Maverick Citizen

The Sadag story — how one woman set up a mental health helpline for the whole of South Africa

Sadag operates three call centres, staffed by over 300 counsellors who respond to callers in varying states of distress, including active suicide calls. (Photo: Supplied)

By Sean Christie

23 Oct 2024

Zane Wilson founded the South African Depression and Anxiety Group in 1994, in the midst of her own debilitating struggle with panic disorder. Thirty years later, the group is the largest and most impactful mental health organisation in South Africa. Bhekisisa’s Sean Christie found Wilson and several of Sadag’s staff in a proud and reflective mood.

Many notable nongovernmental organisations (NGOs) in South Africa today operate almost like secretarial services for the government, doing work that should be the preserve of the department they support.

Nowhere is this dynamic more entrenched than in the sphere of mental health services. On the Health Department’s website, for example, the listed helpline for mental health services belongs to a nonprofit: the South African Depression and Anxiety Group (Sadag).

Sadag is something of an enigma among homegrown NGOs – and not simply because it’s outlived almost all of its peers (Sadag turned 30 in April 2024). NGOs typically depend for their survival on funding, and the extent to which they’re able to raise funds usually depends on the sort of stories they tell in the public sphere. Sadag, however, doesn’t talk about itself in public – there are no emotive Sadag videos or posters in circulation.

How, then, has Sadag survived?

To find out, I contacted the organisation’s founder, Zane Wilson, who has been living abroad since 2023.

On a shaky line Wilson says: “Before we go any further, can you please tell me a bit about yourself?” And she ever so charmingly proceeds to interview me. After a few minutes of this I ask permission to return to the story of Sadag.

“It’s important to establish the context,” she says in a raspy voice.

“Thirty years ago, people simply did not talk about ailments like depression, anxiety and schizophrenia. There were very few nonprofits working in mental health, and the few that did dealt mostly with severe mental health conditions, such as schizophrenia and bipolar disorder. There was a directorate of mental health and substance abuse in the National Health Department, but its resources were likewise largely directed towards the management of severe conditions, and precious little attention was given to the more common mental health issues, such as anxiety and depression. This is the context in which I found myself struggling with wave after wave of panic attacks,” says Wilson.

Sadag Zan Wilson At Zane Wilson’s first community support meeting for people struggling with panic disorder, she put out 20 seats. ‘Nearly 100 people arrived,’ she remembers. (Photo: Supplied)

Here I interrupt, and ask to be taken back in time, to her upbringing in England.

“I was born in 1948 in Skegness, a resort town for people who can’t afford European vacations. The place is still dominated by arcades filled with one-arm bandits, helter-skelter rides and Skegness Rock, which is a type of candy where the name runs all the way through,” Wilson says matter-of-factly.

Her family owned a small hotel, which Wilson’s mother ran, much aided by her daughter.

“I would cycle home from school every day at noon to serve my mother’s lunchtime guests, and do the same thing again at 4pm in time for the evening sitting. We worked, my mother and I – it was through her that I developed my love of business,” says Wilson, who on a recent return visit found her mother, now 97, “still in great shape”.

To avoid being enrolled in a nearby college by her parents, Wilson ran away to London at the age of 16. Lying about her age, she found work with an employment agency by day, and in a Mayfair pub by night. London “worked” for Wilson, but she wasn’t ready to settle down.

She became enthralled by a South African digs mate’s stories about her home country. The South African government was inviting immigration at the time, and paying for airfares, so Wilson booked a flight, and landed at Johannesburg’s Jan Smuts Airport (today OR Tambo International) just before her 21st birthday. She needed paying work, and found it in a Rosebank employment agency. After just four months she decided to go on her own, opening a shop in the old arcade on the corner of Commissioner and Market streets in downtown Johannesburg.

“There were very few employment agencies in Joburg at the time, and those that existed tended to be on the fourth floors of buildings, hidden away,” says Wilson, who saw an opportunity to build a highly visible business, “easily accessible from street level and very welcoming, with the windows open and the available jobs listed on whiteboards”.

