Counselling within South Africa's public health system: Mental healthcare users' experiences.

Background: South Africa faces a significant mental health treatment gap, with many individuals in need unable to access adequate psychological care. Registered Counsellors (RCs) were introduced to reduce this gap, particularly in impoverished communities, by offering accessible, affordable psychological services. Aim: This article forms part of a broader study on the integration of RCs into public healthcare and specifically explores the lived experiences of mental healthcare users who received counselling from RCs within the Western Cape Department of Health and Wellness. Setting: The sampling and interviews were conducted in primary healthcare clinics within the Western Cape Department of Health and Wellness. Methods: An exploratory qualitative design was employed, using purposive sampling to recruit 10 participants. Semi-structured interviews were conducted and analysed using thematic analysis. Results: Four major themes were generated: (1) confronting stigma and misconceptions around counselling, (2) uncertainty about the role of RCs, (3) developing agency and self-reflection through counselling, and (4) recognising the transformative impact of counselling. Findings indicate that RCs play a vital role in providing first-line psychological support by creating non-judgemental spaces that promote self-reflection and emotional processing. However, the study also reveals persistent stigma surrounding help-seeking and a limited public understanding of the RC's role. Conclusion: These insights underscore the need for clearer role definitions, enhanced public awareness and policy reforms to enhance the integration of RCs within primary healthcare. Contribution: Enhancing mental health literacy across communities remains essential to achieving equitable and effective service delivery.