In August 2020, Alastair Campbell, the Labour Party communication expert, writes in The Guardian about his struggles with depression in preparation of the launch of his new book, Living Better: How I Learned to Survive Depression.

He says, “It is part of the human condition; it is certainly part of mine. I’ve spent decades learning to live with that. And now, through trial and error, through medication and therapy, through highs and lows, above all through grief and love, I have finally got to know my enemy. I live better for having dealt with it.”

Many people talk about a relationship with a therapist who helped them overcome struggles with depression or anxiety. The therapist often serves as the first point of support for discussing and finding solutions and mechanisms to help cope with mental illnesses such as these.

In a report released 16 years ago, Africa Check explains that, “According to the only representative study conducted so far in South Africa in 2004, 30.3% of adults will have suffered from some form of mental disorder in a lifetime. In the 12 months covered by the study, about one in six adults – or 16.5% – suffered from common mental disorders.”

The same study provided “figures of lifetime prevalence for any substance use disorders, including alcohol. It showed that 13.3% of adult South Africans met the criteria for a substance use disorder, including alcohol, at some time in their life”.

This happens in a highly complex and violent context. In 2019, Jeanette Sera, counselling services manager at People Opposing Women Abuse (POWA), told Daily Maverick, “We live in a country where a woman is killed every four hours. A country where three children are murdered and 114 women raped every day. A country boasting gender-based violence rates that are five times the global average. A rate so high that it is comparable to countries that are at war.” According to statistics compiled and published by nationmaster.com, our country had the highest number of rape incidents in the world as far back as 2010, at 132.4 per 100,000 citizens.

Nevertheless, in spite of our country having a history rife with violence, trauma and addiction, and where therapy should be accessible to many, it remains an often expensive option.

“Psychologists’ fees vary between provinces and different regions, but they generally range from R600-R1,200 per session,” says the South African Depression and Anxiety Group’s (SADAG’s) spokesperson, Meryl da Costa. Taking into account the minimum wage rate as well as the rate of unemployment, that price range is arguably impossible for many South Africans to include in their monthly budget.

It shouldn’t have to be that way – if you’re not able to afford private consultations with a therapist, there might be other options available that can provide alternative support. However, it is important to note that none of the options below replace medical and psychiatric help but can potentially be used as a first step in sharing one’s struggles and mental  health issues.

Medical aid

One of the more affordable ways to access therapy is through health insurance. Many people believe their insurance does not cover any mental healthcare, without thoroughly researching their policy.

Maverick Life spoke to Dr Noluthando Nematswerani, Head of the Clinical Policy Unit at Discovery Health. She explains that “all members of the scheme have access to Prescribed Minimum Benefits. These benefits include cover for in-hospital care and out-of-hospital counselling, and psychotherapy visits for a defined list of conditions.”

The conditions Nematswerani refers to include major depression and substance abuse. “All members of the scheme have access to Prescribed Minimum Benefits. These benefits include cover for in-hospital care and out-of-hospital counselling and psychotherapy visits for a defined list of conditions, (such as) major depression and in-facility detoxification and rehabilitation for substance abuse and dependence. Schizophrenia and Bipolar Disorder are included in the Chronic Disease List. The benefit includes additional out-of-hospital cover for doctor consultations and chronic medicines,” she explains.

Members on more advanced plans are covered for more comprehensive treatments, including additional visits to psychologists and medicine for conditions such as major depression, anxiety and delusional disorder.

She adds that the extent of treatment covered is decided on a case-by-case basis. “On diagnosis with one of these conditions, members apply for access to these benefits and funding is made available for the relevant basket of care. The level of cover depends on the member’s specific clinical needs.”

When asked how members should go about obtaining this sort of assistance, she says, “Members should discuss their condition with their healthcare provider, who typically completes the required application forms needed to access the necessary benefits. Members are also able to obtain the necessary information by calling the scheme to understand the requirements for accessing the benefit”

Free or discounted options

If you have no insurance or financial resources available for therapy, governmental healthcare services, such as the Western Cape Government’s services, might be an option.

The service levels differ greatly from province to province and from hospital to hospital; you will need to check with the hospital closest to you to find out what mental health support they offer. The benefit? The fee you pay will be directly based on your income.

Some private practices also offer a limited number of discounted sessions. You should never be afraid to ask – be honest with your therapist. Tell them about your financial situation and enquire about a discount; the worst they can do is say no.

When asked about giving discounts to patients, Cape Town-based clinical psychologist James Weideman explains that, “I do, and I also know many psychologists who would give discounts. Some also agree on payment terms with their patients, whereby they can pay off their therapy. Of course, not everyone will be willing to do this. But it is absolutely acceptable to ask for a discount if you’re a patient.”

