If you are experiencing a mental health emergency, contact crisis services immediately: Emergency contacts and crisis lines
SADAG 24-hour suicide crisis line: 0800 456 789
If You Are in Crisis Right Now
If you or someone you know is having thoughts of suicide or self-harm, please reach out to a crisis line before doing anything else. Trained counsellors are available 24 hours a day.
- SADAG Suicide Crisis Line: 0800 456 789 (24 hours, free)
- SADAG general helpline: 011 234 4837 (08:00–20:00 daily)
- LifeLine South Africa: 0861 322 322
These lines exist for moments exactly like this one. You don't have to be certain something is wrong to call. If something feels wrong, call.
Crisis Scenario 1 — Suicidal Crisis (Active Suicidal Ideation or Plan)
Active suicidal ideation — especially with a plan and intent — is a psychiatric emergency. This is not a "mental" problem to push through. It requires immediate clinical intervention.
Warning signs in yourself or someone you love: - Talking about wanting to die or "not being here anymore" - Giving away possessions, saying goodbye, or "putting things in order" - Sudden calm after a period of severe depression (can indicate a decision has been made) - Explicit statement of a plan or method - Escalating hopelessness, withdrawal, and isolation
What to do immediately: 1. Call the SADAG crisis line: 0800 456 789 (24 hours) 2. If there is immediate danger, call emergency services (10177 / 112) or go directly to the nearest emergency room 3. Do not leave the person alone if they have active suicidal intent 4. Remove access to means if possible (medications, firearms, sharp objects)
Crisis Scenario 2 — Psychiatric Hospitalisation
Voluntary or involuntary admission to a psychiatric facility may be indicated when depression is severe, there is active suicidal risk, or outpatient management has failed.
What to expect: - A voluntary admission can be arranged through your psychiatrist or GP — they contact the psychiatric facility (private or public) and organise admission - An involuntary admission (for a person refusing treatment in a crisis) requires a J88 form (mental health assessment) under the Mental Health Care Act - In-hospital treatment includes medication optimisation, monitoring, ECT if appropriate, and individual + group therapy
PMB coverage for inpatient psychiatric admission: PMB 902T covers 21 in-hospital days per year for psychiatric conditions including major depression. Admission to a designated facility is paid at PMB level within this 21-day limit. Beyond 21 days: scheme-dependent benefit.
Crisis Scenario 3 — The Coverage Crisis: Antidepressants Running Out
This sounds mundane, but it is one of the most common depression-related crises: a patient runs out of antidepressant medication because their d2d benefit is depleted, their repeat prescription has lapsed, or they don't know how to access the chronic medication programme.
Why this matters: Abruptly stopping an SSRI or SNRI causes discontinuation syndrome — dizziness, electric shock sensations, mood instability, nausea. It can also trigger relapse of depression, sometimes severe. This is preventable.
Let's focus on what we can control.
| Situation | What to Do |
|---|---|
| Script lapsed, need emergency refill | Contact GP for emergency script. Most pharmacies will dispense a partial emergency supply (typically 7 days) under chronic medication rules while the script is arranged. |
| D2d benefit depleted mid-year | Contact your scheme and ask to register antidepressants under the chronic disease management programme (not CDL, but some schemes have a chronic medication pathway). If not possible, discuss with your GP — generic SSRIs at R90/month can often be self-funded short-term. |
| SSRI not in scheme formulary | Request a formulary exception or speak to your GP about a formulary-compliant alternative. Most SSRIs are interchangeable. |
| Cannot afford medication at all | Most public sector clinics can initiate and manage antidepressant therapy. Consider transition to public sector care for medication management if cost is prohibitive. |
In Hospital Right Now
If you or someone you care for has been admitted to a psychiatric facility:
- Call your scheme's 24-hour pre-authorisation line (number on back of medical aid card) and authorise the admission within 48 hours.
- Confirm the facility is a scheme-contracted psychiatric facility — this affects whether costs are billed at scheme rate.
- The admitting psychiatrist will bill separately from the facility. If the psychiatrist bills above scheme rate, gap cover pays the shortfall.
- If your 21-day PMB limit will be reached, speak to your scheme before discharge about what benefit applies beyond 21 days.
- Arrange a discharge plan before you leave: outpatient follow-up with psychiatrist, continuation of medication, resumption of psychotherapy.
Gap Cover: What It Does for Depression
| Scenario | Gap Cover Helps? |
|---|---|
| Generic SSRI antidepressant cost | NO — d2d funded; very low cost |
| Outpatient psychotherapy sessions beyond 15 PMB | NO — this is a d2d benefit issue, not a gap issue |
| Psychiatrist shortfall on inpatient admission | YES — psychiatrist billing above scheme rate |
| ECT inpatient: facility + anaesthesiologist shortfall | MEDIUM — facility and anaesthesiologist shortfall |
| Crisis line or phone counselling cost | NONE — SADAG is free |
Bottom line: Depression generates minimal gap cover exposure for most patients. The primary advisory question is scheme mental health programme quality (additional therapy sessions, case management) and d2d benefit coverage of antidepressant medication.
If you need help finding the right mental health coverage, AURA can check for you. Run your AURA check
What the PMB covers, in the regulation’s terms
- For major depression and bipolar disorder, the PMB is up to 3 weeks (21 days) a year of hospital-based care, including electroconvulsive therapy (ECT), or up to 15 outpatient therapy sessions instead of an admission. It is one or the other, never both. (902T. Medical Schemes Act regulations, Annexure A; outpatient alternative from the CMS PMB guideline (v1, 30.09.2020).)