Health and Wellness

(1)(a) Mental health services in the Western Cape are delivered through an integrated service platform across all levels of care. Mental health screening, assessment, and treatment are available at all primary healthcare facilities, with referral pathways to hospitals and specialised psychiatric facilities when required. Specialised inpatient psychiatric care is primarily provided at Valkenberg Hospital, Lentegeur Hospital, Stikland Hospital, and Alexandra Hospital.

In addition, acute psychiatric units and mental health services are provided at district, regional, and central hospitals, while primary healthcare facilities provide outpatient mental health services across the province. Staff are trained to provide integrated services in line with the Practical Approach to Care Kit guidelines. Specialised services also provide support to district and primary healthcare facilities where needed.

The total number of facilities that reported mental health visits is 295 across primary healthcare, outpatient, and inpatient services. This includes community day centres, community health centres, clinics, district hospitals, regional hospitals, satellite clinics, specialised hospitals, and national central hospitals. Mobile clinics also provide mental health services in the province, but are not included in this total.

(b) Factors affecting average waiting times for
(i) a mental health assessment, and
(ii) follow-up care, include:

• demand for mental health services, and the increasing prevalence of mental illness;
• availability of mental health professionals providing services or outreach to primary healthcare facilities;
• severity and urgency of cases requiring prioritisation;
• referral patterns from primary healthcare to specialist services;
• bed availability and service capacity at psychiatric hospitals; and
• geographic access to services, particularly in rural areas.

(c) The Department has allocated R19 795 108 funding for mental health services for  2025/26 financial year.

(d) When focusing specifically on staff allocated to mental health and psychiatry components, the workforce spans primary healthcare facilities, hospitals, and specialised psychiatric hospitals. The total number of permanent staff is approximately 1 992, including allied health professionals, doctors, nurses, pharmacists, and pharmacy assistants. In addition, staff appointed through National Health Insurance funding contribute a further 20 personnel, comprising two psychiatrists, one psychologist, one occupational therapist, and registered counsellors.

(e) The Department utilises funding from National Health Insurance, as well as the Strategic Interventions budget, to support the appointment of additional mental health personnel. Measures to strengthen the mental health workforce include:

• recruitment of additional mental health professionals where funded posts exist;
• training of primary healthcare clinicians and nurses in integrated mental healthcare;
• task-sharing approaches using counsellors and community health workers; and
• partnerships with universities to support specialist training and student placements.

(f) The Department supports a range of community-based mental health services aimed at promoting recovery, social inclusion, and improved quality of life for persons living with mental health conditions. These services include:

• licensing of residential and day-care facilities operated by non-profit organisations;
• psychosocial support and rehabilitation services;
• community support and reintegration programmes;
• substance-use treatment and recovery support; and
• funding for community health workers through non-profit organisations to support adherence and retention in care.

The Department’s efforts are further strengthened by the Expanded Framework for Psychosocial Rehabilitation and Support Services, which was developed to address increasing mental health service pressures in the province.

(g) Services are integrated as follows:

(i) Primary healthcare


Mental health is integrated into the primary healthcare service package through:

• routine screening and early detection through the Make Every Contact Count strategy, which supports early screening, identification, support, and referral;
• counselling and medication management;
• referral to specialised services where needed; and
• access to multidisciplinary team support.

The primary healthcare service package follows a generic model in which generalists are encouraged and supported to manage mental health users. The aim is to have at least one mental health nurse at each community health centre. Several facilities receive weekly support from psychiatric registrars and intern psychologists. Recent developments also include the appointment of registered counsellors to strengthen mental health service provision.

(ii) Schools


Integration with schools takes place through close collaboration with:

• the Western Cape Education Department at district level;
• the Integrated School Health Programme, including school health nurses who provide outreach support to schools; and
• Adolescent and Youth Friendly Services at primary healthcare facilities, with selected Youth Zone sites.

These services include sexual and reproductive health services, HIV prevention, HIV and STI screening, peer education, pregnancy support, gender-based violence and intimate partner violence support, and substance-use support, all of which are integrated into youth mental health and psychosocial support initiatives. Referral pathways are also in place for those requiring further intervention.

(iii) Community organisations


The Department partners with non-profit organisations that provide home- and community-based services, support community reintegration, and deliver counselling and peer support services through the Community-Oriented Primary Care approach. This is implemented through the provincial non-profit organisation service package. Referrals are made from non-profit organisations directly to primary healthcare facilities, and monitoring and evaluation mechanisms are in place to support linkage to care.

The province’s community health worker platform also supports medication adherence, treatment retention, and linkage to care.

(2)
Yes. The Department supports programmes targeting several high-risk groups.

(a) Adolescents


Support is provided through Adolescent and Youth Friendly Services, together with referral pathways to specialist child and adolescent mental health services where needed.

(b) Survivors of violence


Support includes psychosocial services through emergency centres and hospitals, collaboration with Thuthuzela Care Centres and social services, as well as trauma counselling and referral services.

(c) People with substance-use disorder

Support includes integrated substance-use treatment services, referral to specialised rehabilitation programmes, dual-diagnosis support for mental illness and substance use, and non-profit organisations based at primary healthcare facilities and in communities that specifically support persons with substance-use disorders.

(d) Older adults


Support includes mental health screening and management at primary healthcare level, referral to specialised geriatric and psychiatric services where required, and support to non-profit organisations in communities that provide services to older persons.