Financial stress emerges as South Africa’s leading mental health risk

Financial pressure has emerged as the leading contributor to poor mental health across generations in South Africa, with rising living costs, debt repayments and family responsibilities leaving many households struggling to cope.

A survey by private healthcare group Mediclinic found that between 59 percent and 66 percent of respondents across different generations identified financial stress as a cause of mental health problems, according to BusinessDay South Africa.

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The findings come as households face higher transport and electricity costs, debt obligations and pressure on disposable income. Rising fuel prices, partly linked to geopolitical tensions in the Middle East, have added to the strain on consumers already struggling to make their earnings last until the end of the month.

The survey also found that 45 percent of respondents had never consulted a mental healthcare provider. Affordability and the stigma surrounding mental health were among the barriers preventing people from seeking support.

Mediclinic drew respondents from communities across Gauteng, KwaZulu-Natal, the Free State, Limpopo and the Western Cape, extending the survey beyond its existing patient base.

“Much of the health data used today may not always reflect the experiences of communities in South Africa,” said Braam Joubert, chief executive of Mediclinic Southern Africa.

“The findings support trends we see in our hospitals while also giving us a broader view of how people beyond our existing patient base experience and think about their health,” he said, adding that the survey would provide a local reference for understanding health trends.

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The results show differences in how generations approach mental healthcare. Millennials, born between 1981 and 1996, and Generation Z, born between 1997 and 2012, were more likely to engage with mental healthcare providers and express openness to treatment. Each group accounted for 28 percent of the survey sample.

Generation X, born between 1965 and 1980, also made up 28 percent of respondents, while Baby Boomers, born between 1946 and 1964, accounted for 16 percent. These older groups were more likely to report never having accessed mental healthcare.

The findings mirror concerns raised by National Debt Advisors, a debt counselling firm that has highlighted the psychological toll of living from payday to payday as household expenses rise faster than incomes.

“For millions of working South Africans, the end of the month no longer brings relief,” said Sebastien Alexanderson, head of National Debt Advisors.

“Payday used to feel like a fresh start. Now it feels like a temporary rescue that lasts two or three days before debit orders clear,” he said.

“When households spend 30 days doing mental math just to survive, the exhaustion is carried into homes and workplaces, hugely impacting the mental health of the entire family.”

The pressure is reflected in the financial position of people seeking debt assistance. An analysis by National Debt Advisors of 109,425 clients who entered debt review since 2014 found that the average client earned R15,737 a month before deductions and owed R174,787, equivalent to 92.6 percent of annual gross income.

Family obligations can add to the burden. Alexanderson pointed to the so-called “black tax”, a term commonly used to describe the financial responsibility many Black earners feel to support extended family members.

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Old Mutual’s latest savings and investment monitor found that four in 10 working South Africans supported their children as well as their parents or other adult dependants.

“When borrowing extends to family members, financial tensions can spill over into family gatherings and personal relationships, adding to the emotional strain,” Alexanderson said. “Unlike traditional creditors, you cannot simply block a relative’s number to escape the pressure of debt.”

Old Mutual’s report, published at the end of July, also found a widening divide between income groups. Middle- and higher-income consumers were in a stronger financial position than a year earlier, while lower-income households faced growing financial pressure, greater reliance on debt and increased insecurity.

Although many consumers expressed a desire to save, drawing down existing savings and relying on informal, short-term savings arrangements suggested that many were struggling to manage their finances effectively.

The effects extend beyond household budgets. Citing Statistics South Africa’s 2025 General Household Survey, published in May, Alexanderson said 21.5 percent of people aged seven to 18 who had left school early cited a lack of money for fees.

The findings point to a wider cost of financial hardship: beyond limiting what households can afford, persistent money worries can affect family relationships, access to healthcare and children’s education. With nearly half of Mediclinic’s respondents reporting that they had never accessed mental healthcare, affordability remains a significant obstacle to getting support when it is needed.