Insight into Eastern Cape’s mental healthcare crisis
As Grocott’s Mail continues to report on the Eastern Cape’s mental healthcare crisis, journalist Kathryn Cleary spoke to the South African Federation for Mental Health (SAFMH) about the roles of the government and NGOs.
What are some of the key things that need to be changed nationally for the betterment of mental healthcare users (MHCU)?
The legal and policy framework speaks to the creation of a continuum of care, but the implementation of this system contains many bottlenecks and blockades at every level. Essentially, there is no part of the system that does not fall short of the constitutional promise made to users by government.
This stems largely from the need to make the existing system work better, but there are also legislative and policy-making efforts that ought to be undertaken to realise the rights of mental health care users. This includes reviewing the Mental Healthcare Act and making a decision as to the next steps forward once the trajectory of the Mental Health Policy Framework and Strategic Action Plan (MHPF) comes to an end.
The structures for providing and protecting users in hospitals and at community based level do exist, but they are perhaps not quite as explicit as they could be ie: there is inadequate provision for a “path” of a mental health care user through various levels of the system. This needs to be rectified to prevent users relapsing and being readmitted to hospital.
Are provincial and national governments prioritising mental healthcare enough?
Mental healthcare has never been prioritised.
Despite an evidence-based deinstitutionalisation model (which constitutes an imperative), mental health care users have been “warehoused” in hospitals with no proper reintegration plan. The conditions in hospitals in South Africa are deplorable and do not follow the recovery model of healthcare despite South Africa’s purported commitment to it. Instead, users are left to languish there – sometimes without the barest of amenities – with only sporadic therapy and treatment.
Community based care is also prolifically inadequate, as has clearly been demonstrated in the last two years with the Life Esidimeni tragedy, where the government embarked on Project Marathon, which culminated in one of the worst human rights violations in the Post-Constitutional Era. Had mental healthcare been prioritised, Life Esidimeni would have simply been an impossibility because the facilities would have been adequate, the staff would have been trained, the licenses would have been granted lawfully and the subsidies would have been timeously received.
If mental health was a priority for national government, licensing of NGOs would have been adequately regulated before any patient was placed in a community-based setting; adequate funding would have been apportioned to the provinces; there would have been oversight into what was happening in the provinces and many others. If provincial government prioritised mental health, hospitals would have adequate staff and appropriate infrastructure; funds would be invested in proper and lawful deinstitutionalisation.
What has changed since Life Esidimeni? Is the current crisis potentially worse?
In somewhat of a knee-jerk reaction, guidelines have been published in the Government Gazette Guidelines concerning licensing of residential care and day care facilities. These Guidelines are so onerous that an NGO cannot possibly comply with the requirements set forth therein. This will have the effect that NGOs that are currently running well could lose their licenses and thus their subsidies, which will compromise the users in their care.
Life Esidimeni was very revealing in that it put the spotlight on the state of the mental health care system in South Africa – but the system has been crumbling for a long time. It is unfortunately only now that deficits in all corners of the system are coming to light. On this basis, most of what is happening is not reflective of the system getting worse, so to speak, but rather of light being shone on what is happening across the country and at various levels of the system.
- Information and comment provided by SAFMH Project Leader Nicole Breen.