Rethinking health system performance in South Africa
6 min read
The most alarming finding in the 2025 Global Mind Health Report is a pronounced generational decline: Young adults globally are functioning worse than older cohorts across multiple mind health domains.
Released by Sapien Labs, the report should be read by South Africans as a mental health commentary and a strategic guideline for health system leaders. Rather than relying on diagnostic labels, it uses a Mind Health Quotient (MHQ) to measure functional capacities, emotional regulation, cognitive clarity, social connection and adaptability.
South Africans face high youth unemployment, persistent inequality, violence, digital saturation and a dual burden of increasing communicable and non-communicable diseases. Functional mind health is not a peripheral issue; it determines educational attainment, employability, chronic disease adherence and long-term productivity. If younger populations enter adulthood with impaired cognitive and emotional resilience, the economic and healthcare consequences will compound over decades.
The report highlights four correlated drivers of poorer youth outcomes: early smartphone exposure, higher ultra-processed food consumption, weakened family cohesion and declining spiritual engagement. These resonate within the South African context: high and rising mobile penetration and rapidly expanding ultra-processed food consumption in lower income communities driven by affordability. Social fragmentation, migration for work and economic stress strain family structures.
On a positive note, in South Africa young adults report a high spiritual connection and the MHQ scores average 30 points higher than in atheist-leaning countries – a difference large enough to separate a functioning population from one in distress. For managed care, this is not a religious argument, but a resilience asset.
South Africa retains vibrant faith-based and communal networks with established trust, regular member engagement and deep community reach. Healthcare providers should explore partnerships with faith-based organisations for peer support, mental health screening and adherence messaging leveraging existing social infrastructure as a cost-effective complement to formal care.
Social connection is a key clinical factor, not a soft benefit. Adults without close family bonds are four times more likely to suffer serious mental distress. Schemes should screen for isolation, fund family therapy to improve treatment adherence and build chronic disease programmes around group and peer support. Members with strong social support are less likely to need intensive case management or unnecessary hospitalisation.
The implications are operational. If we want value-based care, mind health metrics must be incorporated into routine risk stratification, annual reviews and population health dashboards. Yet, mental wellbeing screening remains inconsistently embedded in chronic disease management pathways.
Psychological distress reduces medication adherence, worsens glycaemic control in diabetes, increases cardiovascular risk and drives avoidable hospital admissions. Incentives should reward improvements in functional outcomes alongside traditional clinical markers like HbA1c or blood pressure control.
In South Africa, digital platforms are essential for healthcare access. While the report cautions against unstructured, early digital immersion, the response to this is not digital withdrawal but governance. Managed care can deploy structured, clinically supervised digital tools to counterbalance the harm of unregulated digital ecosystems. Technology becomes a resilience-building instrument rather than a risk amplifier.
The relationship between ultra-processed diets and psychological functioning suggests nutrition benefits should be reframed as cognitive and emotional health interventions, not merely metabolic ones. Benefit structures that incentivise healthier food choices, expand dietitian access for high-risk members and align with national sugar-reduction initiatives can address metabolic and mind health.
The report’s lesson is clear: mind health is ecological. South Africa can integrate this into managed care design, value-based contracting and public policy. This would position resilience, rather than disease suppression, at the centre of our health system strategy.
Medscheme’s decision to embed mental health management within its value-based care (VBC) solutions represents a transformative shift in health outcomes. By recognising that psychological wellbeing and physical health are interdependent, Medscheme moves beyond traditional disease-centric models toward an integrated care paradigm where mental health is a critical determinant of clinical outcomes.
Integrating mental health screening, early intervention and digital therapeutic support within VBC pathways improves clinical outcomes and member engagement. This approach reframes value as cost containment and optimisation of whole-person health, addressing psychological barriers to behaviour change for sustainable improvements in disease control, quality of life and long-term healthcare sustainability.
Medscheme’s model signals an evolution in managed care: one where mental and physical health are managed concurrently to unlock the full potential of value-based healthcare.
South Africa cannot ignore the report’s findings: a generation is entering adulthood with diminished capacity to work, adhere to treatment and sustain families. With 41% of young adults aged 18–34 experiencing significant mental distress and no improvement despite decades of increased mental healthcare spending in wealthy countries, it is clear that downstream symptom management cannot reverse upstream functional decline.
The report invites a broader philosophical shift. Industry and policymakers should prioritise mind health in VBC – not as a niche benefit but as the foundational metric of a functional society. It must include preservation of functional human capacity.
Investments in medical scheme benefits, community partnerships, workplace wellbeing, family-supportive policies and purpose-driven engagement must be seen as upstream health interventions with downstream fiscal impact.
A health system measuring performance only through hospital utilisation trends, claims ratios and clinical process markers, while missing the erosion of functional resilience in its population, is optimising for the wrong outcome.
Ayesha Kriel
Functional Head: Disease and Medicine Management
