The World Federation for Mental Health (WFMH) promulgated this day in 1997 to raise the international community’s awareness of mental health in an empathic and uniting manner, motivating individuals to act and effect change in their personal lives.
This year’s theme, “Mental Health in an Unequal World”, poignantly reflects on the socio-political determinants of addressing mental health, especially during the scourge of the Covid-19 pandemic and confronted by vaccine nationalism in high-income countries.
The World Health Organisation (WHO) details how between 76% and 85% of people living in low and middle-income nations are unable to access mental health care treatment, and how 77% of suicides occur in those nations. Moreover, because of poor mental healthcare around the world, suicide is the fourth underlying cause of death for people between the ages of five and 19 years. Globally, men are 1.8 to 2.98 times more likely to commit suicide than women.
As we move to reflect on “mental health in an unequal world”, Albert Camus invites us to consider a fundamental human question when he observes that “judging whether life is or is not worth living amounts to answering the fundamental question of philosophy”. In view of the current social pressures of capitalist consumption, public perception and the performance of identity that align with the prevailing fixation on material values, it is important to carefully consider whether it is preferable to “live” or to “die”.
In SA, October is commemorated as Mental Health Month and offers an important opportunity to reflect, and indeed reimagine, the narrative around men’s mental health. In The Man Box (2017), Brian Heilman and colleagues provide a succinct understanding of the prevailing masculine narrative according to which men who subscribe to traditional masculine identities “demonstrate limited health-seeking behaviour” and are more prone to emotional repression and risky behaviour.
This is particularly apparent in SA, where from 1997 to 2016 men between the ages of 15 and 35 years accounted for 78.1% of all suicides. Moreover, The South African Depression and Anxiety Group notes that between 90% and 97% of people who commit suicide suffer from mental illnesses. It is estimated that approximately 23 suicides are reported daily in SA, with men being more than four times more likely than women to end their own lives.
This burden is probably far greater than is generally assumed due to a lack of regular reporting on suicides and attempted suicides. Tahira Kootbodien and associates (2020) found that between 1997 and 2016, the leading method of suicide for men in SA was hanging (60.6%), followed by poisoning (14.4%) and death by firearm (8.6%).
Conversely, poisoning was the predominant method used in female suicides (39.8%), followed by hanging (36.1%). The use of firearms was in the lowest quintile.
However, this does not suggest that women’s attempts at suicide should be held in a similar cynical light, or receive any less attention. Rather, there is a dire need to revisit narratives around prevailing masculine identities that ostensibly drive a culture of violence and the resulting demonstrable levels of male suicide.
For example, 97% of incarcerated people in the country are men, due to violent crimes such as aggravated assault, gender-based violence (GBV), rape and murder.
Mental Health in SA needs a new narrative that places those most vulnerable to the effects of mental health – such as men – at the centre of this discourse. This needs to be done using translatable images and words that can be used across the nation’s vast cultural and sociopolitical environments.
SA requires cross-sector collaboration, especially in the private and public healthcare arena, that recognises the need for ongoing treatment and therapy, especially for high-risk people.
• Pinkerton, department of political science, University of Pretoria
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