Life Esidimeni shone a spotlight on the mental healthcare system in South Africa, but what is the way forward?
What is set to change? How will this change be brought about?
All of these questions give rise to a need to explore the system as it currently stands and to question not only the circumstances surrounding Life Esidimeni, but also other areas of the system that appear to be crumbling.
The following will serve to illustrate some of the blockages with which mental healthcare users are faced.
This was hailed as a watershed moment and the arbitration leading up to this point was deemed a success.
While officials involved in the series of tragic events were questioned and asked for explanations, to this day it remains to be seen who will truly be held accountable and how this will come about.
It is also still unclear what exactly the reasons behind the termination of the Life Esidimeni contract were, as evidence given during the arbitration hearings indicated that cost cutting and savings had possibly not been the main drivers behind the process after all.
Subsequent to this, the government published policy guidelines for the licensing of residential and/or daycare facilities for persons with mental illness and/or severe or profound intellectual disabilities.
These guidelines set out requirements for an non-governmental organisation to obtain a licence to operate a facility caring for people with psychosocial disabilities and people with severe or profound intellectual disabilities.
Stringent in nature, they seek to ensure that all facilities are licensed according to a set of strict criteria.
The difficulty with these guidelines is that they are so stringent that virtually no community-based organisation will ever be able to comply with them.
The guidelines are thus another bottleneck, in and of themselves, containing no capacitation plan and no accompanying document setting out how they are going to be implemented.
A further difficulty that has arisen from the Life Esidimeni tragedy is that there has been a loss of trust in non-governmental organisations on the part of both the government as well as the general public.
Non-governmental organisations as a whole are painted with the same brush as those organisations at which the Life Esidimeni victims died, and this is having the effect that they are struggling to obtain subsidies and funding.
This poses an immense challenge because, at present, non-governmental organisations are the only option for community-based care and community-based care is the only answer to propositions of deinstitutionalisation, as outlined in the South African Mental Health Policy Framework and Strategic Action Plan 2013-2020.
While the community-based model is sound and steeped in evidence-based research, poor understanding has led to ultimately catastrophic outcomes.
This has the effect that people believe the system cannot work.
A likely effect of this is that, once again, those with, inter alia, psychosocial disabilities will go back to being warehoused in hospitals that are either state hospitals or private hospitals the state contracts to care for patients, when these people could, given the availability of the necessary community-based resources, function well outside of them and have the opportunity to be integrated into and live as part of the community.
There is thus the concern that a state-heavy model of rehabilitation could bring about certain challenges such as the provision of treatment inappropriate to the needs of mental healthcare users, needless expenditure of resources and restrictions imposed upon them that violate their fundamental rights.
The Life Esidimeni Tragedy came across to many as a revelation – never before had the mental healthcare system been under so much scrutiny.
It seemed that before the tragedy, nobody had ever thought about the lot of persons with mental illness. Since Life Esidimeni, other areas of the system have also come under analysis.
Of late, it has been revealed that, in fact, the problem lies not only in “deinstitutionalisation gone wrong” but in the heart of the institutions themselves.
Shocking details have come to light, for instance, in the Eastern Cape, wherein atrocities in several hospitals have reportedly been found to have taken place.
With a damning report from the South African Society of Psychiatrists surrounding poor hospital records having been kept, deaths not having been properly reported, inappropriate use of below-par seclusion rooms and general poor standard of patient care, Tower Hospital has been identified as a facility in crisis.
In the psychiatric unit at Cecilia Makiwane Hospital, staff and patients are reportedly put at risk every day due to staff shortages.
A former mental healthcare user is reportedly seeking compensation from the hospital in the courts after having been assaulted by a patient at the facility.
An assault charge has also been in the news for having been brought against Fort England Hospital itself, as a response to abuses by nursing and security staff.
Deteriorating conditions and faltering management make it likely that this practice will continue if not increase in prevalence.