Her agency took off, but by 5pm the Johannesburg business centre was deserted. So Wilson opened another agency in a mall in residential Hillbrow, which she staffed herself from 6pm to 9pm each night.

“That’s what I did, and that’s how I’ve continued to approach life, always looking for opportunity, never getting too comfortable with one thing,” she says.

When panic struck

Wilson had built and sold several successful businesses by the time she had her first panic attack – an adverse reaction to medicine. After the first one there were more, increasing in frequency until she became “totally debilitated”.

“Nobody I saw, whether GP or psychologist, could give me a clear diagnosis, and none of the blood tests or lumbar punctures that were performed on me shed any light. Nothing I was prescribed helped to change my reality, which was one in which I was not even able to shop for groceries without experiencing an attack, or drive a car, for that matter.”

Today, panic disorder, with symptoms that include hot and cold flushes, shaking and sweaty palms, is widely recognised and highly treatable – many people who suffer from it recover fully if they receive the right combination of therapies.

Wilson’s search for help took her to England and the US, but ultimately the relief she sought was right under her nose, in the form of Michael Berk, a former psychiatrist with the University of the Witwatersrand’s school of medicine, and now teaching at Deakin University in Melbourne. He was quick to diagnose Wilson with panic disorder, and although the first type of medication he prescribed did not help, the second brought about a remarkable change. Wilson’s panic attacks completely ceased – and they have not returned.

“Imagine my relief at discovering that this thing that had collapsed my life is in fact very treatable,” says Wilson, who in conversation with Berk came to a much clearer understanding of the yawning gaps in care for people with mental health conditions.

“The lucky ones had access to a doctor who knew something about mental health conditions. But for the rest, in the pre-internet era, there was no help,” she says.

Berk spoke about the importance of peer support, particularly, and Wilson felt galvanised to take action, organising, with him, a meeting for sufferers of panic disorder at the Sandton Library in Johannesburg. She put out seats for 20, but nearly 100 people arrived, some having travelled from neighbouring provinces.

Sadag Community events such as this one take mental health awareness to communities, helping to reduce stigma. (Photo: Supplied)

The end of the meeting marked the start of the first support group for sufferers of panic disorder, which rapidly grew. Soon one of the original members, Peter Mamtlhaela, started a second support group in his rural hometown of Siyabuswa.

In a history Sadag commissioned to mark its 30-year anniversary, Mamtlhaela’s is recorded as saying that his condition was triggered in 1991, following a serious car accident.

“The first attack happened on the second day after the accident. At that time I was strapped to the bed so I didn’t make any movements, because my bones were broken. I suffered through that first attack, with those heart palpitations, the fever and the fear that you are going mad,” he wrote.

A call for help

It went on like that, with new groups being started closer to people’s homes but remaining connected in an ever-growing network. Wilson continued to advertise in community newspapers, often listing her own number as contact, and soon the volume of people calling for advice was unmanageable, leading to the birth of the first Sadag call centre, domiciled in Wilson’s dining room and staffed by Wilson and friends.

It wasn’t long before her for-profit and not-for-profit work became enmeshed.

“One of the problems I identified early on was the lack of experience in mental health among doctors, and I wanted to be able to get 80 to 90 of them at a time on a group call to listen to experts sharing,” says Wilson, who approached Telkom (the country’s main telecoms service at the time), but was told they couldn’t do much more than host a handful of people on a call at one time.

She eventually found the software she was looking for in the US.

“I went to this company and said if you let me bring your product into South Africa, I’ll get the pharmaceutical companies to pay for it, because it will enable them to interact with dozens of doctors and pharmacists at a time. They came in with me 50%,” says Wilson, who soon built a lucrative business around the teleconferencing product. When she sold her share back to the parent company, it was with the proviso that Sadag would be allowed to continue to use the service for free.

“I was lucky to have started two or three good businesses that helped raise funds for Sadag, along with all of the expertise that came from building up those businesses, and a lot of the equipment and systems, too. This enabled us to keep our hotline free,” says Wilson.

