Mental health practitioners and gender diversity in substance use treatment: An Africana womanist lens

The study aimed to answer this research question: How do mental health practitioners in substance use treatment contexts in South Africa negotiate gender diversity in their practice, and what culturally grounded training and institutional changes are required to support inclusive service provision? A qualitative study employing narrative interviews was conducted with twelve mental health practitioners in the Southern Cape of South Africa. Data were analysed using reflexive thematic analysis within a constructivist epistemology, theoretically underpinned by Africana Womanism. Findings indicate that practitioners negotiate gender diversity through relational ethics emphasising respect, dignity, and harm minimisation within family and community contexts. Inclusive care was enactedpragmatically through informal adaptations rather than institutionalised policy, constrained by rigid systems, limited training, and cultural stigma. Gender-diverse clients were recognised as facing intersecting exclusions, particularly in rural settings. Policy reforms should embed gender diversity within programme design, intake procedures, and residential care. Practitioner training should prioritise communal, dialogical learning grounded in African relational ethics. Future research should explore the experiences of gender-diverse clients themselves, examine institutional responses across different provinces, and evaluate culturally grounded training interventions designed for substance use practitioners.