When I started working on an article about men and suicide, I wanted to include the voices of men themselves. The SA Federation for Mental Health put out a call on our social media platforms, website and fortnightly newsletter asking men to share their thoughts and experiences. I even posted the request on my personal Facebook page. The call went out far and wide across South Africa. Not a single man got in touch with me. Nothing. Zero. Just silence. For me, that silence says more than many of the facts and figures about men and mental health. South Africa is facing a serious suicide crisis. Around 80% of recorded suicides in the country are among men. Of 13,774 suicides recorded in one dataset, 10,861 – or almost 79% – were men. The problem extends far beyond South Africa. Suicide rates among men are higher than among women in almost every country, even though women have higher rates of suicidal thoughts and behaviour. Men are also less likely to be identified as being at risk of suicide and can be harder to reach through suicide-prevention interventions. Signs that a man’s mental health is deteriorating may also go unnoticed by those around him. It is one reason suicide among men has been described as a “silent epidemic”. Society’s role in silencing men Society still places powerful expectations on men. The familiar instructions to “man up” and the belief that “boys don’t cry” encourage men to be fearless, brave and emotionally strong. Men are expected to be in control and confident. They are often expected to be the provider, protector and dependable person others can turn to in difficult times. But these expectations can have the opposite effect. When a man is struggling with his mental health, the very characteristics society expects from him can leave him feeling inadequate. Seeking help can make him feel vulnerable or as though he has failed to live up to expectations of what a man should be. It is simply unrealistic to expect men always to be the “stronger sex” and to find a way to pull themselves together. Traditional masculine norms can also discourage men from expressing painful emotions or seeking professional help. These expectations can include physical strength, competitiveness, dominance, emotional stoicism, financial independence and being the provider. Men who feel unable to meet these expectations can experience stigma not only from others, but also in how they see themselves. Mental health problems are extremely common, yet stigma continues to make it difficult for people to talk about them. For men, this is particularly concerning. Men are less likely than women to seek help for mental health problems. They are also more likely to stop therapy early and to have negative attitudes towards seeking professional support. Depression looks different in men or goes unrecognised Men may avoid disclosing feelings of depression to health professionals or describe what they are experiencing as problems with work or relationships. They may talk about “stress” rather than hopelessness or sadness. Some try to cope by using alcohol or other substances. Others may withdraw socially, become irritable, engage in risky behaviour or struggle to keep up with ordinary daily activities. When mental health problems remain untreated, these coping strategies may temporarily numb distress but can create additional problems and increase the likelihood that conditions such as anxiety and depression remain unrecognised. This is happening against a difficult social backdrop. In May, the South African government raised concerns about the mental health crisis affecting boys and men, highlighting unemployment, social pressures, substance abuse, economic hardship, family breakdown and unresolved trauma among the factors placing men under psychological strain. Limited access to mental health services, particularly in underserved and rural communities, can make these challenges even harder to address.   Breaking the silence Suicide is complex. There is no single explanation for why a person reaches a point where they contemplate ending their life. But suicide can be prevented. Communities and individuals can play a role by identifying men who may be at risk and offering support. We can create opportunities for people to connect with others and ensure that mental health support is available. When someone shows signs of depression, ask what you can do to help and let them know you are there to listen. Comments about suicide should never be dismissed or made light of. A person who is struggling should be encouraged to seek help from a GP or mental health professional. Practical and emotional support matters. Sometimes a person experiencing suicidal thoughts may not be motivated to seek help themselves. The people around them may need to listen, offer encouragement and help them access professional support. It is also important to remember that the presence of warning signs does not mean someone will inevitably attempt suicide. But those signs should never be ignored. Every suicide is a tragedy that affects families, communities and those left behind. Silent epidemic We cannot continue allowing male suicide to remain a silent epidemic. When I asked men to contribute their experiences to my original article, the response was silence. That silence hangs heavily over conversations about men and mental health, particularly when we start talking about suicide. It can obscure the painful reality of men who are struggling. It can also become a barrier to getting the help they need. Breaking that silence requires greater public awareness, effective prevention strategies, better understanding of male suicide and continued research. But it also requires men themselves to speak. My message to men is simple: speak up and ask for help before it is too late. Asking for help is not “unmanly”. It is not a sign of weakness. We simply cannot continue to lose lives to suicide.  