What the WHO Says About Mental Health in South Africa

The World Health Organization (WHO) is a specialised agency of the United Nations responsible for international public health. Founded in 1948 and headquartered in Geneva, Switzerland, the WHO sets global health standards, coordinates responses to health emergencies, and publishes evidence-based guidance used by governments and health systems worldwide — including South Africa.

The WHO recognises that South Africa faces a significant mental health treatment gap: fewer than 10% of people who need mental health care receive it. The WHO's 2023 guidance calls on countries like South Africa to shift from institutional, coercive models of care toward community-based, rights-respecting, person-centred systems. It explicitly recognises traditional healers, faith-based organisations, and peer support as valuable parts of a holistic mental health network.

The WHO/OHCHR (2023) 'Guidance on Mental Health, Human Rights and Legislation' is a joint publication by the World Health Organization and the United Nations Office of the High Commissioner for Human Rights. It provides a framework for countries to align their mental health laws and systems with international human rights standards. Key principles include: legal capacity and supported decision-making, prohibition of coercive practices, community-based care, and recognition of diverse healing approaches.

WHO guidance is not directly legally binding, but it carries significant weight in South African law and policy. South Africa's Constitution (Section 27) guarantees the right to health care. The National Health Act (Act 61 of 2003) and the Mental Health Care Act (Act 17 of 2002) are interpreted in light of international human rights standards, including WHO guidance. Courts and the HPCSA refer to WHO standards when adjudicating health rights disputes.

The WHO's core principles for mental health care, as set out in its 2023 guidance, are: (1) Respect for legal capacity — people have the right to make their own mental health decisions; (2) Non-discrimination — mental health conditions must not lead to loss of rights; (3) Community integration — care should be delivered in the community, not institutions; (4) Recovery orientation — the goal is full participation in society, not just symptom management; (5) Prohibition of coercion — forced treatment and involuntary admission must be exceptional, last-resort measures with full legal safeguards.

The WHO is explicit that informed consent is a fundamental right in mental health care. Practitioners must provide patients with clear, accessible information about their diagnosis, all available treatment options (including alternatives), the expected benefits and risks of each option, and the right to refuse treatment. This aligns directly with Section 6 of South Africa's National Health Act (Act 61 of 2003), which codifies these rights into domestic law.

Yes. The WHO 2023 guidance explicitly recognises traditional healers, faith-based organisations, and community and peer support as valuable complementary layers of a mental health system. The guidance states these should not be seen as substitutes for clinical care, but as a 'first point of contact' and 'complementary layer' that can reach people who would not otherwise access formal services. In the South African context, this includes sangomas, traditional healers, and church-based counselling.

The WHO acknowledges that psychiatric medications can be effective for some conditions, but emphasises that medication should never be the only option presented to patients. The WHO's 2023 guidance specifically warns against over-reliance on pharmacological approaches and calls for a balanced range of psychosocial, community-based, and alternative interventions to be made available and actively offered to patients as part of informed consent.

The WHO takes a strong position against coercive practices in mental health care. Its 2023 guidance calls for the elimination of forced treatment, involuntary admission, physical restraint, and seclusion. Where involuntary measures are unavoidable in extreme circumstances, the WHO requires strict legal safeguards, independent review, time limits, and the right to appeal. South Africa's Mental Health Care Act (Act 17 of 2002) provides these safeguards, and the Health Ombud can investigate violations.

WHO guidance, interpreted through the National Health Act, means that a registered South African health practitioner must: inform you of your diagnosis in plain language; present all available treatment options, not just their preferred approach; explain the benefits, risks, and costs of each option; obtain your written informed consent before beginning treatment; and respect your right to refuse or change treatment. Failure to do so is a violation of your rights under Section 6 of the NHA and can be reported to the HPCSA.

The full WHO/OHCHR (2023) 'Guidance on Mental Health, Human Rights and Legislation' is freely available on the WHO website at www.who.int. It is a public document and can be downloaded at no cost. The document is approximately 300 pages and covers legal frameworks, rights-based approaches, and practical implementation guidance for governments and health systems.

The WHO's Mental Health Action Plan 2013–2030 sets global targets for expanding mental health services, reducing the treatment gap, and integrating mental health into primary health care. For Africa specifically, the WHO's AFRO (African Regional Office) has published guidance on scaling up community-based mental health services, training community health workers, and reducing stigma. South Africa is a signatory to this plan and is expected to report progress to the WHO.