Zane Wilson has been the driving force behind Sadag’s success for 30 years, with the organisation becoming such a prominent player in mental healthcare in South Africa that its phone number is listed as the helpline on the Health Department’s website. (Photo: Supplied)

There have been lean years too, though, of which Wilson says: “We would do whatever we needed to do to keep going. One year we sold these giant Christmas trees in Sandton for between R100 and R300. Other years, I’d sell lunches with personalities like Mark Shuttleworth and the late Desmond Tutu. I always kept ideas and some money in reserve and I still do, because if it happened once that we ran low, it will again.”

For her efforts in building Sadag, Wilson was presented with the Order of the Baobab in Bronze in 2012, by then president Jacob Zuma.

Sadag at 30 – the big voice in mental health

Today, Sadag operates more than 30 helplines, and maintains more than 180 support groups, all supported by 300-plus counsellors. Their monthly phone bill alone is more than R150,000.

“We’re beyond being able to cover costs with bake sales,” says Sadag’s director of operations, Cassey Chambers, who joined the organisation 18 years ago as a volunteer.

The group doesn’t receive a cent in government funding.

“On the one hand that’s hard to swallow, given what Sadag does. On the other hand, financial independence enables us to advocate strongly to the government for improvements with regard to mental health,” says Chambers.

The value of that independence was highlighted in 2015, when counsellors working in Sadag’s Johannesburg call centre began receiving calls from concerned family members of state psychiatric patients, who had heard rumours that the Gauteng health department was about to terminate its long-term contract with psychiatric care hospital, Life Esidimeni.

Sadag began pushing for answers, and in October 2015 the province’s health MEC announced that the department had cancelled the contract, and that patients would duly be removed to the care of NGOs.

Sadag’s network gave the organisation singular insight into the situation on the ground. From the calls they received it was clear that the department’s plan was deeply flawed. This led Sadag to join SECTION27 in taking the department to court, forcing a pause in the transfer of patients to allow for proper consultation with their families. Ultimately, patients were transferred to 20-odd NGOs, almost none of which was operating under a valid licence. At least 144 patients died. Throughout this saga, Sadag’s Life Esidimeni support group was there for the families and the bereaved.

Earlier this year, I spoke with Christine Nxumalo, who lost her sister in the Life Esidimeni debacle, and whose own family was torn apart by the tragedy.

Said Nxumalo: “If it wasn’t for the support we received from Sadag, I honestly don’t know where we would be.”

‘Mental health is the new pandemic’

For Chambers, Life Esidimeni spotlighted the place of mental health in South Africa.

“Behind that tragedy lay a reality of high stats, poor infrastructure, a shortage of personnel and inadequate funding – the stuff of a full-blown mental health crisis.”

The Covid-19 pandemic amplified all of these issues.

“Mental health is the new pandemic,” she says. “We have the data from our call centres. We can show the huge surge in calls in recent years, and even increased reports of young people who are dying by suicide at school and across communities.

Sadag’s Counselling Containers of Hope offer mental health services in communities that had little or no access to these previously. (Photo: Supplied)

The response, she says, is not keeping pace with the problem.

South Africa has good mental health policies, but according to Chambers they’re not being implemented. Personnel shortages are among the country’s most pressing challenges.

“Of the number of registered psychiatrists in South Africa, the overwhelming majority work in the private sector,” says Chambers.

It gets even hairier when you talk about psychologists, she adds. A study shows that in 2015 there were just more than 4,600 psychologists in the country, which, based on the population size then, works out to about eight of these therapists per 100,000 people. While better than in most African countries, it’s fewer than in, for example, Brazil (12 per 100,000) and Cuba (31 per 100,000) and almost 13 times lower than in Australia (103 per 100,000).

The answer, she believes, is decentralising mental health services, together with training more health workers like registered counsellors and lay counsellors, and having enough funding for this.

“Over the years, less than 5% of the national health budget has been allocated to mental health, and [about] 85% of that is for inpatient psychiatric services in specialised hospitals like Sterkfontein and Weskoppies. But not everyone with a mental health issue needs to see a psychiatrist. It’s not like if you’d see a heart surgeon for chest pains on your first appointment – but that’s exactly how the referral pathways work in mental health.”

