Between privilege and poverty: Mental health inequality with Claire van Dyk
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I sat down with Claire van Dyk, an HPCSA-registered counselor working for the Western Cape Department of Health, and honestly, this conversation shook me. Claire reached out to be on the podcast because she's passionate about having uncomfortable conversations about mental health care inequality in South Africa—and we went there. We traced how colonialism and apartheid created the massive discrepancy between private and public mental health services that we're still living with today.
The numbers tell the story. One psychiatrist for every 3.3 million people in rural public areas, sometimes none at all. Eighty percent of our population depends on public healthcare, but only 5% of the health budget goes to mental health. Claire describes sessions in rooms without locks, folders going missing, months-long waiting lists, and cases far beyond what her scope technically covers. Not because she's overreaching, but because the need is that overwhelming.
I told Claire I felt the same during my community service. We both trained as caring professionals wanting to help, then found ourselves trying to offer something meaningful in chaotic, under-resourced environments while clients dealt with ongoing trauma. We landed somewhere unexpected, though. Maybe the work isn't about having every clinical tool to fix everything. Maybe it's about being present with someone for 30 minutes who finally gets to be heard without judgment. We explored what's actually in our power versus what we have to accept as unresolvable, and why that's not the same as giving up.
Follow Claire on:
Linkedin: https://www.linkedin.com/in/claire-van-dyk-507aa9101/
Instagram: https://www.instagram.com/capetowncounsellor/?hl=en
Facebook: https://www.facebook.com/CapeTownCounsellor/
Follow Carly on:
Website: https://onthecouchwithcarly.com/
YouTube: https://www.youtube.com/channel/UCfBi56xQookfRGL3zvWVzCg
Instagram: https://www.instagram.com/onthecouchwithcarly/?hl=en
Facebook: https://www.facebook.com/onthecouchwithcarly/
TikTok: https://www.tiktok.com/@onthecouchwithcarly
Apple Podcasts: https://podcasts.apple.com/za/podcast/on-the-couch-with-carly/id1497585376
Spotify: https://open.spotify.com/show/3t7A2FMnISQ2fz9D5p0Xuw
The numbers tell the story. One psychiatrist for every 3.3 million people in rural public areas, sometimes none at all. Eighty percent of our population depends on public healthcare, but only 5% of the health budget goes to mental health. Claire describes sessions in rooms without locks, folders going missing, months-long waiting lists, and cases far beyond what her scope technically covers. Not because she's overreaching, but because the need is that overwhelming.
I told Claire I felt the same during my community service. We both trained as caring professionals wanting to help, then found ourselves trying to offer something meaningful in chaotic, under-resourced environments while clients dealt with ongoing trauma. We landed somewhere unexpected, though. Maybe the work isn't about having every clinical tool to fix everything. Maybe it's about being present with someone for 30 minutes who finally gets to be heard without judgment. We explored what's actually in our power versus what we have to accept as unresolvable, and why that's not the same as giving up.
Follow Claire on:
Linkedin: https://www.linkedin.com/in/claire-van-dyk-507aa9101/
Instagram: https://www.instagram.com/capetowncounsellor/?hl=en
Facebook: https://www.facebook.com/CapeTownCounsellor/
Follow Carly on:
Website: https://onthecouchwithcarly.com/
YouTube: https://www.youtube.com/channel/UCfBi56xQookfRGL3zvWVzCg
Instagram: https://www.instagram.com/onthecouchwithcarly/?hl=en
Facebook: https://www.facebook.com/onthecouchwithcarly/
TikTok: https://www.tiktok.com/@onthecouchwithcarly
Apple Podcasts: https://podcasts.apple.com/za/podcast/on-the-couch-with-carly/id1497585376
Spotify: https://open.spotify.com/show/3t7A2FMnISQ2fz9D5p0Xuw
Chapters
- 00:14 Meet Claire van Dyk, registered counselor
- 05:09 Claire's childhood memory of healthcare inequality
- 10:21 Demographics: Who gets private vs public care
- 15:17 One psychiatrist for 3.3 million people in rural areas
- 22:02 Only 5% of health budget for mental health
- 29:14 What is a registered counselor?
- 34:05 Why aren't more registered counselors employed?
- 37:00 Cases beyond basic counseling scope
- 41:43 Maslow's hierarchy in crisis contexts
- 46:13 The power of being witnessed
- 50:25 Chaotic therapy environments
- 54:37 The mind reaching for resolution in chaos