In Gauteng, there have been a spate of reported deaths among mental healthcare users in hospitals, the most recent of these having taken place at Thelle Mogoerane Hospital in Vosloorus where a patient fell to his death after breaking through burglar bars.
In brief, the situation has not changed, the treatment of people with psychosocial disabilities continues to have deleterious effects on their well-being and very little is being done to ensure they are adequately cared for.
Mental healthcare users so-situated continue to suffer with no tangible solution in sight.
The government’s attempts to regulate residential care and daycare facilities represent a concerning level of ignorance as to what will benefit mental disabilities and with psychosocial disabilities, and the emergence of other horrifying acts against these individuals in other parts of the country give credence to the notion that it is not only the mental healthcare users in Gauteng that were, and are, being failed on all fronts by duty bearers.
Much must be done – and fast – to save lives.
The month of July is Psychosocial Disability Awareness Month. A psychosocial disability is when a mental illness becomes pervasive and interferes in a person's functioning, thus preventing them from being able to claim their rights or to participate in society. People with psychosocial disabilities face a number of challenges including poor access to basic services and exclusion. For the awareness month, SAFMH has elected to launch a campaign called "Blockades in an Era of Continuum." We are doing so because although the legal and policy framework exists to provide a cohesive basket of services to people so-situated, this is not reflective of reality. To this effect, we have compiled a press release. Read it here:
PRESS RELEASE: PSYCHOSOCIAL DISABILITY AWARENESS MONTH
The month of July is annually celebrated as Psychosocial Disability Awareness Month. This month, as with any commemorative occasion, is an opportunity to reflect on the past, examine the present and look forward, deciding what we want to see for the people concerned.
According to a report of the United Nations High Commissioner for Human Rights, an individual with a psychosocial disability is described as “a person…who, regardless of self-identification of diagnosis of a mental health condition, face[s] restrictions in the exercise of their rights and barriers to participation on the basis of an actual or perceived impairment.” This description discusses pervasiveness and poor access to the services to which those affected are entitled. It explicitly states that such individuals lack agency within society and that they are rendered voiceless- forced to accept the treatment meted out to them. It includes “perceived impairment”, which refers to disenfranchisement due to stigma and oppression, regardless of the capacities of the person. This should not be the reality of people so-situated- in fact, South Africa has a comprehensive legal framework set up to preclude such exclusion and entrapment. The reality, however, is starkly different, with law and policy seemingly viewed as an ideal as opposed to an imperative. This has the effect that people with psychosocial disabilities continue to languish, left in peril.
People with psychosocial disabilities- whether in hospitals, community-based settings or with their families- require a certain standard of care and a basket of services available to them. What they require in order to recover must necessarily be provided to them in accordance with the prescripts of the Constitution. Despite this imperative, lack of prioritisation means that no heed is paid to the fact that the system needs to flow smoothly, allowing the mental health care user to move from one part of it to another. There is no consistency in terms of that which is provided and no semblance of utilisation of a model designed to facilitate recovery.
The theme the South African Federation for Mental Health has elected to pursue for our 2018 Psychosocial Disability Awareness Month Campaign is “Blockades in an Era of Continuum”- this theme was selected because of the bottlenecks faced by people with psychosocial disabilities in accessing that which government is enjoined to provide. The campaign will aim to start the conversation around the extant challenges in South Africa today, contrasted with how law and policy ought to be implemented. It will have a focus on the challenges in the full complement of services- from hospital care, to community-based care, to family care. It will deal with the construct of stigma within the community as well as among duty-bearers, the lack of clarity surrounding the roles of those responsible for caring for people with psychosocial disabilities, and the challenges in integrating people with psychosocial disabilities into the community. Finally, it will discuss what the expectations of an ideal mental healthcare system are.