In addition, some low-cost organisations offer support services at special rates, such as the Counselling Hub in Woodstock, Cape Town, which offers up to six sessions for only R50 per session through student or volunteer counsellors.

LifeLine Johannesburg is a similar organisation that has offices in Alexandra, Norwood and Soweto. They currently offer free counselling telephonically, due to the Covid-19 pandemic, which can be booked here. They also offer a 24-hour helpline that you can reach at 0861 322 322 or 011 728 1347.

Group therapy

There are also support groups around the country for many of the common conditions that South Africans struggle with. SADAG has a variety of support groups, such as a Depression and Anxiety group; a Trauma, Anxiety and Post-Traumatic Stress group, a Mental Health and Wellness group, as well as an Addiction and Substance Abuse group. Following the Covid-19 pandemic, the support sessions are now available online, meaning that everyone with a connection can attend, no matter where you live.

Groups such as these are designed so that people can gather in a safe space – be it physically or online – to share their experiences, update one another on their progress, and simply spend time with people who are going through something similar. It’s a great antidote to the feeling of loneliness that people with mental health problems often experience.

Group therapy is also generally far less expensive than individual therapy. The therapist generally charges per hour and not per person, with it then being divided by the size of the group. It’s not always exactly what you need, or feel comfortable with, but it might be helpful, especially as a starting step.

“Group therapy can be useful to certain people. It is often used for support purposes, where the patients learn from each other, and it helps them to know that other people are experiencing the same problems as them. It is also useful to teach patients skills such as how to cope with stress, or addiction groups, or losing a loved one.

“However, if you require in-depth therapy for a longer period, individual therapy is usually better, especially if you’re dealing with something very personal and traumatic, such as physical or sexual abuse or childhood emotional deprivation or trauma. You will develop a more in-depth relationship with your therapist and he or she will be able to give you their undivided attention. If a therapist has a whole group to attend to, it’s almost impossible for them to give everyone the support they need,” says Weideman.

Share your story and your struggles

Some schools, universities and companies also have free or discounted mental health services. The University of Cape Town offers counselling services through its Student Wellness department, which one can access through an online booking platform; so does Wits, through its Counselling and Careers Development Unit; and the University of KwaZulu-Natal offers counselling through its Student Support Services department.

There are many mental health organisations that offer helplines and crisis lines. Each caters for a different audience, but they all try to offer low-cost help and assistance.

Some are specifically geared towards crisis situations, while others try to be a starting point for issues that may require medical or psychiatric support. SADAG has a 24-hour suicide crisis hotline (0800 567 567) and a mental health helpline (011 234 4837). You can also find a comprehensive list of these helplines on SADAG’s website.

Apps that can help to get some perspective

They will neither replace in-person therapy, nor should they be used instead of medical consultations, but some apps can be great tools to help you meditate, manage your sleeping habits or just promote relaxation.

Apps such as Calm, Headspace and Expectful help users learn more about meditation, relaxation and breathing exercises. Much has been written about the power of mindfulness, and how it can help ease symptoms of anxiety and depression.

A New York Times article published in October 2018 adds how journaling may also help to reduce stress and anxiety. This is a free exercise that only requires a pen, paper and time.

“Skills that teach you how to manage your emotions, such as somatic experiencing as well as mindfulness techniques and meditation techniques, are becoming very popular. They are so popular because they work. They all form part of self-care and, in that respect, we can learn a lot from the Eastern countries. Meditation, for example, came from Buddhism and when the West started researching it, they realised it worked. So it has a very good psychological basis,” says Weideman.

There are also many fully qualified therapists who have created YouTube and Instagram pages, and written books, that explain ways to help manage your emotions and cultivate self-awareness. A former assistant professor at Columbia University, Dr Ali Mattu, creates psychological and mental health videos on his YouTube channel, The Psych Show. In it, he explains different psychological concepts and gives generic advice for facing situations that can be otherwise difficult to deal with.

Talitha Fosh is a psychotherapist who runs an Instagram page where she shares advice, updates and support with her followers, based on her psychological training.

There are also thousands of self-help books such as Stillness is the Key by Ryan Holiday, recommended by the team behind the Reading List. This New York Times bestseller provides advice on ways to remain calm and focused in our modern-day chaotic world, drawing from a variety of Buddhist and Stoic philosophies and real-life examples.

Preserving our mental health is crucial – and making sure we reach out for help and support should we feel the need is an important decision.

As Alastair Campbell writes, “Cancer used to be taboo. The big C. As a society, we have developed the language so that we can understand, support and sympathise. Now we need to do the same for mental illness. It’s time for people to be as open about their mental health as they are about their physical health, and feel neither shame nor fear in being so.” DM/ ML