected
those of the majority Black South Africans (Geffen, 2013). The transformation of psychology
in South Africa was marked by the disbanding of the “Psychological Association of South
Africa”, which at that time was the body that was considered as being complicit with Apartheid
(Geffen, 2013). This brought about the rise of the “Psychological Society of South Africa”
(PsySA), which was thought to be more inclusive of previously disenfranchised groups
(Geffen, 2013). Research on this topic suggests that the current practice of psychology in the
country might still not be the best way to enhance mental well-being for all, as structures of
Apartheid are still seen in the practice (Rock, 1994). In South Africa 75% of people with mental
health disorders do not receive adequate mental health care (Marie, 2014). Most of these
individuals are Black citizens from low-income communities (Marie, 2014). Section 27 of the
South African Constitution acknowledges the right to health care for all, this consisting of the
Mental Health Act which also makes provisional access to mental health care services a right
to all (Marie, 2014). The profession of psychology in South Africa is criticised for not attending
to the mental health needs of most South Africans. In this paper, we will be discussing some
of this criticism as well as proposing how this critique should be addressed.

Mental health refers to our emotional, psychological and social well-being, and
influences how we think, feel and act (Gallerist, Heinz, Kastrup, Beezhold & Sartorius, 2015).
When people experience mental health problems, their thinking, mood and behaviour can be
affected (Gallerist et al., 2015) The profession of psychology attends to these mental health
problems by attending to one’s emotional, psychological as well as social well-being (Gallerist
et al., 2015). As mentioned above, the Mental Health Act makes provisional access to mental
health care a right to all in South Africa (Marie, 2014). Research on this topic highlights that
there are contextual barriers in the way that hinder the access to psychological services to most
South African citizens who are struggling with mental health, these barriers have been
expressed as critique towards the profession (Geffen, 2013).
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One of the critiques made towards the profession in SA is that it is mostly concerned
with making money, which is why most psychologists in the country practice in the private
sector (Geffen, 2013). With over a quarter of the country’s population being unemployed and
the cost of seeing a psychologist ranging between R650 to R850 per session, psychologists cut
out a lot of people from being able to access mental health care (Geffen, 2013). Despite
subsidies being given to those on medical aid most people in the country cannot afford to see
psychologists because this does little to serve the needs of the majority with mental health
problems because these individuals are not on any medical aid schemes (Rock, 1994). The
profession in the country is structured in a way that serves only the minority elite who can
afford it (Rock, 1994). This contributes to the significant treatment gap (failure to provide for
people in need of treatment) (Rock, 1994). Current mental health policies are aimed at
addressing this problem, but implementation of these policies is proving to be slow.

Another way to address this is by encouraging psychologists to give back to the

community (Geffen, 2013). This can be done by them sharing their knowledge for free, by
hosting information talks to low-income communities about mental health as well as teaching
people in these communities coping strategies to deal with mental health difficulties that are
common (Geffen, 2013). Policies should also be put in place to encourage psychologists in the
private sector to also serve the needs of those in low-income communities, by offering their
services for free as part of their professional obligation (Rock, 1994). Furthermore, the
government needs to create more posts for psychologists within the public sector, these both
allowing low income communities to have more access to mental health care for free (Bantjes,
Kagee & Young, 2016). This will assist in addressing this disparity of access to mental health
care caused by poverty. Psychology in South Africa is also criticised for not being
demographically representative.

Most psychologists in the country are white, middle-class, English- or Afrikaans-

speaking citizens, who mainly come from urban communities, who have a limited concept of
the context that the majority of South Africans with mental health problems come from
(Geffen, 2013). Up until the 1990s, less than 10% of registered psychologists were Black, and
in 2000, 90% of registered psychologists were White and most psychologists who were
practising spoke English, whilst only 8.2% of South Africans spoke and understood English
(Cornell, 2013). This has given rise to the profession’s inability to challenge the broader social
problems facing the majority, which contributes to mental health problems (Rock, 1994). This
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skewed representation has resulted in practitioners and modes of practice that are detached
from the lived experiences and contexts of the majority (Geffen, 2013). Practitioners therefore
fail to have a holistic understanding of the psychological ills facing the majority. This affects
their ability to attend to the needs of the majority. Furthermore, given that most psychologists
are White English-speakers, this creates a language barrier between psychologists and most
mental health patients in South Africa (Geffen, 2013). Black patients are therefore reluctant to
seek help. Consequently, most mental health patients in South Africa cannot receive therapy in
their mother tongue (Cornell, 2013). This could be considered a human rights issue, particularly
since the medium of therapy is language (Cornell, 2013). Research highlights that South
African universities produce an irrelevant educational elite that is unable to adequately serve
the needs of most individuals in South Africa struggling with mental health (Cornell, 2013).
Raune (2010) held a focus group in the township of Mamelodi whereby participants expressed
that White psychologists were too detached from Black communities and highlighted that they
would have preferred to see a Black psychologist, but they had difficulty in finding one (Marie,
2014). In line with this statement, research highlights that there’s a need to alter this
demographic profile of psychologists and to create a more socially-responsible discipline.