SAFMH is a non-governmental organisation (NGO) which advocates for and raises awareness about the rights of mental healthcare users. We are constituted by 17 mental health societies which provide direct services to persons including those with psychosocial disabilities. We call upon the state to prioritise matters concerning mental health and to ensure that the system can work on a continuum such that patients can remain stable and recover. We urge the state to embark on a proper and considered process of deinstitutionalisation absent of irregularities and to adopt the recovery model for people with psychosocial disabilities and other mental health concerns. In addition, we urge the state to provide education and training to people with psychosocial disabilities and the general public so that they will understand the rights to dignity, equality, freedom and security of the person, access to healthcare, access to food and water and other associated rights as they relate to people so-situated.
People with psychosocial disabilities are prolifically vulnerable and near-universally neglected. The need to remove these blockades is desperately urgent. Psychosocial Disability Month may not be a panacea for this social ill, but it is an opportunity to raise awareness about these issues. It is time for the system to #takeitsplace and provide adequately for people with these illnesses.
Project Leader: Information and Awareness
South African Federation for Mental Health
011 781 1852
072 2577 938
Corporate wellness is an integral component of the work environment. In an unhealthy work environment, there is decreased productivity, higher absenteeism, poorer work ethic and even less safety in the workplace. The 2nd to the 6th of July is Corporate Wellness Week- an opportunity for the raising of awareness surrounding the need to create a healthy work environment. SAFMH has compiled a press release to this effect. it appears below:
PRESS RELEASE: CORPORATE WELLNESS WEEK 2018
From the 2nd to the 6th of July is Corporate Wellness Week. A healthy workplace is key to ensuring productivity among employees. According to the World Health Organisation (WHO), the average person spends a third of their adult life in the workplace. It is thus important that the workplace is somewhere that employees can function at their peak. The WHO proposes the following:
A healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being of all workers and the sustainability of the workplace
According to Stoewan, (2016) organisations have- in addition to the obligation to provide physically safe work environments- the opportunity to foster healthy workplaces. She cites the psychosocial work environment as one such component. Indeed, the promotion of good mental health among workers is integral. Unfortunately, there is a prolific lack of focus on this component, with the effect that many employees work in a state of poor mental health. To this effect, the World Federation for Mental Health states that 10% of the employed population have taken time off for depression, that 6 in 10 people say poor concentration impacts on their concentration at work, that mental health conditions cost employers over $100 billion per annum and that 217 million workdays are lost per year. According to Hamdulay (2018), “mental illness in the workplace leads to decreased productivity, increased sick-related absenteeism, poor work quality, wasted materials and even compromised workplace safety.” Supporting employees’ mental well-being should therefore not be an option, but an imperative.
Often, employees do not feel comfortable addressing their mental health issues with their employers. A survey by the South African Depression and Anxiety Group (2017) showed that only 1 in 6 employees who had a mental illness indicated that they would be comfortable disclosing this to their manager. This is undoubtedly due to actual or perceived stigma. Stigma is pervasive throughout society, but can be increasingly pernicious in the workplace, where employees fear reprisals for what they perceive to be weakness.
Brohan and Thornicroft (2010) highlight further difficulties, such as prospective employees’ job applications being turned down on account of their mental illness or cessation of people looking for work because they anticipate being discriminated against. They also illustrate that the disclosing of a mental illness in the workplace can lead to phenomena such as “micro-management, lack of opportunities for advancement, over-inferring of mistakes to illness, gossip and social exclusion.” Breaking through these barriers is vital in ensuring that a workplace is healthy.
Stoewan also pinpoints examples of other “psychosocial hazards” in the workplace. These include poor work organisation, poor organisational culture, issues surrounding “control and command management style” and “lack of support for work/life balance.”
There are ways in which an environment can be modified in order to make it conducive to the promotion of good mental health among employees. One example is that of reasonable accommodation. Provision for this is made in South Africa’s Basic Conditions of Employment Act. This concept denotes making justifiable allowances for an employee with an illness or a disability who can still fulfil the inherent requirements of their job provided certain adjustments are made. This however excludes instances where the accommodation would lead to unjustifiable hardship or restrictions upon the employer. Examples of this include flexible working hours, introducing tasks incrementally after an employee has been on sick leave, creating a quiet work environment, change of supervisor if required and reassignment of employee to an alternative post.
