In an op-ed published today, three researchers argue that South Africa keeps paying the price of waiting until young people reach crisis; and that prevention, built into schools, workplaces and youth centres, would cost far less than the damage delay causes.
Published 26 October 2026 · 19:02 GMT
In an op-ed published today, three researchers argue that South Africa keeps paying the price of waiting until young people reach crisis; and that prevention, built into schools, workplaces and youth centres, would cost far less than the damage delay causes. On 26 October 2026, Daily Maverick published an op-ed by Crick Lund, Simone Peinke and Anya Hollands arguing that South Africa must shift youth mental health care from crisis response to early prevention and intervention.
On 26 October 2026, Daily Maverick published an op-ed by Crick Lund, Simone Peinke and Anya Hollands with a blunt thesis: South Africa needs to rethink how it invests in mental health, because preventing problems from the start of adolescence costs far less than treating someone whose mental health has already deteriorated. Lund is professor of global mental health and development at King's College London; Peinke leads the FETCH project and Hollands leads its communications. Their argument is not a government announcement and it carries no new funding. It is a published case, built on the country's Mental Health Investment Case and on UNICEF polling, for moving youth support from a crisis response to early prevention and intervention. The piece lands in a week when South African children's wellbeing is already in the news, after the country's human rights commission argued that the law misses the design of children's safety online; a reminder that the systems around young people are being questioned from several directions at once.
The numbers at the centre of the argument come from South Africa's Mental Health Investment Case, commissioned by the national Department of Health and published in 2025, as the op-ed presents it. It estimates that unaddressed mental, neurological and substance-use conditions could cost approximately 4% of GDP annually; the South African Health Review's account of the case puts that at ZAR 161 billion a year, or ZAR 2.4 trillion over the scale-up period. Against that, public spending on mental health is around R8 billion a year, about 5% of the public health budget, and fewer than one in ten people who need mental health care receive it; a treatment gap Health-e News likewise reports at more than 90%. The demand side is documented by UNICEF South Africa's 2023 U-Report poll: about 60% of children and youth said they had needed mental health support in the previous year, rising to 70% among 15- to 24-year-olds, yet only 63% of those who needed support actively sought it, with not knowing where to go the main barrier. Almost half of young respondents, 48%, were most anxious about building skills for future employment. The Bureau's recent coverage of the human rights commission's children-and-safety findings shows the same age group at the centre of a separate but related debate about protection.
Several of these figures need handling with care, and the authors themselves flag the first limit: the U-Report poll, answered by nearly 26,000 young people, is not nationally representative, so its percentages describe respondents, not the whole youth population. The 4% of GDP figure is a modelled estimate of lost productivity, not a measured cash loss, and it should not be merged with employer-health estimates that reach roughly R250 billion a year through presenteeism and absenteeism; those are different studies with different methods that happen to land near the same share of GDP. The returns the op-ed cites are projections over very different horizons: South African research estimating $2.30 back per dollar invested in universal school-based social and emotional learning over 15 years, and a WHO estimate of $24 returned over 80 years per dollar invested in adolescent mental health. Neither is money in hand. The New Delhi school trial the authors cite reduced problems over 12 months, but they warn its findings cannot simply be transplanted to South Africa. And the op-ed itself costs no package and names no budget line: what early support would cost to deliver at national scale remains unpriced.
The argument turns on timing. The authors treat adolescence as stretching from age 10 to 24, a period when identities form, consequential education and work decisions are made, and the brain remains highly responsive to experience; often amid poverty, unemployment, violence, discrimination and uncertainty. By the time a young person reaches crisis point, distress may already have disrupted education, work, relationships and hope for the future, which is why a system built only to respond to those already in crisis is, in their words, costly and inequitable. The Lancet Commission on Adolescent Health and Wellbeing, which they cite, describes a triple dividend from investing early: benefits today, into adulthood, and for the next generation. The WHO figures they cite point the same way: one in seven adolescents experiences a mental health condition. Violence is one of the pressures young South Africans navigate, and the cost of delay is therefore measured not only in budgets but in disrupted schooling, lost employment and narrowed prospects across a whole cohort.
The most consequential idea in the op-ed is not that prevention matters, but how it could be staffed. Drawing on Patel's work, the authors argue that earlier investment need not rely solely on more psychologists, psychiatrists and social workers. Instead, trained and supervised community workers, school counsellors and other frontline providers can deliver structured psychosocial interventions, with referrals and specialist care for greater or persistent needs. The evidence they offer is a randomised trial in low-income schools in New Delhi, where trained, supervised lay counsellors without prior clinical qualifications delivered four to five brief sessions, helping young people identify a problem, consider options and try a practical solution, and reduced psychosocial problems and mental health symptoms over 12 months. The authors are explicit that this is not an argument for replacing professionals. It is an argument for a layered system: the least-intensive support available to many, difficulties identified early, care escalated when needed. Whether South Africa can recruit, train and supervise such a workforce, and hold someone accountable for referral follow-up, is the practical question the op-ed leaves to government.