One of the ways to address this skewed demographic profile and the problems that come
with it is to increase the number of psychologists who are Black as well as psychiatrists who
understand the context that most of individuals with mental health illness come from (Rock,
2013. It is important that these individuals are included in think tanks such as the National
Health Forum, as this will allow them to add valuable insight and knowledge to help respond
to the needs of the majority (Marie, 2014). This also introduces practitioners, who are sensitive
and understand the socio-cultural issues that contribute to mental health problems that are
affecting these low-income communities (Marie, 2014). Adding to this, non-African students
should be encouraged to immerse themselves into understanding these communities (Bantjes,
2016). They should to be encouraged to learn at least one African language that is popular in
the context of their surroundings (Geffen, 2013). This introduces local languages and concepts
into the profession, making psychology more accessible to all in the country (Geffen, 2013).

Postgraduate programmes need to select candidates who are more representative of the
country’s demographic to undergo training as psychologists (Cornell, 2013). Research
highlights that there is a need for alternative recruitment strategies to ensure a larger number
of Black South Africans enter Honours and master’s programmes (Cornell, 2013). One of these
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alternative strategies could be selection based on experience in low-income community settings

as well as personal characteristics such as leadership (Cornell, 2013). These have been
suggested as useful criteria to consider. Programmes should prioritise students who are
culturally and linguistically diverse to serve the mental health needs of all South Africans
(Cornell, 2013). Mental health resources and services in South Africa are criticised for not
being equally distributed amongst all living in South Africa (Marie, 2014).

Psychological services and resources in the country are skewed in favour of white urban
communities (Marie, 2014). Most psychologists in South Africa operate in the private sector,
providing services to a limited number of people, mostly White middle-class patients (Marie,
2014). Research highlights that 80% of clinical and counselling psychologists who responded
to a survey worked primarily in urban areas, whilst only 10.55% worked solely in rural areas
(Bantjes et al., 2016). The location of both public and private mental health services is mostly
stationed in the cities and in urban areas which serve the elite white minority (Burns, 2011).
‘Whilst the majority of South Africans living with mental illness are clustered in rural areas’
(Geffen 2013, p. 3). The marginalisation of township life continues to be apparent even after
24 years of a democratic government (Marie, 2014). In Mamelodi, one of the biggest townships
in South Africa, there are almost no mental health care resources and services, in which there
are no psychological assessment centres (Marie, 2014). Within this context, the schooling
system is one of the only formal systems whereby behavioural problems can be detected
(Marie, 2014). This highlights the fact that not enough is being done in these communities to
identify individuals with mental health problems (Marie, 2014). This contributes to the increase
in the “diagnostic gap”, which refers to the failure to diagnose patients with mental health
illnesses (Burns, 2011). This uneven distribution of resources contributes to the critique that
the profession of psychology in South Africa fails to attend to the mental health needs of most
South Africans (Burns, 2011). Despite psychology being a growing profession in South Africa,
research suggests that there is a shortage of psychological resources and services in the country,
marked by a stark racial disparity in the distribution of these resources (Rock, 1994). Various
scholars have suggested the use of alternative means to combat this shortfall and the uneven
distribution of these resources (Marie, 2014).

‘Margaret Chan, the former Director-General of the World Health Organisation,

proposes alternative methods in health care practice to extend health care to a greater number
of people, who would not have normally had access to formal mental health care’ (Marie, 2014,
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p. 7). One of these alternative methods is “task-shifting”. Task-shifting is defined as a strategy

used in resource-poor communities to maximise health care benefits for patients who
previously would not have had access to formal treatments (Marie, 2014, p.7). Community or
lay health workers are trained and supervised by professionals to provide frontline care (Marie,
2014). These non-specialists include nurses, nursing assistants, professional counsellors,
retired teachers and unemployed youth who are trained in various skills, such as screening,
assessments, counselling and evaluation of the symptoms of common mental disorders, so that
they can provide primary health care and refer clients when necessary (Bantjes, 2016). This
increases the mental health work force and extend health services to all in a way that is
effective, affordable and sustainable (Marie, 2014).

