Clinical Psychology

The Hurts of Helping: Addressing perceived cultural barriers to accessing psychological support

This project explores the experiences of social workers and counsellors delivering psychological support to communities in low-resourced areas in South Africa.

Following the liberation from apartheid, South Africa has faced four epidemics: HIV and tuberculosis; a high burden of chronic illness and mental health disorders; deaths related to injury and violence; and a silent epidemic of maternal, neonatal, and child mortality. Recent evidence from the largest psychological study in South Africa; the South African Stress and Health Study (SASH) found high rates of mental health disorders in the population (30.3% of participants reported having at least one lifetime disorder). Further, data estimates that lifetime risk for the development of a mental health disorder is nearly as high as 50%. This is in line with other evidence that suggests rates of trauma exposure and subsequent development of disorders such as posttraumatic stress disorder (PTSD) are high in the general South African population, as well as specific sub-populations that live in more dangerous and high-adversity contexts, where continuous exposure is probable.

Despite the high reporting of trauma and mental health rates, evidence suggests there is little uptake of formal psychological support services. There have been suggestions in the literature about the potential barriers to accessing psychological support, particularly for the Black African population. These barriers include, lack of finances for counselling or travel to a counsellor, a large distrust of psychological services, a limited understanding of what support may involve, lack of mental health literacy causing an inability to recognise mental health symptoms, or fear of shame and stigma from the community for seeking support.

It is important to try and gain a deeper understanding of why people in need of psychological support are not accessing services, and to develop programmes that are effective, accessible and acknowledging of contextual factors. It has been argued that the development of various mental health treatments, including those for trauma, have been primarily developed based on knowledge and understanding from Western participants. However, these traditional Western approaches may be seen as inappropriate given their lack of incorporation of socio-cultural factors; such as the dismissal of positive effects of natural or indigenous healing. The nature of the mental health situation in South Africa requires a South African solution, to be developed within this context and to move away from Westernised models and more towards more inclusive approaches that consider a multitude of social, environmental, cultural and contextual factors. A co-creation and participatory involvement approach is required in order to begin to develop more effective and accessible services. This involves assessing current existing organisations that offer services to families following trauma exposure; and gaining a better understanding of how these services operate, identifying room for improvements, and discussing perceived barriers preventing clients from accessing the service. From here, findings can be used to begin to piece together the beginnings of an improved, tailored, and accessible services that can be utilised by those who need it.

There is a need for psychological support for caregivers and their families following trauma, as decades of past research has found that trauma and PTSD can cause detrimental effects to physical and psychological health, not only to those directly affected, but those closest to them. However, before effective, tailored and accessible support can be developed and implemented for low-resourced settings, it must first be understood the factors that make this support effective. Therefore, the potential benefit to society is to gain a better understanding of existing support structures, as well as evaluating their current effectiveness and learning from those on the ground where barriers to access may exist. Through unpacking these issues, it will aid in illuminating the most effective way(s) to addressing mental-health support needs in resource limited settings.

This project is part of Hope Christie’s Global Challenges Research Fellowship. The main aim of this project is to gain a better understanding of what support services are offered to traumatized caregivers and family who live in low-resourced settings in and around Cape Town. By understanding more about services that are currently offered, as well as exploring counsellor’s perceptions about barriers to accessing, or continuing with treatment, we can begin to further understand the key components to developing psychological support that is tailored to caregivers and their families following trauma, and that will be accessible and utilized by those who need it. One NGO that has remained operational through the COVID-19 pandemic and who actively operates in low-resourced, high-adversity settings is the Trauma Centre for Survivors of Violence and Torture. This NGO will be the focus of the current project. 


The specific objectives will be to:

  1. Learn more about the referral processes at the Trauma Centre
  2. Learn about the accessibility of services at the Trauma Centre
  3. Understand more about the ‘client’s journey’; what services are offered, challenges with delivery of services and identifying where current services could be improved
  4. Explore perceived barriers to accessing psychological support within township communities, as well as unpacking why continued service uptake is low
  5. Document the evaluation process used within the Trauma Centre (i.e., baseline assessments of incoming clients and follow-up evaluations following exiting the service)  


Team: Hope Christie, Karen Goodall, Clara Calia, Mark Tomlinson (ILCHR), Sarah Skeen (ILCHR), Marguerite Marlow, Jackie Stewart (ILCHR), and Marguerite Holtzhausen (Trauma Centre)