‘Bills burnout’: Money stress now SA’s top mental health risk

Financial stress is the leading contributor to poor mental health across all generations in South Africa, with 59% to 66% of respondents surveyed by private healthcare group Mediclinic citing it as a cause.

The data was published as consumers grapple with a spiralling cost of living partly due to geopolitical tensions such as the Middle East conflict, which has sent fuel prices soaring.

It shows that 45% of respondents have never accessed a mental healthcare provider, ironically partly because they cannot afford it, and also due to the stigma still attached to the ailment.

Mediclinic drew the sample for its newly launched generational health survey from residents across all generations and beyond its patient base in Gauteng, KwaZulu-Natal, the Free State, Limpopo and the Western Cape.

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

“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. This survey provides a unique local reference source and marks the start of a journey to build richer, relevant knowledge.”

The report shows that millennials, born between 1981 and 1996, as well as Gen Z respondents, who were born between 1997 and 2012 — each cohort accounting for 28% of the sample — engage more often with mental healthcare providers and are more open to receiving treatment.

Gen X respondents (born between 1965 and 1980 and also making up 28% of the sample) as well as Baby Boomers (born from 1946 to 1964 and accounting for 16%) were the most likely to say they had never accessed a mental healthcare provider.

Broadly, all generations were susceptible to fears about the perceived stigma still attached to mental illness, said Mediclinic’s national manager of mental health, Leandri Hattingh.

While seven in 10 Gen Z respondents believe mental health should be prioritised, more than one in three expressed concerns about being judged by their friends or family. In the same vein, 32% of Gen Xers and 34% of Baby Boomers perceived mental health conditions as a sign of weakness.

The survey coincides with a recent report from debt counselling firm National Debt Advisors, which highlighted the mental health toll of living payday to payday for the breadwinners of many financially strapped South African households faced with higher transport costs due to fuel.

Electricity is also becoming more expensive after recent tariff hikes, and households must contend with higher borrowing costs after the Reserve Bank raised interest rates to tame inflation.

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

Instead, as living costs outstrip income, financial pressure spills from bank accounts into homes, fuelling marital conflict, disrupting children’s schooling, and driving widespread psychological burnout.

“Payday used to feel like a fresh start,” Alexanderson said.

“Now it feels like a temporary rescue that lasts two or three days before debit orders clear. 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.”

Analysis by National Debt Advisors of 109,425 clients who have entered debt review since 2014 shows the average person earns R15,737 a month before deductions and owes R174,787, equivalent to 92.6% of annual gross income.

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.

— Sebastien Alexanderson, head of National Debt Advisors.

The so-called black tax — the responsibility that many black salary earners face of taking care of their extended families — only adds to the pressure, with Old Mutual’s latest savings and investment monitor finding that four in 10 working South Africans support their children and their parents or other adult dependants, said Alexanderson.

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

The monitor, published at end-July, showed that the financial gap between South Africa’s economic classes is widening, with middle-income to affluent consumers in a stronger financial position compared with last year, while lower-income households face rising financial stress, debt reliance and insecurity.

While many people demonstrate strong intent to save, the drawdown of savings and a reliance on informal, shorter-term savings vehicles indicate that consumers are battling to effectively manage their finances, Old Mutual said.

To highlight the stress that households are under, Alexanderson also cited Stats SA’s 2025 general household survey published in May, which found that 21.5% of early school leavers aged seven to 18 cited a lack of money for fees.

Business Day