Treated Men, Safer Women: The Case for Men's Mental Health as a GBV Prevention Strategy

On 15 December 2025, a man identified as Philani, 45 years old, was travelling with his wife in Mayville, Durban. An argument broke out between them on the road. He pulled over. He produced a firearm and shot her multiple times, killing her at the scene. He then turned the gun on himself.

They had recently married in a traditional ceremony. Two children were left behind.

The country read the story and scrolled on.

What no headline asked, and what this post will, is what was happening inside Philani before that car journey. What had accumulated, unaddressed, untreated, unnamed, over months or years. Not to excuse what he did; nothing excuses what he did. But because understanding the conditions that produced that moment is the only path to preventing the next one. Prevention is the only thing that would have kept his wife alive.

South Africa has committed billions to gender-based violence legislation. It has held shutdowns, passed laws, declared a national disaster, and placed femicide on the G20 agenda. It has done almost nothing about the untreated psychological crisis driving the men who kill.

The Argument This Post Makes

This is not a men's rights post. It is not an attempt to redirect the GBV conversation away from women. The violence South African women experience is real, documented, and catastrophic, and this platform has analysed it in depth in prior work.

What this post argues is something the public health literature has established with increasing precision: untreated mental illness in men, specifically depression, post-traumatic stress disorder, and substance use disorders, is one of the documented mediating factors in intimate partner violence perpetration. Machisa, Christofides, and Jewkes (2016), writing from the SAMRC Gender and Health Research Unit and the University of the Witwatersrand School of Public Health, conducted a randomly selected, two-stage clustered household survey of 416 adult men in Gauteng and used structural equation modelling to test whether poor mental health mediates the relationship between childhood abuse and male-perpetrated intimate partner violence. It does. PTSD, depression, and binge drinking were confirmed as the mediating pathways. Fifty-six per cent of men in that sample had physically abused a partner at least once in their lifetime. Twenty-four per cent had PTSD symptoms. The pathway from childhood trauma to adult violence runs directly through untreated mental illness (Machisa et al., 2016, PLOS ONE).

Research published in the South African Medical Journal in 2026, from the University of the Witwatersrand Department of Psychiatry, identified the same diagnostic patterns across perpetrators of gender-based violence and femicide: most are male, single, and unemployed, with commonly identified diagnoses including substance use disorders, intellectual disability, and personality disorders (SAMJ, 2026). The HSRC's first National GBV Study, published in 2024, confirmed deeply ingrained gender norms and power dynamics, strong cultural reinforcement of traditional gender roles, and a troubling acceptance of male aggression as defining features of the landscape within which South African GBV occurs (HSRC, 2024). Jewkes and Morrell (2018), writing in Men and Masculinities, argue that hegemonic masculinity, the dominant form of masculine identity that valorises strength, sexual conquest, and emotional invulnerability, is not a fixed trait but a socially reproduced set of practices that are sustained through both formal and informal enforcement. When those practices are built on suppression of pain, the consequences are not confined to the men who carry them.

The question this literature raises is not whether men who commit violence deserve sympathy. The question is whether this country is addressing the conditions that produce violent men, or simply waiting for those men to kill someone, and then responding with outrage and legislation that arrives too late.

South Africa has been doing the latter for decades. The outrage is justified. The response is incomplete.

What a Man Is Not Allowed to Feel

In South African communities, across multiple cultures, ethnic groups, and generations, a man is not permitted to be fragile. He is not permitted to be uncertain. He is not permitted to grieve visibly, ask for help, or name what is happening inside him. These are not abstract cultural norms; they are enforced codes of behaviour applied to boys from early childhood, codes those boys carry into adulthood as the only emotional grammar they know.

