Of the national burden of disease, neuropsychiatric disorders are third only to HIV/AIDS and infectious disease, according to revised DALY (disability-adjusted life-years) estimates for the year 2000. (1,2) Yet mental health services are grossly under-resourced and there are many barriers to health care for the mentally ill. (3,4) Barriers include lack of accessibility, acceptability and availability of services, stigma, lack of awareness, perceptions that treatment may not be effective, cultural beliefs, and language problems. (5,6) Failure and delays in treatment seeking for mental disorders are greater and more pervasive in developing countries, contributing to high levels of unmet need. (7) South Africa has a legacy of racially inequitable, fragmented and inadequately resourced mental health care services, (3,8) characterised by provincial variability. (4) Findings suggest that two-thirds of patient contacts with mental health services occur through ambulatory care services, with low outpatient attendance rates corresponding with low admission rates in most provinces. (9) No systematic data exist on (i) the current use of health (and non-health) services for the mentally ill, or (ii) the nature and extent of unmet treatment needs. Nationally it is critical to identify how to allocate resources more efficiently and equitably across provinces and ensure that the mentally ill receive adequate and appropriate care. To do this it is important to develop population-level insights into the unmet need for mental health services among individuals with mental disorders. As part of the South African Stress and Health (SASH) study, we examined 12-month mental health service use and its association with socio-demographic (gender, race, province) and mental disorder variables in the general population. We expand on findings (10) by reporting on (i) provincial prevalence rates of service use for mental health reasons by type of service, and (ii) gender differences in patterns of use.