It is also important to raise awareness of mental health issues throughout the workplace- involving employees and their managers so as to dispel the aforesaid stigma and ensuring that it is made known what steps are to be taken in the event that an employee does develop a mental health issue or has a pre-existing condition. It is wise to put this in a policy document to create certainty.
The South African Federation for Mental Health is a non-governmental organisation (NGO) seeking to uphold and protect the rights of people with mental illnesses, psychosocial disabilities and intellectual disabilities. We offer training and resources on corporate wellness from a psychosocial support perspective. We call upon employers to facilitate mechanisms to achieve the objective of achieving a healthy workplace.
The WHO defines mental health as…
… a state of wellbeing in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.
Let us be healthy in our work.
The 16th of June 2018 was Youth Day. This is an important commemorative occasion celebrated annually. Coincidentally, the World Federation for Mental Health's theme for Mental Health Awareness Day in October 2018 is "Youth and Mental Health in a Changing World." While this occasion is still some months away, SAFMH would like to emphasise that this is not a once-off, but rather something that should reverberate throughout the year's activities. Innovation is an important component of the changes that have taken place over the years. The internet is a veritable font of information that young people can use to their advantage. There is also the opportunity to become part of valuable networks of support. Despite this, there are also risks to using the internet for the purpose of dealing with mental health issues. Young people may end up incorrectly diagnosing themselves with mental illnesses, or may fall victim to cyberbullying. In view of this, SAFMH has drafted a press release that was disseminated to the media. It appears below:
SOUTH AFRICAN FEDERATION FOR MENTAL HEALTH
PRESS RELEASE: Youth Day 2018
The 16th of June 2018 is Youth Day. This is a commemorative occasion offering the opportunity to reflect on the past, examine the present and contemplate the future of young people in this country. Good mental health is one of the biggest determinants of overall good wellbeing among all people. Maintaining good mental health is especially important during a person’s formative years, when mental health difficulties can arise.
According to the World Health Organisation (WHO) 10%-20% of all children and adolescents have some type of mental illness, with 50% of these disorders occurring by the age of 14 years and 75% by the age of 20. The WHO further cites neuropsychiatric conditions as the worldwide leading cause of disability in young persons, and highlights that young people so-situated face challenges with both access to rudimentary basic services such as to education and health care as well as social challenges in terms of discrimination, isolation and stigma.
Ahead of World Mental Health Day in October 2018, the World Federation for Mental Health (WHMH) has announced its theme for the occasion to be “Youth and Mental Health in a Changing World.” Although October is still some months away, SAFMH is placing emphasis on the fact that this should not just be a one-off event but rather a lasting theme that ought to resonate within activities throughout the year. The South African Federation for Mental Health (SAFMH) recognises the importance of this theme and wishes to highlight on the 16th of June how youth are presently situated- what the positive and negative aspects are of living in a modern day society and what resources are available to young people now that perhaps were absent before. In an age of innovation, the possibilities are endless. While indisputably a positive development overall, there exist dangers and risks for the youth that could serve to hinder, rather than aid their growth and development.
First of all, it is necessary to note that young people have access to a spectrum of sources of information that were not there before. There is an immense wealth of material on the internet about how youth can achieve good mental health and mental wellbeing. Youth now have a greater capacity to become informed about their mental illness or intellectual disability or those of their loved ones. While this is undeniably positive, there is a negative flipside- accessing such information can lead, for example, to self-diagnosis, a dangerous phenomenon. According to Pillay, writing for Psychology Today, self-diagnosis can lead to a person trying to treat a mental health issue themselves incorrectly, which can ultimately have many negative ramifications. They may miss a concealed disorder they simply lack the expertise to diagnose, or may mistake a physical issue for a mental health issue. This can lead to a person failing to seek proper treatment.