Connell and Messerschmidt (2005), whose foundational work on hegemonic masculinity remains the most-cited framework in gender and health research globally, argue that dominant masculinity is not a natural state but a social achievement, one that requires constant performance and that is policed by communities, institutions, and peers. In South Africa, Morrell, Jewkes, and Lindegger (2012), writing in Men and Masculinities, applied this framework directly to show that South African hegemonic masculinity is not singular but context-specific, shaped by race, class, and the particular legacies of apartheid-era social organisation. The common thread across contexts is the suppression of vulnerability as a condition of masculine identity.

Mokhwelepa and Sumbane (2025), in a systematic review of 47 articles published in the American Journal of Men's Health from the University of Limpopo, confirmed that traditional masculinity norms directly suppress willingness to seek mental health support. Five of the reviewed articles specifically documented that men expressed significant concerns about being perceived as weak or unmanly if they sought help for mental health problems. Three confirmed a direct link between masculinity norms and engagement in risky behaviours, including binge drinking, substance use, and emotional withdrawal, as coping mechanisms for unaddressed mental distress. A 2025 study on men's healthcare utilisation in Seshego, Limpopo, found that culture and masculinity beliefs are primary drivers of clinic avoidance, with men explicitly citing the belief that a real man does not fall sick, does not attend clinics, and does not expose weakness (Ledwaba & Peu, 2025). One participant captured it in language that no clinical instrument quite manages: men tend to be well until they are too late.

That sentence deserves to be read slowly. Not too late in the sense of delayed diagnosis. Too late in the sense of irreversible consequence.

Mogano and Letsoalo (2025), writing in BMC Psychology from North-West University and the University of South Africa, studied the effects of masculine culture on the mental health of Northern Sotho male youth specifically. Their findings confirm that in sub-Saharan Africa the male suicide rate stands at 18 per 100,000, considerably higher than the global average of 12.4 per 100,000. They document how cultural practices tied to initiation, manhood, and social roles produce expectations that are psychologically damaging when men cannot meet them, and that the same practices discourage the help-seeking that would allow those men to process what they carry.

Young et al. (2025), writing in Men and Masculinities (SAGE), found that across South African contexts, including both men who have sex with women and men who have sex with men, the pursuit of the "ideal man" is consistently associated with delayed healthcare-seeking and problematic substance use. Men who fail to embody the dominant masculine ideal face social penalty, not from institutions but from peers, family members, and communities that enforce the norm informally and relentlessly.

Brooda John @Nigeriangod_ identified something that Morrell, Jewkes, and Lindegger (2012) documented academically but that public discourse rarely names this plainly:

Patriarchy does not only harm women. It produces men who cannot process pain, cannot name it, cannot seek help for it, and who, without intervention, displace that pain outward onto the people closest to them. The research supports this; the streets confirm it daily.

The Scale of What Is Not Being Treated

South Africa's suicide rate stands at 23.5 per 100,000 people; the third highest on the African continent (SADAG, 2024; Kootbodien et al., 2020, International Journal of Environmental Research and Public Health). The South African Depression and Anxiety Group reports 23 recorded suicides every single day. Of the 13,774 suicide deaths recorded in 2019, 10,861 were male: 79% of all suicide deaths in a single year (Council for Medical Schemes, 2024; IntechOpen, 2022). Men are four times more likely to die by suicide than women. Approximately 450 men die by suicide every month in this country.

Suicide is the second leading cause of death among people aged 15 to 29 in South Africa (SADAG, 2024). Eseadi (2023), writing in the World Journal of Clinical Cases, identifies South Africa's male suicide rates as a public health emergency that intersects directly with untreated depression, alcohol misuse, and the structural absence of men-centred mental health services. A systematic review published in Psychiatry International (2024, published December 2024) found across 18 studies that hegemonic masculinity has a detrimental influence on both the occurrence and frequency of suicide among men, with a particularly significant impact on vulnerable men experiencing addiction, depression, or other mental health conditions.

These figures are not background statistics. They are the visible edge of a much larger body of untreated illness; the men who did not die by suicide but who are living with undiagnosed depression, unprocessed trauma, and accumulated pain that has nowhere to go.