A good place to start, says Chambers, would be with the learner support agents (LSAs) whose job it is to offer counselling services at schools.

“Many LSAs are desperate to have training on mental health and psychosocial issues, because that’s what they’re seeing in the schools. We have incredibly high teen suicide rates. Doing this should be easy because the LSAs are already being paid for,” Chambers says, insisting that Sadag’s advocacy is entirely informed by the data that comes through the call centres.

“The projects that we’ve done, whether it’s support groups or outreach or training, have all been based on what people are calling in about. Sadag may have branched out in recent years, but its heart remains the call centre and helping people every day who call in for help .”

Intense counselling, intense debriefing

From humble beginnings, Sadag’s Johannesburg call centre now occupies two floors of a building in Rivonia, and there are smaller centres in Cape Town and Durban.

The one in Cape Town is two years old, housed in a newish development in an area of carbon-copy houses that seems to have been landed all at once on the sandy white soils of Milnerton, about 15km northeast of the city centre. Stains on the perimeter walls give away the colour of the groundwater used to irrigate rows of wild garlic.

It’s an unlikely site for a hub of mental health crisis support, but the rooms are offered gratis by the landlord, which aligns with Sadag’s focus on investing every available cent in its services.

I’m met by senior counsellor and call centre manager Kia Cordeiro, who is well within her twenties. Behind her, in the office, heads float above desks. A few figurative paper butterflies have been pasted on otherwise bare walls.

“In the Joburg offices they have headsets, but here, for now, we just use our cellphones,” she says.

Rochelle Sampear, one of the permanent staff members at Sadag’s Cape Town call centre, briefs counsellors in training Nontlahla and Lihle. (Photo: Supplied)

The office is preparing for a shift change. The team of 68 – mostly volunteers – are assigned to three separate shifts, with three permanent workers across the day shifts. At night it’s only permanently employed counsellors manning the helplines, and they work from home.

It’s hot, and late in the day close to the end of a long week. Permanent staff Rochelle Sampear, Karla Heynemann and Huimei “LuLu” Lu, and volunteer Ashley Mahlunge, have stayed on to talk with me.

When I ask what a typical day in the call centre is like, glances and smiles are exchanged. There’s no such thing.

“You never know what you’re going to get,” says Cordeiro. But after some thought, she adds: “A typical day consists of intense counselling, followed by intense debriefing.”

I change tack, and ask what makes for a hectic shift.

Again, there are smiles and looks – because they’re mostly hectic.

Heynemann ventures an answer.

“You can get a hectic shift where you can help a lot of people, or you can get a hectic shift where you have one or two calls that are quite hectic, especially when it’s active suicide calls.”

An active suicide call is where someone has actually done something to harm themselves, or in an attempt to take their life.

“It could be an overdose, or someone with a gun in their hand, or trying to use a rope. I’ve heard everything – from [someone] taking rat poison to drinking bleach or brake fluid,” says Heynemann.

Cultures and counselling

Calls from all over the country are routed to the Cape Town centre, giving counsellors a strong sense of different regions’ particular burdens.

In the Western Cape, says Cordeiro, “it’s substance issues, it’s gangsterism and living in communities with a lack of resources, a lack of accessibility to mental healthcare”.

There are many cases involving children: teen suicide, abuse and neglect.

“We also receive quite a few calls from kids whose parents had little in the way of formal education, and the child is perhaps the first person in the family to be in matric. The pressure to do something for the family is so immense that the child crumbles, and the family lacks the know-how to support them,” Cordeiro says.

To handle such calls, volunteers receive 12 weeks of training, split between theoretical and practical components. Many of them are psychology or social work university students – people with a strong theoretical background and who are looking to beef up their practical experience.

“A lot of the content that we learn at university is grounded in Western psychology and often it can’t be neatly applied in the South African context,” says Lu.

This is a big subject, and there’s ongoing debate about what African psychology is, or could be. I ask if the culture of the counsellor makes a difference to the caller.

“Language makes a difference, for sure,” says Heynemann, relating the palpable relief of Afrikaans callers when they find out that Afrikaans is her home language. Where possible, Sadag routes calls to counsellors who share the same first language, but given the many different mother tongues spoken in South Africa, this isn’t always possible.

