Steps on the path to recovery

Staff at SolidarMed’s partner organisation SCPS are faced with difficult and sad stories on a daily basis: the young woman who grew up in an environment surrounded by AIDS and drug use who fell pregnant at 17, and who struggled to bring up her child; the 22-year-old from Zimbabwe who has HIV and is living permanently in an informal settlement in extreme poverty and without any prospects; or the teenager who lost her mother and grandparents and shows signs of severe trauma.

They are all receiving mental health support from counsellors and community and social workers from the non-profit organisation SCPS (Sophiatown Community Psychological Services). SolidarMed’s partner organisation offers individual and group therapy for some 700 children, adolescents and adults. The sessions are either held in one of the two offices in two different neighbourhoods of Johannesburg, or staff visit clients at home. People are encouraged to talk about their experiences and are helped to identify solutions and ways of dealing with their situations.

“We deal with children who have behavioural problems, major learning difficulties, who have dropped out of school all together, or, in the worst case, who have got into drugs.”

Tshepo Nyembe, Mental health counsellor at SCPS

For many people, the meetings are the only time in their day-to-day lives when they can focus on their own needs and express feelings such as grief and shame. Particularly for children who have lost their parents at a young age, it is a new and liberating experience, explains psychological counsellor, Tshepo Nyemba: “We often see that children aren’t used to talking about their feelings of loss. Instead, they start to exhibit behavioural problems, have major learning difficulties, drop out of school, or in the worst case, get into drugs.” But precisely for young people growing up in the toughest conditions, mental health support is particularly important. “Otherwise, they’ll turn into another generation of angry and desperate adults,” explains Johanna Kistner, psychologist and longstanding director of SCPS. 

The individual and group therapy sessions enable people to deal with their own feelings, overcome obstacles, and increase self-confidence. The sessions also provide an opportunity to question role models. For example, adolescents and adults are encouraged to challenge problematic notions of masculinity, to end toxic relationships, and to break away from conservative family expectations. The SCPS also offers space for these issues as they too are steps towards recovery. 

To gauge the effectiveness of the sessions in their clients, SCPS considers three criteria: “First, we look at people’s agency, in other words, how actively that person can take back control of their life,” explains Johanna Kistner. This also includes obvious things like sticking to appointments and taking care of their appearance. “Second, we look at people’s ability to cope with stress in everyday life. And third, accepting support from family and friends is also considered an important success,” she says. All these are indications of improved mental health, healthier relationships, and enhanced skills to cope with everyday life.

However, the difficult living conditions in which many people in Johannesburg find themselves remain a major challenge. This is why for some people, support is not only provided over weeks, but over months or years. One such recipient of support is 38-year-old Sarah Makwetu.* She lives alone with her four children, the three daughters of her sister who died of AIDS, and a younger brother in Meadowlands, which is part of Soweto. The neighbourhood is characterised by unemployment, crime, sexual violence, high HIV rates and poor infrastructure. Like almost everywhere in South Africa, it also has to contend with power cuts lasting several hours every day. 

“Thanks to SCPS, my children and nieces are growing up to become responsible young adults.”

Sarah Makwetu*, single mother from the Soweto neighbourhood in Johannesburg

The family initially came into contact with SCPS eight years ago through another local organisation which was supplying them with food parcels. The three nieces were able to attend group therapy with other children whose parents had died of AIDS. 

Later, the four eldest children joined the ‘Khula Nathi’ group, which means ’growing together’ in Xhosa. There, they met other young people from similar backgrounds, talked about their difficulties and wishes, and took part in excursions together to open their minds to a world beyond life in Soweto. Some of the children from the family also received vocational support and were encouraged to re-take exams they had failed.

“Thanks to SCPS, my children and nieces have grown into responsible young adults,” says Sarah Makwetu with more than a hint of pride. And she says she has also become a better mother. The sessions provided her with a sympathetic ear to talk about the difficulties she has encountered as a single mother without a fixed income. She has also had the opportunity for the first time to talk about the loss of one of her twins shortly after birth. This would otherwise be taboo in her community: “People say that you shouldn’t grieve for a twin who died, otherwise it brings bad luck to the surviving twin,” she explains. SCPS helped the 38-year-old cope with her grief and find new motivation to apply for jobs. She went on to complete a baking course. She is now training others and would like to become self-employed soon.

Access to mental health support for all?

By providing free mental health support, SCPS is plugging a gap that the South African government is failing to fill. For the wealthy population of Johannesburg who live outside of the city centre and are predominantly white, mental health services are freely available for those who can pay. But for the poorer, mostly black, population in the neglected city centre, in the densely-populated townships and in informal settlements, this is not the case. In these neighbourhoods, there is barely any mental health provision apart from SCPS, although demand is particularly high owing to the precarious living conditions and widespread violence. In addition, these neighbourhoods are home to many migrants and asylum seekers from other countries in southern Africa, which are often completely cut off from public health services. Widespread corruption means that many residents have no valid papers or they are refused access to services on xenophobic grounds. This is why SCPS mainly supports people from very poor backgrounds, many of whom are migrants or asylum seekers.

The example of Sarah Makwetu and her family shows the diversity of the mental health support provided by SCPS. It not only includes handling acute crises, but also building resilience and personal responsibility to prevent or better cope with future crises. For some clients SCPS also covers school fees or finances school uniforms. Director Johanna Kistner firmly believes that to provide long-term support, the whole range of causes behind someone’s distress need to be addressed, including family, social, educational and economic reasons. The boundary between what SCPS can deliver and what goes beyond what the organisation can do is not always clear cut. SCPS therefore works with other local non-profit organisations that are more focussed on financial and material support. 

When a person’s mental health has improved and they are empowered to face life again, this is down to a combination of factors: the person’s own strength and willpower, support from those around them, material and psychosocial services, and ideally a bit of luck to find a job and break out of poverty. SolidarMed’s support allows SCPS to make a targeted impact. Above all, however, it allows the staff to be there and to listen when no one else will.

*Name has been changed to protect the person’s identity.

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HIV prevalence is disproportionately high in the townships of Johannesburg. SolidarMed helps children and carers affected by poverty and HIV to break the cycle of depression and helplessness and to actively and responsibly shape their lives.