For all references and source links, read the original article. Mental health support resources can be found here. Author Leon de Beer Leon de Beer is the Deputy Director for the South African Federation for Mental Health. View all posts

Thapelo Tshabalala, author and co-founder of Tshwane Disability Empowerment Projects, knows what it is like to feel excluded because of a disability. Growing up, Tshabalala struggled to read and write and says he was repeatedly told by teachers and family that he would not succeed. “Living with digraphia was difficult for me because every time I have to go to school I will always think about the words from the teachers saying I am not going anywhere,” he says. Dysgraphia is a neurological condition that can affect a person’s ability to write. Despite his difficulties at school, Tshabalala continued studying and completed a master’s degree at Tshwane University of Technology in 2022. His research focused on creating accessible adventure tourism experiences for people with disabilities. Listening to the experiences of people who participated in his research prompted him to become more involved in disability advocacy. “I then decided to be a voice for them,” he says. His experiences eventually led him into disability advocacy. He published Epitome of Disability: Challenging Barriers in Education and Beyond and in 2023 co-founded Tshwane Disability Empowerment Projects in Stinkwater in Hammanskraal, north of Pretoria. Creating opportunities Tshabalala’s centre now provides programmes to 45 people with disabilities between the ages of 18 and 45. These include sewing, agriculture, baking, sport and recreation. A mobile vegetable garden, created using recycled tyres, produces vegetables including spinach, beetroot and onions for its kitchen. Tshabalala is currently a third-year PhD student at the University of the Western Cape, where his research focuses on developing guidelines for accessible transport for people with disabilities in South Africa. Keeping the programme going The Department of Social Development funds places for 20 people with disabilities at the centre as well as four staff positions. But Tshabalala says funding does not cover some of the practical programmes at the heart of the organisation’s work. “The centre is not interested in feeding persons with disabilities with food only, but to empower them with skills that can open doors for them.” He says the organisation struggles to buy materials for its sewing, agriculture and baking programmes, while some volunteer facilitators have left because there is no funding to pay them. “We struggle to develop our agriculture project because of lack of resources and struggle to maintain baking programs because we can’t get funding for material,” Tshabalala says. Tshabalala says keeping these programmes running is central to what he wants the organisation to achieve – giving people with disabilities practical skills that can help them become more financially independent. Author Lucas Phelwane View all posts

Residents of Mafarafara village outside Burgersfort in Limpopo are again struggling to reach healthcare after a makeshift bridge across the Steelpoort River, also known as the Tubatse River, was washed away by heavy rains. The community-built crossing, made from corrugated iron, wooden poles, wire and metal rods, lasted less than five months. Mafarafara has no clinic. Residents rely on Taung Clinic in Ga-Taung, about six to seven kilometres away. Using other routes to reach healthcare can cost residents up to R160 for a return trip when using public transport. In July, Health-e News reported that Mafarafara residents had built the makeshift bridge after 27 years of asking their local municipality for a permanent crossing. Before the makeshift bridge had been built, elderly residents, heavily pregnant women and patients who were too frail to reach Taung Clinic on foot and unable to afford public transport, had relied on a ‘sewaiwai’ — a steel cart tied to ropes on both sides of the river and pulled across by villagers.  The sewaiwai carried up to four adults and cost R5 for a single trip. But the cart was damaged and is now out of use. Residents told Health-e News that this prompted the construction of the makeshift bridge.  Home-based carers had to make use of the same community-built crossings.  Home-based care suspended Following the recent collapse of the makeshift bridge, home-based carers who deliver chronic medication, monitor pregnant women and support bedridden patients told Health-e News they have temporarily suspended services in Mafarafara because they cannot cross the flooded river. “This may result in patients not accessing healthcare at all,” says Kamogelo*, a homebased carer in Mafarafara.  “We cannot cross to do our work and our patients on the Mafarafara side are currently not receiving their treatment.” “Especially high-risk pregnant women are not being followed up, and it doesn’t risk not only the mother’s life, but also the unborn babies,” she says. Kamogelo* says family-planning and follow-up visits have also declined over the past month. After the sewaiwai became unusable, 65-year-old resident Otho Mnisi used money from his SASSA grant towards the construction of the makeshift bridge which was built by residents in May this year.  Mnisi told Health-e News at the time that residents contributed R5 per crossing while local helpers would assist them with their belongings and help them across. Mnisi says residents plan to rebuild the makeshift bridge after it was washed away, but fear another collapse. “Our biggest fear remains if we fix the bridge, it collapses with patients.” “Chances of survival are low. We need proper building materials for long-lasting structures,” Mnisi says. Residents told Health-e News in July that several people had drowned in the past while crossing the river with the ‘sewaiwai’, including a man who was returning from Taung Clinic eight years ago after collecting high blood pressure medication. Municipality considers mobile health services Fetakgomo Tubatse Local Municipality representatives say Mayor Eddie Maila has approached Limpopo Premier Phophi Ramathuba and the provincial health department about possible interventions, including mobile health services. Municipal spokesperson Freddy Mokoena says building the permanent bridge needed at the crossing would require intervention beyond the municipality. Mokoena says residents are not completely cut off because the municipality built another access bridge about a kilometre from the affected crossing in 2018 and residents can also use the main road network. But residents say these alternatives are too far for sick and elderly people trying to reach healthcare. “We’ve lost hope in the government.” Community member Melvin Serola says residents want to rebuild the crossing themselves. “We waited more than 27 years for a clinic. At this point we doubt the bridge will be built any time soon,” he says. “We want to build our own bridge, we just lack material.” *Not her real name. Author Keletso Mkhwanazi Keletso Mkhwanazi is a South African investigative journalist with a proven track record of delivering impactful stories that drive change. She has worked as a freelance reporter since 2016. View all posts

Joel Raphiri lives by the Northern Sotho adage ‘letsema le ema ka mong’, meaning a group effort only succeeds if the person who initiated it takes the lead and puts in the work first.  For more than a decade, the 64-year-old Raphiri, with the help of his wife, Plantina, has put the principle into practice through a community garden that provides fresh vegetables to families in Refentse, Stinkwater, near Hammanskraal, who struggle to afford healthy food.  As staunch members of the Hope For Christ Ministry, Joel could not ignore the persistent dreams that visited him every night, so they decided to take Joel’s tithe, or a tenth of his salary to build a fence, dig a well and sink a borehole to create a vegetable garden that could provide the community with fresh produce. At the time, the pair had more than 70 mouths to feed in their single garage, which had turned into a community centre and church, and served as a kitchen too.  “We had to take every cent from the family coffers and buy ingredients and some foodstuffs to prepare meals for the community young ones, and we are glad that some are grown-ups today from the little we provided,” says the energetic Plantina. An organic garden feeding the community The resulting garden, which the community has dubbed the Raps garden, derived from the couple’s surname, is entirely organic, using natural borehole water for irrigation and only cow dung manure as fertiliser. “We don’t use any GMOs or chemicals which would weaken our systems, that is why we are so strong today – from eating organic vegetables. We are not using any pills or medication and do not have diseases like diabetes or high blood pressure,” says Joel. The garden now provides healthy fresh produce to more than a hundred people in the Stinkwater community and the surrounding areas, Dilopye, Eersterus and Mogogelo. The couple is clear that the aim is not to make money out of this garden but to feed families that can’t afford to buy healthy food to eat. Even though Joel works as a bus driver, he notes that he has not received a salary for more than a year, adding to their own reliance on the garden. “Letsema le ema ka mong – A communal work party stands through its owner” In Sepedi culture, a letsema is a traditional practice where community members gather to help a neighbour clear land, farm, or build a house. The Rahiris currently have seven volunteers assisting them with gardening. Though the proverb highlights community solidarity, Joel knows the project’s success depends on his personal responsibility and leadership.  “People are willing to offer support but you must drive your own project.” Author Lucas Phelwane View all posts