“You should be able to help regardless of differences in culture,” Sampear suggests, explaining that they follow the Rogerian approach, otherwise known as person-centred therapy.

“One of the core principles of this is to have unconditional positive regard, which means that you should put your own bias aside. Instead of judging a caller’s actions or deeds, you should communicate complete support and acceptance. Then cultural differences between caller and counsellor become less important.”

‘Leave a little love and let it go’

When it comes to motivations for volunteering in this space, several of the team members I spoke to said their personal mental health struggles, and the difficulties they faced in trying to find help, played a part.

“I come from a coloured community where there’s a lot of stigma around mental health. I had no one to guide me in the right direction. After doing my own research to steer my healing process, I decided to become a clinical psychologist, so that I could work with people who, like me, struggle with mental health,” says Sampear.

Lu says it was the same in the Asian-South African household she grew up in.

“I was not even aware of what psychology was until university, but once I found my space in this field, I knew that I was meant to be here. Psychology not only allows you to understand the people around you, but it also helps you understand yourself. You develop a lot more grace and empathy for people in a world where they are often misunderstood,” she says.

Sadag operates three call centres, staffed by more than 300 counsellors who respond to callers in varying states of distress, including active suicide calls. (Photo: Supplied)

I’m struck by the fluency of the counsellors, no doubt a by-product of thousands of hours spent talking on the phone. What does it cost them, I wonder?

“What gets me is the crying,” says Heynemann.

“We get quite a few calls every day where people are crying. But there’s a specific type of cry where you can really hear the pain in someone’s voice, and that’s heartbreaking – those are the calls that usually sit with me for about a week or so.”

Sampear is haunted by a call she received from a young woman whose mother had physically, emotionally and psychologically abused her for years.

“The sadness in her voice was so deep. Her phone battery was about to die. She told me not to call back as her mom would be upset. I wish I could have done more for her.”

Mahlunge remembers one of the first male callers he talked to.

“He was deeply upset by his failings as a father. All his life he’d told himself he won’t be like his own father. He wanted to break that cycle, but had ended up being just like his dad. It stayed with me because it flew in the face of the belief that most men avoid seeking help.”

Sadag’s training and culture emphasises to counsellors that they do not have to fix people’s problems.

“We are there to hold space for the caller, and to guide them to their next possible solution. We don’t have a magic wand. But we can listen, talk and come up with an action plan that’s really practical, because we’ve visited the clinics and worked in these communities, so we understand the challenges,” says Cordeiro.

To help them cope with the relentless exposure to sadness, trauma and crisis, Sadag’s counsellors are constantly debriefing – whether it’s the routine unpacking of calls with experienced supervisors or the ongoing interplay between colleagues in the office, sharing tips and advice. On a table stands a jar with a label “Leave a little love and let it go”.

Says Cordeiro: “Often counsellors take home the worry of never knowing how a call ends. Did the person take their life? Did they survive? The jar is there to remind us all to put down what is not ours to carry, and we do that mainly through sharing with colleagues. Never underestimate the power of a group of people sharing an experience.”

Government to step up

Wilson, who admits she habitually lied about or obscured her true age for much of her life – “I never wanted to be judged on that” – turned 76 this year. She remains very much at the helm of Sadag, but speaks with the urgency of someone all too aware of life’s vicissitudes.

“There’s so much to do, but nothing is more important than creating spaces in communities from which counsellors can work safely and effectively,” she says.

“This can be basic infrastructure, like a mobile clinic or a converted shipping container. We’ve shown this works. In Diepsloot and Ivory Park [in Gauteng] we have two converted containers costing around a million rand a year to manage, which isn’t much given that they accommodate four or five counsellors. [These units] service populations of around 300,000, doing vital outreach to clinics and schools. There should be 50 in the country, not two,” says Wilson, with something nearing anger in her voice.

Sadag, Wilson feels, has shown how the government’s progressive policies can be practically and affordably translated into structures and systems, and while the organisation is here to stay, her message is clear: it’s time for the government to step up and do its part. DM

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.

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