With the continuous flow of information has come a flow of communication. It is possible to make contact with people all over the world at the click of a button. This means that there is a network of support available to young people that never previously existed. This has the effect that if a young person feels alone, or lost, or unsure of which path to take, there are structures and communities upon which they can call for guidance. Unfortunately, for all the helping hands extended online are others which seek to cause harm. This is known as cyberbullying. According to a global online study conducted by YouGov (2015), it was found that 24% of teens in South Africa had fallen victim to cyberbullying, with South Africa having the 4th highest rate of the 11 countries surveyed. A broad spectrum of sources link cyberbullying to depression, self-harm and suicide among young people.
SAFMH is a non-governmental organisation seeking to preserve and protect the rights of people with mental illness, psychosocial disability and intellectual disability. Through ongoing advocacy and awareness activities, one of our initiatives has been to create an online resource for the youth, providing them with information on mental health. During 2017, SAFMH created a website which provides comprehensive information on various issues pertaining to young people and mental health and wellbeing. It is user friendly and comprehensive and also provides useful resources for accessing support. It is our hope that the website is of use to the youth in helping them to better understand mental health issues and how to deal with them. The address for the website is: https://my-mh.org/
According to StatsSA (2016), there are 20.1 million youth in South Africa. Given the aforesaid proportion of youth with mental health issues, it is important to take cognisance of the need to protect their mental health and wellbeing. Let Youth Day 2018 be an opportunity to take things forward; a chance to start taking care of our country’s young people’s mental wellness in a concerted fashion. #takeyourplace
Project Leader: Information and Awareness
011 781 1852
072 2577 938
SAFMH has crafted a press release on this issue. Parliament was briefed on the topic on the 29th of May 2018. The question was whether mental health care users- previously denied the franchise by section 8 of the Electoral Act- ought to be permitted to vote in future elections. The proposed amendments to the aforementioned legislation make provision for this and, should it be passed, this stands to be a watershed moment in South African History. SAFMH's stance is that to fail to allow such individuals the right to vote is unfairly and unjustifiably limiting their rights and that the offending provisions in current law must be abolished. The big question people ask is if severely and profoundly disabled persons voting will not unduly influence the outcome of the elections. We strongly feel it will not as such individuals are highly unlikely to vote to begin with. The ability to vote bestows on one the rights to dignity, equality and freedom of expression. it is a most important entitlement and must be realised. eNCA conducted a poll to find out what public opinion is on the matter. 60% of the respondents said that such individuals should be able to vote while 40% said they should not be able to. While it is encouraging to see that the majority of people do not have a discriminatory attitude towards people with psychosocial and intellectual disabilities, is is alarming that such a large percentage of respondents do. Many of the remarks made by SAFMH in the press release discuss this issue. The full press release appears below:
PRESS RELEASE: MENTAL HEALTH CARE USERS AND THE RIGHT TO VOTE
On the 29th of May 2018, Parliament was briefed on possible reforms which will allow mental health patients to vote in elections. First and foremost, SAFMH would like to applaud government on the measures taken thus far to make this previously extinguished right a reality. eNCA also released a poll which posed the question as to whether “mental health patients should be allowed to vote.” The results were that 60% of voters in the poll said yes they should and 40% said no they should not be able to. We support eNCA’s decision to request the public to give their opinion and to start the conversation around this issue. It is important for pending law reform to be publicised and for the perception of the public surrounding important and controversial topics such as this to be known by decision-makers, especially leading up to the general elections. While heartening to know that more than half of respondents were in favour of the right to vote extending to people who have been denied the franchise in the past, it is concerning that such a large proportion of voters expressed that this right should be curtailed against people so situated. Public opinion is important in the law reform process because of the participatory nature of our democracy. Social stigma often puts a pin in this, however, frustrating the course thereof. While not decisive, the view of the public is very important and thus, on this basis, SAFMH has some aspects it wishes to raise surrounding the issue.
