‘Our phone bill alone is R150,000 a month’: how Sadag keeps SA’s only suicide crisis helpline running

The South African Depression and Anxiety Group (Sadag) says it spends up to R150,000 a month on telephone costs alone to ensure that South Africans in crisis can access help around the clock through the country’s only suicide crisis helpline.

Speaking to the Sunday Times, Sadag operations director Cassey Chambers said maintaining a 24-hour service without government funding remains one of the organisation’s biggest challenges as demand for mental health support continues to surge.

“As an NGO that doesn’t get government funding, we work really hard to make sure that our lines are always answered 24 hours a day. We run the country’s only suicide crisis helpline, and we have to do whatever we can to make sure that there are trained counsellors available when someone needs them,” said Chambers.

She said all Sadag helplines remain toll-free to ensure that cost is never a barrier for someone seeking help.

Chambers explained that every crisis call often generates multiple additional calls as counsellors coordinate emergency interventions and support services.

“When we’re providing crisis intervention or support, we might be having to make 10 other phone calls to find a hospital bed, to find security or emergency services, notify family members or loved ones, doing case management. So one call is never just one call,” she said.

Chambers said without government funding, the NGO has a huge responsibility.

“Our phone bill per month could range from R110,000 to R150,000, and Sadag is responsible for that bill. We work really hard to make sure that that service is always on and always there because mental health, and especially suicide, doesn’t have working hours,” she said.

The comments come as minister of women, youth and persons with disabilities, Sindisiwe Chikunga, revealed in a parliamentary response that suicide is the second leading cause of death among young people aged between 15 and 29 in South Africa.

The minister said the country’s suicide rate stands at approximately 23.5 deaths per 100,000 people.

“While recognising that men account for nearly 80% of all recorded suicides in the country, this makes it a critical issue for young men,” Chikunga said in response to a parliamentary question from Vuyo Zungula.

According to Chambers, South Africa’s economic pressures are having a direct impact on mental health.

She pointed to rising living costs, unemployment, inflation, load-shedding and financial strain as key drivers of distress.

“We see this as a direct impact when there are different inflation rates that are announced, or a petrol price increase, or a new load-shedding schedule. We’ve seen many households that are impacted, who’ve lost breadwinners, who’ve lost incomes, who are really just struggling day-to-day. Over a long time, that does negatively impact our mental health,” she said.

Especially younger and younger people are dealing with so many different complex issues all at once. It’s never just one problem or one primary stressor. It’s a combination and a collection of all of it that comes together that makes it really hard to cope.

—  Cassey Chambers, Sadag operations director

The organisation says people seeking help are increasingly presenting with multiple overlapping challenges rather than a single crisis.

“Often we’re having to triage to figure out what is the most important issue today, what can we deal with today, what can we help with today. Especially younger and younger people are dealing with so many different complex issues all at once. It’s never just one problem or one primary stressor. It’s a combination and a collection of all of it that comes together that makes it really hard to cope,” she said.

Chambers said untreated depression remains one of the leading risk factors associated with suicide.

She noted that men remain particularly vulnerable because they are less likely to seek professional help.

“I think when we’re looking at the fact that 80% of suicides in South Africa are by men, we know that men are four times more likely to die by suicide than women. They have very poor help-seeking behaviour. They’re not talking about their emotions, they’re not reaching out for help, they’re not seeking professional treatment. So their depression gets worse and that’s where it leads to thoughts of suicide,” she said.

To tackle stigma, Sadag has launched several awareness campaigns aimed at normalising conversations around men’s mental health.

“First and foremost is to create more awareness, creating more conversations where we’re using men as ambassadors, we’re using male mental health professionals, psychologists, psychiatrists. We’re encouraging really masculine, stereotypical men, the tough guy, to talk about something like mental health. So having ex-rugby stars or athletes or soccer players or even celebrities talk about mental health and the importance of getting help,” said Chambers.

The organisation has also focused on educating families and communities about recognising signs of depression in men.

“We’re empowering women who are wives, sisters, mothers, colleagues, cousins and girlfriends on how to identify signs and symptoms of depression in men, how to have those conversations, how to encourage support,” said Chambers.

Chambers said the growing concern around youth suicide predates the Covid-19 pandemic, but the crisis has become more visible in recent years.

“This isn’t something that just happened overnight. There has been no acute mass trigger. What we have seen is that this has been thrown in the forefront since Covid where we were all confronted with our feelings of stress and anxiety and depression,” said Chambers.

She warned that adolescents are among the most vulnerable groups.

“The majority age group that reach out to Sadag every single day are youth. Young people are saying, and we’re seeing it from the stats, that they’re not coping and that they’re not okay,” she said.

Among the factors affecting young people are unemployment, poverty, crime, violence and a lack of accessible community-based mental health services.

“We’re seeing that as young as teenagers, where young people are choosing, they’re dying by suicide at schools, they’re attempting suicide at schools. There is a huge issue with teen suicide. It’s happening younger and younger and it is very concerning,” said Chambers.

Recent data from the World Health Organization’s Global Health Observatory showed South Africa has the fourth-highest suicide rate in Africa, with 21.1 deaths per 100,000 people.

Chambers said she believes the true figure is likely significantly higher.

“I think that the stats that we do have are still really conservative. We know that suicide is still very underreported,” she said.

She said many cases are never formally recorded, particularly in rural communities, while weaknesses in reporting systems also contribute to gaps in the data.

Chambers also said that one in four calls received by Sadag is related to suicide and that, despite the challenges, increased awareness and improved help-seeking behaviour offer some hope.

“We are seeing men reach out more for help than we have in previous years. We are seeing more men in places of influence talking about their own mental health struggles,” she said.

She stressed that more safe spaces are needed where men can speak openly without fear of judgment.

“We need to be creating these safe spaces in the workplace, in our communities, in our churches and in our men’s groups,” she said.