If the system stays crisis-led, the costs do not disappear; they move. They land on schools as disrupted education, on employers as presenteeism and lost productivity, on families as strain, and on young people themselves as unemployment, exposure to violence and narrowed prospects. The Investment Case's logic is that the combined value of lost productivity greatly exceeds both current mental health expenditure and the projected cost of scaling up services, which makes delay, in fiscal terms, the expensive option. But there is a second, less comfortable consequence: prevention rhetoric without budgets becomes another unfunded layer, and a system that promises early support but cannot staff it risks teaching young people that seeking help leads nowhere. That is why the authors pair investment with measurement, wellbeing, participation, retention and progression tracked alongside education and employment outcomes; and with coordinated budgets and clear accountability across departments. South Africa's strained public financing is a familiar constraint, and mental health will compete for the same scarce fiscal room.
Three things will show whether this argument becomes a service. First, whether the departments of Basic Education and Higher Education and Training embed psychosocial support in schools, colleges and skills programmes, as the authors urge, and whether public employment programmes and employers provide accessible support during placements and transitions into work. Second, whether the Department of Sport, Arts and Culture equips youth centres and community programmes to offer supportive spaces, and whether the Department of Health links those settings to primary and specialist care so that identified needs lead to timely treatment. Third, whether any of this is funded: a diverse, supervised community-based workforce, assigned responsibility for referral follow-up and continuity between services, cannot be conjured from existing crisis budgets. Watch the next budget cycle, the next UNICEF youth pulse, and any formal government response to the Investment Case; those, not another op-ed, will tell whether South Africa starts investing sooner rather than later.
Western and global-health literature frames the case primarily as investment economics. The Lancet Commission's triple dividend and the WHO's global adolescent figures supply the return-on-investment language, while Harvard's Vikram Patel supplies the workforce model: earlier investment need not mean only more specialists, but a wider, supervised front line. The debate in this literature is less about whether early support helps than about which delivery model survives contact with thin budgets.
East Asian coverage shows the same school-based instinct running into a different bottleneck: consent. Singapore's CNA reports practitioners calling for the parental-consent age for counselling to fall to 13 or 14, after teenagers walked away rather than involve parents, while schools remain more likely than community providers to require consent. The Straits Times reports the government's answer on the service side: Grow Well SG, extended to Secondary 1 and 2 pupils at 20 schools in early 2027 and to all secondary schools in 2028, with community teams unified under a HealthierMind SG network; and stigma, including fear of a permanent record, named as the remaining obstacle.
Coverage from the Global South centres the budget share and the treatment gap. Daily Maverick carries the argument; the South African Health Review carries the Investment Case arithmetic; UNICEF South Africa carries the youth voice, including the finding that 91% of young respondents felt confident, to some degree, in supporting a peer's mental health. The South African debate is therefore not abstract: it is about whether 5% of the public health budget can plausibly carry a problem priced at 4% of GDP.
Crick Lund, professor of global mental health and development at King's College London, Simone Peinke of the FETCH project, and Anya Hollands, its communications lead, wrote the 26 October 2026 Daily Maverick op-ed. They ask South Africa to shift youth mental health support from crisis response to early prevention and intervention, starting in adolescence, with support built into schools, workplaces and youth centres.
The Investment Case, commissioned by the national Department of Health, estimates that unaddressed mental, neurological and substance-use conditions cost about 4% of GDP a year, or ZAR 161 billion annually. Public mental health spending is around R8 billion a year, about 5% of the public health budget, while fewer than one in ten people who need care receive it.
In UNICEF South Africa's 2023 U-Report poll, about 60% of children and youth said they had needed mental health support in the previous year, rising to 70% among 15- to 24-year-olds. Only 63% of those who needed support actively sought it, with not knowing where to go the main barrier. The poll covered nearly 26,000 young respondents and is not nationally representative.
The authors propose a layered system: widely accessible self-care and community support linked to primary and specialist care, with trained and supervised community workers and school counsellors delivering structured psychosocial interventions. Support would sit where young people learn, work and connect, with referrals and specialist care for greater needs, and with wellbeing and retention measured alongside education and employment outcomes.