The way in which South African law already addresses this issue is as follows: the right to vote is guaranteed to all citizens over the age of 18 years of age in terms of section 19(3)(a) of the Constitution of the Republic of South Africa (CRSA); however rights are capable of limitation in terms of section 36. This limitation in respect of people with mental illness and intellectual disabilities voting is contained within sections 8(c) and (d) of the Electoral Act, which excludes people deemed to be of “unsound mind,” the “mentally disorderly” and those held under the Mental Health Care Act. It is unclear what exactly the first two of these exclusions refer to as they are archaic terminology, but the third refers to people who have been involuntarily admitted to a psychiatric hospital. Section 36 of the Constitution states that rights may be limited only if that limitation is reasonable and justifiable. It is our submission that it is not. This is because of the extent to which it limits the person’s rights to dignity, equality and freedom of expression. It is contrary to international law and does not take cognisance of the fact that people with mental illness, psychosocial disability and intellectual disability can, with reasonable accommodation, be quite adept at making decisions concerning what is best for them and those around them.
As to the international law concerned, Article 29 of the United Nations Convention on the Rights of People with Disabilities (UNCRPD) provides that the political rights of people with disabilities are guaranteed, that States Parties must bestow upon people with disabilities the right to vote, must ensure that voting procedures and facilities are “appropriate, accessible and easy to understand and use,” and protect the right of the person to vote by secret ballot, but with assistance if they so choose. The UNCRPD does not make distinctions regarding the types of disabilities to which this applies. It is therefore submitted that as a state that has ratified the UNCRPD, South Africa must make these provisions for people so-situated.
The South African Federation for Mental Health (SAFMH)
is a non-governmental organisation (NGO) seeking to uphold and advocate for the rights of mental health care users. We submit that the South African legal framework is currently very outdated and bourn of stigma against people with mental illness, psychosocial and intellectual disabilities. It represents perceptions that existed before Post Constitutional Democracy and does not reflect the human rights-based model for which we advocate. We call upon the public to become educated on these issues, to know what the law states and what it means and to gain an understanding of the fact that people with mental illness, psychosocial and intellectual disabilities can be extremely capable citizens. Similarly, we call upon duty-bearers to facilitate this educational process.
It is time to #takeyourplace and be freed from societal perceptions that things should stay the way they are. Mental health care users ought to be on a same footing as everyone else. They have the right to have aspirations about how this country should be taken forward, rights to offer their support to a political party. For them to be denied that represents a flagrant dereliction of their constitutional entitlements. Let’s take that 60% yes and make it 100%.
The South African Federation for Mental Health has published an opinion piece in the City Press on the right to equality for children with psychosocial and intellectual disabilities. The piece outlines this right from both an economic and social standpoint and discusses how stigma on the part of duty-bearers and the public at large contributes to failure to realise this right. It illustrates that children so-situated do not receive the services they require in order to be protected from violence, exploitation and neglect and proposes ways forward such as education deployed not only in the form of the provision of information but also through the teaching of empathy towards these vulnerable individuals.
The link is as follows #takeyourplace :
Saturday the 7th of April is World Health Day. The World Health Organisation (WHO) has set the theme for this occasion as “Universal Health Coverage: Everyone Everywhere.” States are encouraged to commemorate this occasion through the lens of the Sustainable Development Goals (SDG’s) and examine what steps need to be taken in order to achieve them. SDG 3 deals with health, specifically to “ensure healthy lives and promote well-being for all at all ages.” This includes that of people with mental illnesses and intellectual disabilities, the former of which having recently been recognised by the WHO as one of the non-communicable diseases. The South African Legal System contains all of the components necessary to realise this target with regards to people so situated. The right to access to healthcare is espoused in the Constitution and instruments such as the National Health Act, Mental Health Care Act, Mental Health Policy Framework and Strategic Action Plan and others. Unfortunately the reality on the ground is quite different with woefully inadequate basic services available to such individuals leading to poor health, relapse, hospitalisation, poor compliance with treatment, unavailability of medication, rudimentary components of care and others. This is particularly so in the case of individuals in tertiary community-based care.