Depression in men does not always present as sadness. The clinical literature documents a distinct male phenotype of depressive illness, characterised by irritability, sudden anger, risk-taking behaviour, substance misuse, and withdrawal from relationships. Cavanagh, Wilson, Kavanagh, and Caputi (2017), in a systematic review and meta-analysis published in the Harvard Review of Psychiatry, confirmed that men and women express depressive symptoms differently, and that the male presentation is the one least likely to be recognised as depression by either the man himself or those around him. Von Zimmermann et al. (2024), writing in the European Archives of Psychiatry and Clinical Neuroscience, specifically identified what they call "masculine depression": a pattern in which men use alcohol, drugs, overwork, and avoidance of psychiatric care as substitutes for naming and treating their distress.

This is why most depressed South African men are never diagnosed, never treated, and never offered an alternative to the coping strategies, including alcohol, aggression, and emotional shutdown, that their environment has normalised as masculine behaviour. Mokhwelepa and Sumbane (2025) found that men turned to substance abuse as a means of avoiding emotional expression, leading to a cycle of destructive behaviour that further deteriorated their mental health and, in some cases, escalated into violence directed at intimate partners.

Mahlangu et al. (2024), writing in Injury Epidemiology (Springer Nature), studied economic hardship and IPV perpetration by young men in South Africa during the COVID-19 pandemic. They confirmed that both income loss and food insecurity function as IPV catalysts, mediated through mental wellbeing. Their findings extend Gibbs et al.'s (2018) earlier cross-sectional work in PLOS ONE, which found that poverty, mental health deterioration, substance use, and gender power imbalances are structurally associated with IPV perpetration in South African urban informal settlements. The economic crises this platform has documented elsewhere, including unemployment, structural exclusion, and the indignity of poverty in a country that exports food, are not separate from the mental health crisis; they feed it.

The Infrastructure That Does Not Exist

There are 14 dedicated men's health clinics in Gauteng. One in Cape Town. Five in Limpopo. In a country of 62 million people, with a documented male suicide emergency and a femicide rate more than four times the global average, the public health infrastructure built specifically to reach men is negligible (South African National Integrated Men's Health Strategy, 2020 to 2025).

A 2024 study on the design of public men's clinics found that the few that exist are not built with men in mind. Condition-specific queues publicly expose health diagnoses, breaching privacy in ways that reinforce the stoicism driving men away in the first place (Mathenjwa & Maharaj, 2024). The physical environment communicates, before a word is spoken: coming here is an admission of weakness. Consequently, men do not come. Kim and Yu (2023), in a scoping review published in the Journal of Men's Health, confirm that mental health interventions tailored specifically to masculinity, delivered in male-appropriate settings without requiring public disclosure of vulnerability, are consistently more effective at engaging men than standard clinic-based services. South Africa has almost none of them.

The SA Federation for Mental Health, in a 2024 report titled "A Silent Pandemic," notes that poor mental health among men is directly linked to the high rates of gender-based violence in South Africa, citing Gema (2023) and Ngwenya and Sumbane (2022). The report identifies the same pattern this post is arguing: men face the expectation to remain strong and silent in the face of extraordinarily difficult challenges; and when that expectation is internalised without any outlet, it produces outcomes that extend far beyond the individual man. The South African Society of Psychiatrists, speaking through Newzroom Afrika in December 2024 during the 16 Days of Activism Against Women and Child Abuse, called publicly for urgent interventions to address mental health problems facing men; explicitly connecting untreated male mental illness to gender-based violence. Dr Wisani Makhomisane stated the link directly, on national television, to an audience of nearly 9,000.

The connection is not contested in the clinical literature. It is simply not reflected in how this country spends money, trains health workers, or designs the spaces where help is supposed to be available.

South Africa has built a culture that celebrates endurance as strength, in men especially. The cost of that confusion is not abstract; it is paid by women and children, in the most intimate spaces of their lives, by men who were never given another way to cope.

