Strengthening quality and accessibility of public mental health services is key to breaking the cycle of South Africa’s crisis of gender-based violence (GBV) that begins with exposure to intimate partner violence and abuse in childhood.
South Africa has one of the world’s highest rates[i] of GBV and it is rooted in an inter-generational cycle, with experiencing or witnessing GBV as a child increasing both the risk of future mental health conditions[ii] and of becoming a victim or perpetrator of GVB as an adult.
Three-quarters of South African men (74.6%) report being physically abused in childhood, and 15% report being sexually abused, while over half of SA’s women (58%) report childhood physical abuse according to the first comprehensive study on GBV in South Africa released by the Human Sciences Research Council (HSRC) last month.
Up to 34%[iii] of women victims of physical or sexual violence by their male partner report witnessing their own mothers being abused by a partner – an indicator of the cyclical nature of intimate partner violence.
During the annual 16 Days of Activism against Gender-Based Violence, the South African Society of Psychiatrists (SASOP) has called for an urgent review of social and mental health services, to provide effective mental health support for all survivors of intimate partner violence and child witnesses to GBV, as a key preventative measure to curb the scourge of GBV.
Specialist psychiatrist and member of SASOP Dr Janine Brooker said “Particularly, there is an urgent need to recognise and address the unmet mental health crisis amongst South African men as this perpetuates the cycle of violence against women and children.”
“Many of the same gender norms – such as expectations that men are providers, strong, in control and not emotionally vulnerable – that underpin violence against women, also discourage men from seeking mental health support and from reporting violence perpetrated against them.
“Activism against GBV must acknowledge the long-term effects of male victimisation and poor mental health, not to excuse male perpetrators but for the greater purpose of healing and social cohesion.”
While the physical impacts of GBV are highly visible in serious injury or death, SASOP emphasises that the less visible mental health consequences can be equally severe and long-term, with approximately 50% of women victims of GBV, and 35% of male perpetrators, having considered or attempted suicide.[iv]
Dr Brooker said that in addition to experiencing or witnessing violence and abuse in childhood, men who perpetrate physical or sexual violence against their female intimate partners are more likely to consume alcohol at “hazardous” levels, report low levels of current life satisfaction and high levels of depressive symptoms, have a history of attempted suicide, and to have been bullied or bullied others in childhood.
“There is no clear, direct cause-and-effect, but these risk factors point to a complex relationship of the impact of childhood trauma on mental health and unhealthy coping mechanisms to deal with both past trauma and current mental health and socio-economic challenges, that are expressed through abuse and violence.
“Unmet mental health needs are a combination of individuals not feeling able or willing to seek help, the social stigma associated with mental health conditions, poor support structures within families and systemic challenges of an under-resourced public mental healthcare system hindering access,” she said.
South Africa’s current context of high unemployment, financial pressures on households and increasing poverty adds to the strain on mental health, along with breakdown of traditional extended family structures, high levels of alcohol and substance abuse and the effects of social media and early exposure to physical and sexual violence online, she said.
The fact that living in a household currently experiencing food insecurity was associated with perpetrating violence against their partners for up to 25% of men is an indicator of the mental health impact of expectations that men must be providers, she added.
“GBV is fundamentally rooted in the unequal power dynamics between men and women. The HSRC study revealed profoundly ingrained gender norms and power dynamics with firmly accepted traditional gender roles and an acceptance of male aggression and dominance.”
She said it was concerning that 70% of men believed a woman should obey her husband, and up to 10% of both men and women believed that a woman should tolerate violence in the household in order to keep her family together.[v]
Over half of men and 30% of women agreed that ‘to be man, a person needs to be tough’, while about two-thirds of both men and women believed that a woman’s most important role in life is to take care of her home and cook for them.
“While these beliefs are not fundamentally a problem when held in a hardline, chauvinistic manner, they facilitate gendered power relations and dynamics that impact mental health and perpetuate the cycle of violence”
“It is clear that GBV is not solely a women’s issue but rather one that needs a holistic approach of interventions at individual and interpersonal level as well as more broadly at community and societal levels,” Dr Br Brooker said.
“Interventions must be collaborative and culturally relevant, drawing on our communities' and organisations' strength and resilience to foster human development, social cohesion, and nation- and neighbourhood-building.”
“Communities don’t heal in parts, but as a whole. Thus, interventions must include the boy-child and men who also deserve safe healing spaces in their journey to becoming men who will respectfully break down these gender norms, confidently address their past trauma, substance abuse and mental health issues, and provide and teach safety and genuine respect in their communities.”
Getting help
National GBV Helpline (toll-free, 24/7): 0800 150 150
SA Depression & Anxiety Group (SADAG) is a resource for mental health information, support groups and other resources, https://www.sadag.org/
SADAG 24-hour toll-free helpline: 0800 567 567 (for all mental health concerns, including suicide crisis)
SADAG WhatsApp helpline for free online counselling (7 days a week, 08:00-17:00): 087 163 2030
National Counselling Helpline (share call, 24/7): 0861 322 322 or chat 24/7 on Facebook @TheLifeLineSouthAfrica (crisis counselling, trauma debriefing, mental health support)
Childline South Africa: 0800 055 555
Sonke Gender Justice, https://genderjustice.org.za/helpline-numbers/ for more helpline numbers; and a list of the locations and contact details for the countrywide network of Thuthuzela Care Centres, one-stop facilities where a rape survivor receives medical, psychosocial and legal support.
REFERENCES
[i] HSRC. 2024. The First South African National Gender-Based Violence Study, 2022: A Baseline Survey on Victimisation and Perpetration. https://hsrc.ac.za/news/latest-news/results-of-the-first-south-african-national-gender-based-violence-study-2022/
[ii] Byansi, W., Galvin, M., Chiwaye, L. et al. Adverse childhood experiences, traumatic events, and mental health among adults at two outpatient psychiatric facilities in Johannesburg, South Africa: a cross-sectional analysis. BMC Psychiatry 23, 581 (2023). https://doi.org/10.1186/s12888-023-05085-0
[iii] HSRC study.
[iv] HSRC study.
[v] HSRC study.