What started as a toothache in 2021 led to a rare cancer diagnosis and years of medical treatment for 29-year-old Lerato Mosai. Four years later, the Sasolburg woman is bedridden and dependent on her mother for her daily care. Mosai first went to a dentist after experiencing severe toothache in 2021. Several teeth were removed, but the pain continued. During another examination, the dentist noticed swelling on the hard palate of her mouth and referred her for further investigation at Mediclinic Emfuleni Hospital. “After the dentist examined me and removed the third tooth, he observed that I was swollen on the hard palate of my mouth, with a blister that looks like a pimple,” says Mosai. A biopsy in April 2021 confirmed that Mosai had adenoid cystic carcinoma, a rare cancer that can occur in the salivary glands. By early 2024, the cancer had progressed and Mosai returned for specialist treatment. In March 2024, Mosai was admitted to Lenmed Hospital in Lenasia South, where she underwent extensive surgery to remove the tumour and part of her upper jaw. This was followed by radiation treatment.  “I went to the surgery walking and full of life. Today I can’t walk, take care of my son, I can’t even turn myself on the bed,” Mosai says. “I need justice.” She continues to receive medical care related to her cancer diagnosis and subsequent treatment. Reconstructive surgery Mosai says she was told that part of her jaw would need to be reconstructed following the cancer surgery. “In October 2024 I was booked for another operation which was for the artificial jaw reconstruction, according to the specialist,” she says. She says she woke up after subsequent treatment having undergone procedures involving her thighs and neck, with a feeding tube inserted into her stomach. Mosai and her mother, Monalisa allege that some procedures were carried out without adequate explanation or consent. Medical records reviewed by Health-e News show that tissue was taken from Mosai’s thigh as part of reconstructive surgery. The records also document complications and further procedures. Mosai’s mother says her daughter subsequently developed severe pain in her thigh and difficulty walking. Mosai eventually became unable to walk and now relies on her for care. “I received Lerato as if I was being handed a dead person to bury.” The medical records document the thigh procedure and subsequent complications, but do not establish why Mosai is now unable to walk or whether the procedure caused her loss of mobility. Medical records reviewed by Health-e News include signed consent documentation. The family disputes whether all the procedures were adequately explained to them before they were performed. Surgeon denies allegations Mosai has since taken legal action over her treatment. Dr Zain Dangor, the maxillofacial surgeon involved in Mosai’s treatment, is represented by MacRobert Attorneys. His legal representative, Hanneke Verwey, who responded on his behalf, says the matter is pending before the High Court. “Our client is defending those proceedings, disputes and denies the allegations made against him,” Verwey says. She says the issues will be determined through the court process and that Dangor’s professional obligations regarding patient confidentiality prevent him from commenting publicly on Mosai’s clinical treatment. Makunyane Attorneys, which represents Mosai, confirmed that legal proceedings have commenced. “Due to the nature of the issues raised in the proceedings, we shy away from litigating in the media and/or disclosing any other information beyond this,” the firm says in a statement in response to Health-e News’ questions. Turned to the public health system Mosai’s family says by March 2025, they had run out of private medical funds and turned to the public health system for help. Her mother says she took Mosai to Fezi Ngubentombi Provincial Hospital in Sasolburg, but that she was turned away because she did not have her medical history and a referral letter from the private doctors who had treated her. She says they returned on another occasion when Mosai was experiencing severe pain but again did not receive the help they were seeking. Mosai subsequently received care at Sebokeng Hospital in Gauteng after experiencing severe abdominal pain. She was also treated at Chris Hani Baragwanath Academic Hospital last year for problems with her feeding tube. Her mom says she is currently receiving care at National District Hospital in Bloemfontein, where she has been assessed by a specialist. According to her family, doctors are examining her legs and reviewing the operations she previously underwent. But according to Monalisa, her daughter’s condition has deteriorated and the family is increasingly concerned about her health. Health-e News sent questions to the Free State Department of Health about whether there are any records of Mosai being assessed at Fezi Ngubentombi Provincial Hospital and why she was allegedly turned away. The department had not responded by the time of publication. Author Lerato Kodisang Lerato Kodisang from Orange Farm,  is a mental health facilitator, a former deputy chairperson for research sector in Gauteng for SANAC civil society forum, and a freelance journalist. View all posts