What the Public Is Actually Saying

The conversation on X is divided in ways that are analytically important, because that division captures the full complexity of what this post is arguing. What is striking is not just what people say; it is how closely what they say mirrors what the peer-reviewed literature has been documenting for decades. The alignment between social media discourse and academic findings is itself a methodological argument for treating public digital voices as legitimate research data.

There are those who follow the data to its logical conclusion. Lungile Ndaki @Ndusi27, responding to the HSRC's first National GBV report in November 2024, wrote without equivocation: "South African men need to prioritise their mental health." This reflects what the HSRC (2024) itself documented: that gender norms and power dynamics are the structural context within which GBV occurs, and that addressing those norms requires engaging men, not only sanctioning them. Whipstick @Whipstick14, citing SADAG data in March 2025, named the 23 daily suicides and the four-times-higher male mortality rate, a figure confirmed by both SADAG (2024) and the Council for Medical Schemes (2024), and called explicitly for targeted mental health interventions and support systems for men.

There are those who recognise the cultural trap from within it. Zulu fox @fatherrwethu offered something rare, a man speaking honestly about what accountability requires:

Gibbs et al. (2023), writing in Global Health: Science and Practice, examined the Stepping Stones and Creating Futures intervention among young men in South African informal settlements and found that treating depression mediates the reduction in IPV perpetration. The intervention works not by telling men to stop being violent, but by addressing the underlying mental health conditions that produce violence in the first place. Zulu fox's observation, confront the trauma transparently, is the lay articulation of exactly what that evidence shows.

Then there are voices that make the analysis uncomfortable, but that belong in it precisely because of that discomfort.

Mo the Mbokodo @imbokodos, responding directly to the Philani murder-suicide in December 2025, wrote: "They don't want mental health support; they want submission by any means necessary. Let's stop acting like the majority of Black South African men want help. They call those who seek help 'simps'." In a second post on the same day: "The majority of Black South African men don't want emotional intelligence workshops or mental health workshops. They hear 'no' and get emotional, respond with violence, and blame women for their own poor emotional regulation."

These observations are uncomfortable because they are, in significant part, accurate, and because the research supports them. Mokhwelepa and Sumbane (2025) found that the fear of being judged as less masculine was the most consistently reported barrier to help-seeking across 47 reviewed studies. The culture does police itself. Ling Dior on X documented the enforcement mechanism directly: a South African man opened a Facebook page to speak openly about his mental health struggles, posting resources and encouragement for other men. Other men arrived in his comments and mocked him. The post reached 88,000 views. The mockery was the point. This is what Folorunsho (2025), writing in Sociology Compass, describes as the social policing of masculine norms: older and established men experience shame when they are unable to meet gendered expectations, and they reproduce that shame in men around them. The culture is not only imposed from outside; it is internalised and enforced from within.

That is not incidental. That is the culture performing itself, publicly, efficiently, and at scale.

That post reached 137,000 people. It is instructive not because it is correct, but because it reveals precisely the distortion this post is arguing against. The idea that women's emotional availability is the solution to men's mental health crisis is not only empirically unsupported; it is the precise inversion of the evidence. Young et al. (2025) found that traditional gender norms compound mental health vulnerability for both men and the women around them. Placing the burden of men's emotional regulation onto women, who are already managing the consequences of men's unprocessed pain, is a cultural logic that the research literature identifies as part of the problem, not a remedy for it. It circulated without serious challenge to 137,000 people.

The counter-argument is not that men do not need support. It is that the support must come from systems, institutions, and communities, not from women who are already managing the cost of men's silence.

What the Research Requires; and What Policy Has Not Done

A 2025 scoping review published in HTS Theological Studies, examining Christian communities and intimate partner violence across sub-Saharan Africa, found that pastoral interventions frequently lack trauma-informed care; with forgiveness narratives, marital submission theology, and "spiritual battle" framings displacing survivor-centred responses (Crowe et al., 2025). This matters because the church is often the first institution South African men and women approach in crisis; and it is systematically unprepared for what it receives.

