Background and Objective: COVID-19 has exacerbated the pre-existing mental health pandemic globally. Additional human resources will be needed to provide mental health services. Clinical associates, the mid-level medical worker cadre in South Africa (SA), could potentially be used to deliver these services as similar cadres have been used elsewhere in Africa. The study aimed to determine the self-reported knowledge and confidence of clinical associates in providing mental health services. Methods: A cross-sectional study of clinical associates was conducted between December 2021 and July 2022. The questionnaire was finalised after expert validation and cognitive interview processes. The link to the electronic (Qualtrics) questionnaire was distributed to all clinical associates that could be reached using alumni databases and social media. Data was imported into Stata v17 for analysis. Results: Of the 209 clinical associates included in the analysis, 205 (98.1%) indicated they had training on management of patients with mental illness during their clinical associate undergraduate degree and 192 (91.9%) indicated they had a mental health rotation. Approximately one-tenth of participants (10.7%) had some additional mental health training after qualifying. Most participants rated their knowledge of various mental disorders that are considered important in the SA context as ‘good’ or ‘excellent’ with the only exception being attention-deficit hyperactivity disorder (29.5%). Only 43.2% of participants felt ‘quite confident’ or ‘very confident’ in carrying out a mental health examination. Most participants rated their knowledge of suicide risk (59.0%), the aggressive patient (55.6%) and the confused patient (66.3%) as ‘good’ or ‘excellent’ though fewer participants felt ‘quite confident’ or ‘very confident’ to manage patients presenting with suicide risk (44.9%), aggression (46.9%) and confusion (53.1%). Conclusions: Clinical associates have a contribution to make in mental health service provision based on their existing mental health knowledge but this may need to be supplemented by additional practical training.