SA FEDERATION FOR MENTAL HEALTH
2012-2013
YOUTH AND MENTAL HEALTH OVERVIEW
“Youth are the valued possession of the nation. Without them there can be no future. Their needs are
immense and urgent. They are the centre of reconstruction and development.” Nelson Mandela
1. INTRODUCTION
For the 2012-2013 period, the SA Federation for Mental Health has decided to place a specific emphasis on
Youth and Mental Health throughout its awareness and publicity campaigns. The young people of today are
our adults of tomorrow, and due to the fact that mental illness is an increasing problem amongst young people
not only in South Africa, but also on a global scale, the Federation has identified it as the key priority on which
it would like to focus for the next 12 months.
2. A GLOBAL PERSPECTIVE
The Lancet (Global Mental Health, October 2011) states that 10-20% of children and adolescents are affected
by mental health problems worldwide. This age group constitutes close to a third of the world’s population, and
almost 90% of these young people live in low and middle income countries. Sadly (given the fact that mental
illness is a leading cause of health-related disability in this age group, and the continued, detrimental effects of
mental illness on people throughout their lives), the mental health needs of children and adolescents are still
very neglected, particularly in low and middle income countries. Despite widespread recognition of the
importance of mental health promotion and prevention in children and adolescents, there is still a very
substantial gap between needs and resource availability. The Lancet further states that the failure to address
mental health problems (including developmental and intellectual disorders) in children and adolescents in
low-resourced settings is a public health issue with wide-reaching consequences, because of the fact that
failure to do so also affects the young person’s basic development beyond childhood and adolescence. Lastly,
it also states that, since mental illnesses are seen as chronic disorders of young people, and because a
disproportionate number of young people live in low and middle income countries, it is a priority to address
mental health problems in early developmental stages. Doing so in these countries is a global health priority.
Besides reducing costs to society through these early interventions, there is also an ethical responsibility to
vulnerable young people, whose full developmental potential could be at risk of being derailed by mental
illness.
3. THE SOUTH AFRICAN PERSPECTIVE
To ensure that mental illness can be more effectively detected and treated in young people in a country such
as South Africa, a dual approach is required. Firstly, we need to ensure that adequate mental health support
structures are in place and equipped to provide high-quality care and support, and that affected young people
have sufficient, accessible options available to them and their families. And secondly, we need to ensure that
young people themselves are aware of mental health issues, feel confident to address it, know of support
options available, and recognise that having a mental illness is something that can be well managed through
effective health care. This basic awareness raising forms the cornerstone of the work the SAFMH would like to
undertake over the following year, ensuring that the profile of mental health is raised amongst young people
and families, and that young people have the opportunity to become informed about the relevant issues
through innovative and age-appropriate methods. This is particularly important, given the South African
context.
The National Youth Development Agency’s Demographic Profile of South African Youth provides the following
information:


The 2011 mid-year population estimates indicated that 68.3% of South Africa’s population were between 034 years old, and roughly 40% of the total population were between the ages of 14 and 35 years of age
The mid-year population estimates also indicated that the 14-35 years population had been growing
slightly higher that the total population for the past 10 years, meaning that young people were becoming an
even larger section of South Africa’s total population

The overall youth mortality rate in SA is very high, and has been on the increase since 1998. There has
however been a slight reduction since 2005, but it remains very high

Between 2002 and 2010, roughly 30% of young people were living in households without an employed
member of the family

Hunger is an indicator of poverty, and 32.8% of households with young people between the ages of 15-34
in 2010 were in households that had reported hunger. Households that reported hunger decreased sharply
from 2002 to 2007 and then started to increase again sharply in 2008

In terms of basic living conditions (in 2010):
o In the age group 0-14, 49,5% of young people were living in dwellings with flush toilet facilities (with
on or off site disposal), whilst 57,5% of young people 15-34 had access to these facilities in their
dwellings
o In the age group 0-14, 47,1% of young people were living in dwellings where rubbish was being
removed by municipalities, whilst 54,4% of young people 15-34 had access to these facilities in
their dwellings
o In the age group 0-14, 83,2% of young people were living in dwellings which were connected to
mains (had electricity), whilst 84,3% of young people 15-34 had access to these facilities in their
dwellings
o In the age group 0-14, 92,9% of young people were living in dwellings with a landline or cellular
phone in the dwelling, whilst 90,1% of young people 15-34 had access to these facilities in their
dwellings
o In the age group 0-14, 7% of young people were living in dwellings with access to internet, whilst
8,1% of young people 15-34 had access to these facilities in their dwellings
In the NYDA’s report, Statistics South Africa provided the following information on disability in South Africa in
2005:

780 623 persons between the ages of 0 and 29 were classed as disabled. The total number of disabled
persons in SA in 2005 was 2 255 982, meaning that a substantial number of disabled persons were young
people

In terms of the types of disabilities (age 10-34):
o 199 565 people had sight disabilities (all ages 724 169 people)
o 157 243 people had hearing disabilities (all ages 543 104 people)
o 62 417 people had communication disabilities (all ages 146 164 people)
o 168 944 people had physical disabilities (all ages 668 082 people)
o 140 812 people had intellectual disabilities (all ages 279 094 people)
o 137 703 people had emotional disabilities (all ages 354 495 people)

As seen above, the total figure (for all ages) for intellectual disabilities was 279 094, whilst the total figure
for emotional disabilities was 354 495, meaning that a very substantial proportion of persons with
intellectual and emotional disabilities in SA were in fact young people, where young people with other
disabilities made up a notably smaller percentage of the overall figures

In terms of levels of education of persons with disabilities:
o 29.8% had not received any schooling
o 27,9% had only received some primary education
o 6,7% had completed primary education
o 22,2% had had some secondary education
o 7,4% had attained Grade 12 / Standard 10
o 2,9% had achieved any forms of higher education

In terms of employment status of persons with disabilities:
o 12,7% of persons with disabilities were employed
o 13,9% were unemployed
o 41,8% were not economically active at all
Where persons with disabilities were heads of households:
o 21,2% had piped water inside their dwellings
o 29,3% had piped water inside their yards
o 12,4% had piped water on a community stand (within 200m distance of their dwellings)
o 14,8% had piped water on community stands that were further than 200m
o 22,3% had no access to piped water at all


In terms of sentenced offender rates for 2008, the Department of Correctional Services’ National Offender
Profile showed that:
o People aged 26-30 accounted for 24,5% of offenders
o People aged 18-21 accounted for 9,9% of offenders
o People aged 22-25 accounted for 20% of offenders
o This meant that more than half of sentenced offenders were young people under the age of 30
In a recent report on the importance of Youth Work in SA, the Human Sciences Research Council provided the
following information:

Between 1997 and 2002, the number of 18-25 year olds who could be working but are not increased from
6 to 8,4 million, while the number of people who were employed only rose from 4,3 million to 4,9 million.

The number of unemployed young people therefore increased from 1,7 million to 3,5 million
In another report on Education and Skills among South African youth, the HMRC reported the following

In terms of the status of education and skills amongst the youth, 31% were in education, 36% in
employment and 32% were not employed

Reasons for the high unemployment rate amongst the youth were:
o High age of first job (males 24 and females 26)
o Reluctance of youth to initiate self-employment (4% vs. 11%)
o High duration of unemployment spells (50% longer than 3 years)
o Gender dimension

In terms of educational attainment and enrolment rates amongst youth:
o Mean years of education (age 21-35) for youth with no disabilities were 10,15, whilst the enrolment
rate (age 14-17) for youth with no disabilities was 90,58%
o Mean years of education (age 21-35) for youth with sight disabilities were 8,41, whilst the enrolment
rate (age 14-17) for youth with sight disabilities was 82,02%
o Mean years of education (age 21-35) for youth with hearing disabilities were 7,42, whilst the
enrolment rate (age 14-17) for youth with hearing disabilities was 82,03%
o Mean years of education (age 21-35) for youth with communication disabilities were 4,9, whilst the
enrolment rate (age 14-17) for youth with communication disabilities was 54,77%
o Mean years of education (age 21-35) for youth with physical disabilities were 7,65, whilst the
enrolment rate (age 14-17) for youth with physical disabilities was 71,42%
o Mean years of education (age 21-35) for youth with intellectual disabilities were 5,58, whilst the
enrolment rate (age 14-17) for youth with intellectual disabilities was 69,02%
o
o
Mean years of education (age 21-35) for youth with emotional disabilities were 6,22, whilst the
enrolment rate (age 14-17) for youth with emotional disabilities was 61,14%
Mean years of education (age 21-35) for youth with multiple disabilities were 7,69, whilst the
enrolment rate (age 14-17) for youth with intellectual disabilities was 73,29%