Another way to combat the lack of resources in low-income communities is the use of
sporadic psychiatric services (Marie, 2014). This refers to psychological services that are
periodically offered in these communities and are not normally available due to a lack of
finance allocated to mental health (Marie, 2014). The mental health budget is combined with
the general health budget and less than 2% of this budget is allocated to mental health (Marie,
2014). These sporadic services are made available in these low-income communities for a brief
period (Marie, 2014). For example, in the context of Mamelodi where there are no
psychological assessment centres, the use of these services would allow for the community of
Mamelodi to have access to psychological assessment centres, even if it is for a brief period.
This contributes to decreasing the diagnostic gap (Marie, 2014).

Research highlights that there is an urgent need for the profession to lobby the
government for more money to be allocated to mental health (Marie, 2014). This requires those
at the top of the profession to convince the government that more money is needed to deal with
mental health as well as the fact that this money will be used to benefit the majority of South
African citizens with mental health illness (Marie, 2014). Psychological services are not a
priority of the South African government due to other social pressures and the necessary
changes to the money allocated to the profession will only come by the mass lobbying of the
government to prioritise this in the broad government policy and ensure that these policies are
followed through (Marie, 2014). The increased allocation of resources to mental health services
would contribute to the profession’s ability to address the mental health needs of all South
Africans. The profession of psychology is also criticised for not doing enough to raise
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awareness about the profession and what it encompasses of to these low-income communities
(Cornell, 2013).

In low-income communities there is little knowledge of what psychologists do as well

as what the profession encompasses of (Cornell, 2013). The Psychological profession is
structured in such a way that it is tailored to serve the needs of those, who can afford it, therefore
little attention is paid to those in low-income communities (Geffen, 2013). This results in a
lack of knowledge being distributed to these communities (Cornell, 2013). Therefore, when
mental health problems arise in these communities, people do not think to seek help from
psychologists (Cornell, 2013). Instead, they seek assistance from their local healers and
traditional doctors as symptoms are often not seen in psychological terms but instead seen as
psychosomatic symptoms, such as proclaimed spirit-affiliations or vague feelings of disease in
which many of these symptoms are stigmatised (Marie, 2014). This contributes to a cycle of
untreated mental health issues just as a lack of knowledge about mental illness does
(Marie,2014). The lack of knowledge about mental illness as well as its treatments hinders
access to effective psychological treatment to those in low-income communities who make up
most individuals with mental health illnesses in SA (Cornell, 2013). Due to this lack of
knowledge, psychologists are perceived as seeing people who are ‘mad’ (Marie, 29014). This
contributes to the reluctance of patience from these communities to seek help from
psychologists (Marie, 2013). Due to familiarity and what has just been mentioned above, this
contributes to why people in these communities choose to consult traditional healers instead
(Marie,2014). This lack of knowledge in low-income communities’ acts as a barrier to the
profession’s ability to attend to the mental health needs of everyone in the country (Cornell,
2013).

In order address this lack of knowledge about the profession in low-income

communities, psychology will have to take responsibility for communicating about mental
health issues and how psychologists are able to assist individuals (Rock 1994). It involves
informing people about psychology and what it contributes to the community as well as playing
an advocacy role (Rock, 1994). This can be done through media using things like television,
radio as well as print, to convey information about psychology (Rock, 1994). Promoting the
profession as well as mental health within these low-income communities (Rock, 1994). South
Africans need to know about mental health and what the best ways of dealing with mental
health issues are, therefore more people will be inclined to make use of psychological services
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(Cornell, 2013). By providing this knowledge of mental health and what psychologists do, the
perception of individuals in low-income communities about psychology as well as the
perception that psychologists deal with ‘mad people’ will be addressed (Rock, 1994). Low-
income communities will become more open to the idea of reaching out to psychologists for
assistance. The profession of psychology in South Africa is also criticised for its lack of
integration of culture into its practice.

