caring for the mentally ill in south africa

The NGO’s to which the Esidimeni patients were transferred were lacking in the personnel, facilities and knowledge required to manage people with mental health care needs.

The de-institutionalisation process, so attractive in principle and so easy to defend in the abstract, can go catastrophically wrong if community-based resources are not in place prior to implementation. It is quite clear that the NGO’s to which the Esidimeni patients were transferred were completely lacking in the personnel, facilities and knowledge required to manage people with mental health care needs.

While much progress has been made in the development of a primary care-based health system, mental health care users have been at a disadvantage from the very beginning of the project. This is partly because there is still profound ignorance among both lay people and health care professionals concerning the nature of mental illness, intellectual disability and the needs of those who live with these conditions, but also because mental health care users are frequently not in a position to know what their rights are or even comprehend adverse changes occurring in their environments.

It is indeed difficult to think about the subjective experience of a confused and frightened person with few intellectual or emotional reserves facing torment and death by neglect, hunger or abuse and it should fill us all with shame and deep sadness.

Adding to the pain of this needless loss of life is the fact that the Gauteng Department of Health was warned on several occasions by experts in the field of what would happen if the Esidimeni residents were discharged without proper planning and the establishment of appropriate community-based resources. The South African Society of Psychiatrists, the Psychological Association of South Africa, the South African Depression and Anxiety Group, the South African Federation for Mental Health and others attempted to dissuade the Gauteng Health Department from pursuing this course, and even applied for a court interdict to prevent an action that was clearly going to have extremely negative consequences. Neither effort was successful.

If nations are judged on their care of the vulnerable amongst them, we have surely failed miserably and we appeal to all health authorities to make this the last incident of its kind ever to occur in our country. We support calls for accountability but would also like to see education about mental illness happening at the highest levels of decision making in every department. We appeal to those who are involved in the formulation of policies and the development of services to consult with and listen to the expertise we have in our country.

The dreadful outcome of the premature transfer of mental health care users from Esidimeni facilities should never have happened and we would like to work with relevant government departments to make sure it never happens again. We also appeal to all Health Departments and health care funders to ensure that mental health care across the life span receives equitable and adequate funding and staffing at all levels. Only in this way can we prevent a recurrence of this tragedy and begin to address the many ills which plague our society, from the neglect of chronic mental health care users to the carnage of road accidents and interpersonal violence, from trauma-related impairment to educational failure and fragmented families. At national and provincial levels, both private and state funded, the mental health care system is struggling to provide even basic services to most of our population and the chronic under-resourcing of this sector should receive urgent attention.

Submitted by: Department of Psychiatry and the Faculty of Medicine and Health Sciences of Stellenbosch University

Author: Department of Psychiatry and the Faculty of Medicine and Health Sciences of Stellenbosch University