Main reasons for dropping out of school were:
o Financial constraints
o Attitudes that education is useless and uninteresting
o Pregnancy and family commitments (females)
o Low quality in the early grades

In terms of Matric outcomes:
o Pass rates provided mixed signals
o Rising numbers passing Matric since 1995 was seen as a positive trend
o Numbers passing mathematics was seen as a concern
o Numbers achieving university endorsements were rising moderately but were still too low
The overall quality of education being received by young people in SA was seen as low


There was also evidence that poor children in SA performed less well than equally poor children in other
countries

The implications of low quality education as a poverty trap were:
o Educational inequalities evident very early in primary school
o They persisted and were evident in Matric outcomes and access to post-school education
o This affects employability and one’s expected earnings
In terms of youth and health and wellbeing, the South African Medical Research Council provided the following
information in a recent study:

In terms of South Africa’s Health Care model:
o SA spends roughly 4% of its GDP on health care
o 44% of the total health budget goes to the private sector, which serves only 15% of the population
o This funding discrepancy contributes to poor health indicators
o SA’s health care model is highly curative
o SA has the worst health outcome indicators when compared to other countries of similar or even
lower income

Health risk factors include:
o Unsafe sexual practices
o Interpersonal violence
o High Body Mass Index
o Alcohol use
o Tobacco use

Social determinants of health were listed as:
o Economic – household income
o Educational – highest level of school education
o Behavioural – such as smoking or sexual behaviour
o Environmental – access to clean water and sanitation
o Demographic – urban vs. rural residence
o Infrastructural – such as distance travelled to work
o Biomedical – access to ARVs and TB drugs etc

In terms of wellness and health amongst young people:
o Youth carried the highest burden of mortality from violence and communicable disease
o Higher rates of alcohol and substance abuse
o Increasing mental health problems amongst young people
o Emerging obesity epidemic and other NCDs

As stated earlier, the mortality rate of young people in SA is very high. Causes of death were:
o Violence – 39%
o Traffic – 29%
o
o
o
Suicide – 11%
Undetermined – 11%
Non traffic – 10%

In terms of mental health:
o 1 in 4 learners (23,6%) felt sad or hopeless
o 1 in 5 learners (20,7%) considered attempting suicide
o 16,8% of learners had made plans to commit suicide
o 21,4% had attempted suicide on 1 or more occasions in the 6 months prior to the survey

In terms of suicide related behaviour:
o Sad or hopeless feelings – 31,6%
o Considered suicide – 23%
o Attempted suicide – 32,7%


In terms of gender, females were more vulnerable in this category
In terms of violence:
o 31,3% carried a weapon
o 41,3% was bullied
o 44,8% had been in a physical fight
o 53,7% had been injured in a fight
o 24,3% was a member of a gang
o 18,9% had been forced by someone to have sex
o 18,5% had forced someone to have sex
o 22,6% had been convicted of a crime
o 24% had experienced being held in prison or a police cell

Males were more prone to carrying weapons and getting into physical fights, whilst females were slightly
more vulnerable to being bullied

In terms of HIV prevalence rates:
o 15-19 year olds – 2,5% in males and 6,7% in females
o 20-24 year olds – 5,1% in males and 21,1% in females
o 25-29 year olds – 15,7% in males and 32,7% in females
o 30-34 year olds – 25,8% in males and 29,1% in females

In terms of tobacco use:
o Current cigarette smokers – 50,4%
o Of current smokers 44,6% tried to quit and 81,2% is exposed to passive smoking

In terms of alcohol
o 60,4% has used alcohol
o 55,1% has used alcohol in the past month
o 19,1% drank alcohol for the first time over the age of 13
o 48,4% had engaged in binge drinking during the past month

In terms of using illegal drugs:
o 33,4% had used cannabis in the past month
o 25,2% had used Mandrax
o 21,8% had used Cocaine
o 23,2% had used Heroin
o 27,9% had used over-the-counter drugs to get high

Males were overall more prone to substance misuse

In terms of access to Medical Aid, figures for 2009 showed that:
o Only 13,7% of male children had access
o Only 13,5% of female children had access