The profession of psychology in South Africa is criticised for its adoption of a Euro-
American structure in its practice (Geffen, 2013). Duplicating this structure into the South
African context without any consideration of the variation in culture between the two contexts
is problematic (Geffen, 2013). This acts as a barrier to the profession’s ability to attend to the
mental health needs of most South African citizens, because this Euro-American structure in
the profession does not consider that cultural beliefs of South African citizens vary to those in
the Euro-American context (Geffen,2013). What may work there may not be relevant to the
majority South African citizens struggling with mental health because of different beliefs and
different perspectives in the South African context (Geffen, 2013). These different beliefs and
perspectives may deter patients who struggle with mental health in the country from seeking
assistance from psychologists because the profession neglects to address these different beliefs
and perspectives with culturally sensitive interventions (Collins, 2010).

The profession uses a blanketed approach to assist individuals, who come from both a
Euro-American context and those from a South African context (Geffen, 2013). This might not
align with the cultural beliefs of those who come from the South African contexts, thus
deterring them from seeking assistance from psychologists (Collins, 2010). Lack of cultural
integration into the practice also hinders the ability of psychologists in the country to fully
understand patients and their suffering because one’s culture can help the psychologist to
understand how patients’ contexts has shaped their mental health problems as well as their
understanding of their mental illness (Collins, 2010). This understanding allows a psychologist
to formulate a holistic therapeutic intervention (Collins, 2010). The lack of cultural integration
into practice prevents the procurement of effective psychological services by most patients in
the country as well as a holistic understanding of clients and their suffering by therapists
(Cornell, 2013). Therefore, the profession of psychology fails to address the mental health
needs of most South African citizens. Many suggestions have been made with regards to
addressing this lack of integration of culture and its beliefs into the profession.
 9

One of the suggestions that have been made is increasing the number of Black
psychologists in the profession, who ideally come from these low-income communities or have
experience in these communities (Rock, 2013). This would result in psychologists who are
cognisant of the cultural beliefs of most patients suffering from mental illness as well as the
barriers these beliefs come with (Collins, 2010). This allows psychologists to deal with these
cultural beliefs and barriers in a way that is sensitive to the cultural needs as well as therapeutic
needs of the patients and they can holistically attend to the mental health needs of the majority
of South Africans (Collins, 2010). The introduction of more Black practitioners will also
encourage the possibility for a larger number of Black low-income patients to be more open to
the idea of seeing a psychologist, because they feel more cultural affiliation and understanding
with these practitioners than with White psychologists (Rock, 2013). Another suggestion made
is that all psychologists should be required to be competent in multicultural practice, especially
those who are of non-African descent (Collins, 2010). This competence will allow them to
better understand the cultural beliefs and barriers of their clients (Collins, 2010). This is
important to building effective therapeutic relationships with clients, as well as to putting
forward therapeutic interventions that are aligned with clients’ beliefs (Collins, 2010). which
will encourage patients to be more inclined to access psychological interventions.

In conclusion, the profession of psychology in SA is deeply influenced by the country’s

history of racial exclusion and exploitation of the majority (Bantjes et al., 2016). 24 years since
becoming a democratic state, psychologists in the country are still predominantly White and
still primarily serve a White elite with the resources being heavily skewed to serve these
individuals whilst the majority of citizens with mental health problems in low-income
communities are being neglected by the profession, with regards to things like service
provision, resource allocation as well as knowledge distribution (Bantjes et al., 2016). It is
devastatingly clear that the profession of psychology in SA fails to attend to the mental health
needs of most South Africans (Bantjes et al., 2016). To address this, a national mental health
plan needs to be drawn up to appropriately allocate the general health budget to extend
resources to support mental health in the country (Marie, 2014). Policies need to be put in place
to address this lack of funds being allocated to the profession as well as the uneven distribution
of resources and services (Bantjes et al., 2016). These steps are essential to providing mental
health care for all and not just an elite few (Bantjes et al., 2016).
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Medical and Dental Council, 1-11

This is a very good essay Yandisa. You have clearly described the ways in which the
profession of psychology in South Africa is deeply influenced by the country’s history of racial
exclusion and exploitation of the majority. You have identified a wide range of criticisms of
the profession of psychology and you have included a detailed, evidence-based discussion of
these criticisms. You have also included a good discussion of the ways in which these criticisms
can be addressed. It was a good idea to discuss these suggestions after each criticism rather
than at the end of the essay.

There are several referencing errors. Please consult the blue referencing book to ensure
that you reference correctly according to APA format
Grade: 88%