South Africa's National Strategic Plan on Gender-Based Violence and Femicide, running from 2020 to 2030, makes almost no provision for the systematic mental health treatment of men as a prevention strategy. The focus is, correctly, on survivor support, legal reform, and institutional accountability. But a ten-year plan to reduce femicide that does not address the mental health of the men committing it is a plan built on an incomplete analysis of the problem. Bantjes, Kagee, and Meissner (2017), writing in the South African Journal of Psychology, found that young men in post-apartheid South Africa are capable of engaging with questions about masculinity and mental health when given the space to do so; but that public health policy has consistently failed to create those spaces at scale.

The mediation pathway from childhood trauma to adult violence through untreated mental illness is now established across multiple South African studies (Machisa et al., 2016; Gibbs et al., 2018; Gibbs et al., 2023). The Stepping Stones and Creating Futures intervention, studied by Gibbs et al. (2023) in Global Health: Science and Practice, demonstrated that when depression is treated in young men living in urban informal settlements, IPV perpetration decreases. This is the intervention proof. The evidence exists. The programmes, at any meaningful scale, do not.

Mahlangu et al. (2024), in Injury Epidemiology, confirmed that economic hardship mediates the relationship between stress and male aggression; meaning that the unemployment crisis, the food insecurity crisis, and the mental health crisis are not parallel emergencies. They are the same emergency, expressed in different registers. Policy that addresses one whilst ignoring the others will not move the needle.

The newly established National Council on Gender-Based Violence and Femicide must incorporate male mental health intervention as a documented prevention pathway, not as a concession to men, but as an evidence-based requirement for women's safety. Community health worker training must include mental health referral pathways specifically designed to reach men, delivered in environments that do not require public disclosure of illness. Kim and Yu (2023) confirm that masculinity-tailored interventions in non-clinical settings produce better engagement outcomes than standard services. Mkwananzi and Nathane-Taulela (2024), writing in Frontiers in Global Women's Health, found that the people closest to the GBV crisis remain the least consulted in designing responses to it, a structural failure that applies with equal force to the men's mental health question. Workplace wellness programmes, particularly in sectors with high concentrations of low-income male workers, must be funded as prevention infrastructure rather than discretionary benefit.

The Child Support Grant, currently set at R560 per month against a food poverty line of R796, is producing food-insecure households in which male frustration, already untreated, is compounded by economic humiliation (Patel et al., 2025). As Mahlangu et al. (2024) confirm, food insecurity is not only a hunger crisis; it is a documented IPV catalyst. As this platform documented in its analysis of child malnutrition, these are connected systems. Policy must treat them as such.

A Final Word: To Everyone

To South African men: the culture that tells you that asking for help diminishes you is not protecting you. It is isolating you, and producing, in some of you, a level of internal pressure that eventually finds an outlet. The people who pay for that outlet are not the system that failed you; they are the woman beside you, the children at home, the community that loses another person to something that was treatable.

Seeking help is not weakness. It is the hardest thing the culture will ever ask of you. Do it anyway.

To the institutions: the Department of Health, the National Council on GBV and Femicide, the SA Society of Psychiatrists, the churches, the employers, the ward councillors. The research is settled. Untreated mental illness in men drives intimate partner violence. Men will not come to you; you have to go to them, in forms and in spaces that do not require them to perform vulnerability publicly. That is a design problem. It is your design problem. Solve it.

To South Africa: we cannot keep declaring GBV a national emergency whilst ignoring one of its documented upstream causes. The women of this country deserve a comprehensive response, one that supports survivors, prosecutes perpetrators, and systematically addresses the conditions that produce violent men. All three. Not two of three.

Philani's wife deserved to come home from that drive.

Her name was not widely reported. She did not receive a candlelight vigil. She did not receive a hashtag.

She left behind two children who now have neither parent.

That is what untreated pain costs. And South Africa keeps paying it.