In its conclusion, the South African Medical Research Council states that:
o Youth health and development is a key priority that feeds into the Millennium Development Goals
o The increase in risky behaviours calls for a national effort in dealing with youth health issues
o
o
Programmes should be all inclusive and not only rely on experts and officials
Creative partnership models should be explored, involving government, researchers, communities,
traditional leadership, NGOs, Faith Organisations and other civil society members
In its report on the South African Youth Context, the National Youth Development Agency includes a very
poignant section on Youth and Mental Health, specifically on the prevalence of suicide, which further
emphasises the need for a strong focus in this area. Key points were the following:

Suicide rates tend to increase with age; however, global trends suggest that suicide is increasingly being
reported amongst younger people (World Health Organisation, 2002)

Suicidal behaviour is a major health concern in countries around the world, both developed and
developing.

Many more people, especially the young and middle-aged, attempt suicide.

The 2002 Youth Risk Behaviour Survey was the first school-based study into non-fatal suicides, which
provided information based on a national sample. They found that:
o 1 in 5 learners (19%) considered attempting suicide
o 15,8% of learners made plans to commit suicide
o 17% attempted suicide on 1 or more occasions in the 6 months preceding the survey
o 27.8% required medical treatment as a consequence of attempting suicide

A number of explanations for the rise in the suicide trend has been postulated, including:
o Loss of social cohesion
o Breakdown of traditional family structure
o Growing economic instability
o Unemployment
o Rising prevalence of depressive disorders
o School-related pressures

The YRBS 2008 reported that in the 6 months preceding the survey:
o 1 in 4 learners (23,6%) felt so sad or hopeless that they stopped doing some usual activities for 2
weeks or more in a row
o 1 in 5 learners (20,7%) considered attempting suicide
o 16,8% made plans to commit suicide
o 21,4% attempted suicide on 1 or more occasions

Of the learners who experienced sad or hopeless feelings, 38,3% had to see a doctor or counsellor for
treatment

Of those who attempted suicide, 29,1% had to have medical treatment as a consequence

At a national level there were no gender or race difference in the expression of sad or hopeless feelings by
learners. However, there was an age-related difference with more older learners reporting a higher
prevalence of these feelings, seeking treatment for these feelings, considering suicide, making a plan to
commit suicide and attempting suicide.

Limpopo had the highest rate of learners who considered suicide, attempted suicide, and required medical
treatment after attempting suicide as well as a significantly higher prevalence of those needing to see a
doctor or counsellor for sad or hopeless feelings than the national average

The Western Cape had the highest provincial prevalence of learners who made a plan to commit suicide,
while learners in the Free State reported the highest prevalence of experiencing sad and hopeless feelings
Lastly, the South African Depression and Anxiety Group informs us that in South Africa:

There are 23 completed suicides every day

There are 230 attempted suicides every day

9.5% of all teen deaths are attributed to suicide

The youngest suicide victim was 7 years old
They also inform us that:

According to the World Health Organisation, a suicide occurs every 40 seconds and an attempt is made
every 3 seconds

In SA, hanging is the most frequently employed method of suicide, followed by shooting, gassing and
burning

Risk factors for suicide among young people include:
o The presence of mental illness (depression, conduct disorder, drug and alcohol abuse, previous
suicide attempts)
o The availability of fire arms in the house

In SA, 60% of people who commit suicide are depressed

The suicide rate for young people age 10-14 has more than doubled over the past 15 years

In SA, the average suicide is 17.2 per 100 000 (8% of all deaths). This figure however only shows the
number of deaths reported by academic hospitals; the actual figure is much higher
4. RATIONALE FOR 2012-2013 YOUTH FOCUS
The above statistics are some examples of why young people in South Africa have so many factors which
could impede on their personal wellbeing, specifically in terms of their mental health. We live in a country
where we are faced with multiple stressors on a daily basis, and it is our responsibility to ensure that the young
people of this country are effectively equipped to deal with these. Unemployment, substandard education, poor
living conditions, low morale, substance misuse, risky sexual behaviours, bullying, violence, and inadequate
access to health care are but a few examples of the challenges that could influence young people’s resilience
to dealing with mental wellbeing. By focusing on Mental Health and Youth for the 2012-2013 period, and
raising the awareness of mental health on a national level, the SAFMH could potentially make a substantial
contribution towards specifically also raising the profile of mental health issues amongst young people. Lastly,
the SAFMH would also be positively contributing towards addressing the crucial key points as set out by the
SA Medical Research Council in its conclusion above.