Red curtains and ceiling drapes create a pink-tinged glow inside the run-down community centre, an hour south of Johannesburg, where Palesa Hlohlolo tells her neighbours about her experiences of domestic violence.
“I’m not a punching bag and I’ll never be one. For anyone,” she says, grabbing a tissue from a rapidly emptying box.
Every Wednesday, 30 women meet here at Orange Farm township for an hour, their notebooks decorated with stickers spelling out “COURRAGE”. Each letter represents a session’s theme in an eight-week group counselling programme, which asks participants to reframe trauma as stories of survival and strength.
It is an idea from Ncazelo Ncube-Mlilo, a Zimbabwean psychologist who has dedicated her career to developing “culturally sensitive” therapeutic tools.
Her charity, Phola, reaches more than 10,000 women, men and children in townships around Johannesburg every year. And the need is immense: one in four experience depression or anxiety in a country which remains plagued with high rates of unemployment and violence, and ranks among the lowest globally for mental wellbeing.
“Today, we are on the second R of COURRAGE: ‘Reframing’,” says Karabo Ramabulana, the session facilitator. “Why do these problems exist in our lives?” Past meetings have included “celebrating” survival and “remembering” the hardships.
Penelope Mokgele, 43, talks about her son’s drug use. “It’s a pattern: my brother used to smoke, and now it’s my son,” she says.
“I think we are hurt as black people, and we bottle it up. The more we talk – not just as a person, but as a family, a group – the more it will help.”
Hlohlolo raises her hand. Thirteen years ago, she was caught in the crossfire of a shooting on her way to work. She woke up in a body bag, having been taken for dead. Seriously injured, it took her months to relearn how to walk.
“After all the challenges I’ve been through, I’m thankful because now I can be open to help others,” she says.
The sessions have been an “eye-opener”, says Hlohlolo. “To come here and see I’m not alone, that someone else’s problems are bigger than mine but we have the same mentality, it helps.”
Mental health in South Africa is rooted in past oppression, Ncube-Mlilo believes.
“Not enough was done to respond to the impact of apartheid on people’s lives: the trauma was left unresolved and has had ripple effects in communities, families, schools and everywhere.”
With fewer than one psychologist for every 100,000 people, mental health support at state clinics focuses on the most acute conditions. “If we talk about day-to-day coping with stress, anxiety and depression, there is very little [help] available,” says Ncube-Mlilo. Stigma exacerbates the problem.
In the early 2000s, Ncube-Mlilo was working with HIV/Aids orphans and finding that accepted therapeutic tools were poorly suited for these children, so she designed the Tree of Life, a programme using the tree metaphor to talk about heritage, hardships and dreams.
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The method has since been used in more than 40 countries, including the UK. “My work is better known internationally than in the country I live in,” says Ncube-Mlilo. In 2016, she founded Phola – “heal” in Zulu – to provide “an African solution for African people”.
“It’s about moving away from the therapist being the expert, and locating expertise within communities,” says Ncube-Mlilo.
At first she drove her camper van around Johannesburg to hold sessions. Now, 40 staff run programmes in schools, clinics, trailers and community halls, on a shoestring budget.
Funding comes mainly from international donors and foundations – government support stopped this year as budget cuts bite.
Participants have gone on to form their own support groups. “That’s exactly what I was hoping for: that people can move from vulnerability to a place of strength,” she says. “For me, that is evidence of healing.”
Lerato Magongwa, 40, joined an 11-week Phola programme called “OUTRAGED’” after losing his job in 2022. “As a man, you grow up with many expectations: you need to be a leader, a provider, a protector.”
Sessions gave him “an opportunity to roar out my anger and problems”.
“After that storm is gone,” says Magongwa, “you can see clearly and continue with your life.”
He now runs a men’s forum in Orange Farm. “Now we are there for each other,” he says. “If one of us is going through something, we are just a call away.”