The recent ongoing case regarding the termination of the Gauteng Department of Health’s contract with Life Healthcare Esidimeni, which would result in the closure of four hospitals and the displacement of over 2000 mental health care users, is extremely worrying. The termination of the Life Esidimeni contract is causing widespread panic amongst mental health care users, their families and NGOs alike. It also raises a number of serious questions about the ways in which mental health services are being regarded, prioritised and planned within the South African context.
Statements made by The Department of Health regarding the termination of the Life Esidimeni contract seem to suggest that the contract termination is being done in the spirit of deinstitutionalisation. However deinstitutionalisation (or downscaling of institutionalised care) ideally needs to go hand in hand with the upscaling of community based care, and there is no indication that this seems to be the Departments intention.
Deinstitutionalisation should involve a purposeful effort to support and upscale community based mental health services including increased funding and other resources to NGO’s. At present, it seems that NGO’s will receive no additional financial support (apart from a small subsidy) from government to enable them to absorb these additional clients. NGO’s operating in the mental health sector are in many cases already operating to full capacity and a sudden and overwhelming demand for services (such as spaces within residential facilities) could prove to be very difficult for NGO’s to manage without substantial increased financial support from Government.
Another challenge related to this is the fact that most of the mental health care users currently housed within the Life Esidimeni facilities are at the higher end of the care spectrum, in many cases requiring intensive, 24-hour clinical care, which is not in-line with the type of services rendered by NGOs at community level in many cases. This raises concerns about Government’s supposed notion that a like for like transfer of patients will take place as the facilities are closed. It also raises concerns about Government’s understanding of the different types of needs related to mental health care users at differing levels of functionality.
It is also important to understand that many of the residents of the Life Esidimeni Hospitals do not have family or homes to return to, or the family that they do have are unable to provide them with the highly specialized care that they require. Therefore, if they are unable to find an NGO or residential facility that is able to care for them, many of them will undoubtedly end up on the street, or potentially in prison.
At present psychiatric hospitals are overburdened because of a lack of beds. The Department of Health’s proposed plan to refer service users to hospitals with psychiatric wards causes a revolving door syndrome where service users are admitted to already full psychiatric wards, where they are often stabilised and discharged prematurely thus leading to increased rates of relapsing. The notion of wanting to treat service users in the “least restrictive environment” yet wanting to use psychiatric wards as the environment to achieve this in seems contradictory.
Deinstitutionalisation of mental health services alone cannot bring about the vision outlined within the Mental Health Policy Framework (Care Act of 2002). Deinstitutionalisation of mental health services needs to be planned and executed within a framework of simultaneous upscaling of community-based mental health facilities to ensure that mental health care users that are displaced from institutions can seamlessly be integrated into service provision at community level. However, given the way in which the Life Esidimeni issue has been dealt with, and the rationale for the decision provided by the Gauteng Department of Health, there are serious concerns about the ways in which the “deinstitutionalisation / upscaling of community-based services” concept is being understood and / or prioritised within the South African context. This misconception about or disregard for the concept is likely to result in a serious crisis for mental health care users, their families and NGOs alike if contingency plans and remedial measures are not put in place as a matter of extreme urgency.
The Life Esidimeni issue also raises concerns about the implementation of the Mental Health Policy Framework and Strategic Action Plan 2013-2020 and Government’s understanding of and commitment to realising the vision, as set out in the important documents. As an important piece of legislation, meant to guide the purposeful empowerment and development of the mental health sector, issues such as these (which involve conscious decisions made by Government which are seriously detrimental to the wellbeing of mental health care users and could be defined as human rights violations) are extremely concerning as it would appear that Government is failing to take these pieces of legislation and their intended outcomes serious.
SAFMH would like to highlight the fact that the apparent lack of commitment from Government to not only the mental health but also the wider disability sector is truly becoming alarming within the South African context. 3 November - 3 December marks Disability Awareness Month as well as International Day of Persons with Disabilities. Rather than seeing an upscaling of mental health services during this period, mental health care users are still fighting for their basic human rights such as dignity, access to services, housing and education. The last minute cancellation of the 2015 Disability Rights Summit (planned to take place in Ekurhuleni on 4 and 5 December 2015), which should have served as an opportunity for persons with disabilities to consider a variety of topics, particularly the White Paper on the Rights of Persons with Disabilities with the aim of expediting implementation thereof, is a prime example of the way in which the wider disability sector is not prioritized in the South African health sector.
SAFMH, together with mental health care users, their families and other NGOs operating in the field will continue to advocate against the closure of the Life Esidimeni facilities and holding Government accountable. SAFMH will also aim to work with strategic partners such as SADAG, SASOP and legal bodies such as Section 27 to try and ensure that human rights violations against mental health care users do not occur because of this. SAFMH would also like to urge Government more especially provincial departments to start taking important mental health policies and legislation serious and working alongside NGOs and other partners to ensure their full implementation to bring about meaningful improvements in the lives of mental health care users.