Community-based care is an important part of the deinstitutionalisation model. This model was implemented to provide for recovery and reintegration of people with mental illnesses or intellectual disabilities into their communities. It is a component of the human rights-based paradigm from which the sector operates. This is in line with international obligations as well as our own law. It is a departure from the previously-utilised medical model which had hospitalisation as a key focus. Hospitalisation should be a last resort as it is expensive and restrictive. This means that the emphasis should be on these community-based services. Sadly, this is not the case. Recovery cannot take place in the absence of support. Support should therefore be available in community-based settings. This is not the reality. Distressingly under resourced, those providing the services- mostly non-governmental organisations (NGO’s) - cannot ensure that those they serve receive the necessary support. The state, as the primary duty-bearer is obliged to subsidise and capacitate these organisations but does not do so adequately or sometimes at all. This violates the right of the mental health care users to access to healthcare.
The shortcomings of the present system of community-based care were recently thrust into the spotlight in the Life Esidimeni Tragedy in which some 144 mental health care users lost their lives with many remaining unaccounted for. These individuals were transferred from 4 institutions to ill-equipped NGO’s many of whom had obtained their licenses illegally due to government’s failure to follow due process in the implementation of their Project Marathon. A consequence of this was that mental health care users were left to die inhumane deaths through starvation, dehydration and preventable diseases. In this case deinstitutionalisation was fronted, but the exercise was merely a cost-cutting one with no regard paid to recovery and rehabilitation. In the hospitals where the mental health care users were previously kept, they were provided with shelter, food, water and medication where necessary. The hospitals had their faults but the people were cared for with a relative amount of dignity and certainly did not have their lives placed at risk. Provision should have been made for support to “follow” them out of the hospital and into the community and to organisations where their needs could be provided for. Instead they were cast out into cruel and brutal conditions and treated in a manner amounting to torture. Far from a mere violation of their right to health, this chain of events in fact extinguished this right as well as a host of others.
In a knee-jerk reaction to Life Esidimeni, government has Gazetted Policy Guidelines for the Licensing of Residential and/or Daycare Facilities for Persons with Mental Illness and/or Severe or Profound Intellectual Disabilities. These provide for comprehensive and stringent criteria with which an NGO must comply in order to be able to obtain a license to operate a care centre. While laudable, these criteria are simply too onerous for most NGO’s to comply with, with the effect that once these Guidelines come into force many of these organisations will not be able to obtain licenses. This will mean that they will not receive government subsidies and will likely either have to compromise standards of care or shut their doors. This too will violate the right to health of mental health care users as it will take away existing services. This is plainly regressive and unconstitutional.
The South African Federation for Mental Health (SAFMH) is a non-profit organisation seeking to protect and uphold the rights of people with psychosocial disabilities and people with intellectual disabilities. We call upon the state and other stakeholders- to come together and ensure that “Universal Health Coverage: Everyone Everywhere” is achieved in South Africa. Individuals with psychosocial disabilities or intellectual disabilities are among societies most vulnerable and what is required is for issues surrounding individuals so-situated to be prioritised on an ongoing basis- not simply when a crisis arises. Good health enables people to live happy and fulfilling lives- something of which such individuals are fully capable. Do not let community-based care remain shrouded in darkness- appreciate its importance and #takeyourplace
For Inquiries contact:
SAFMH Project Leader: Information and Awareness
011 781 1852- Extension 201
Aaron Motsoaledi, Minister for Health, has officially gazetted Policy Guidelines for the Licensing of Residential and/or Daycare Facilities for Persons with Mental Illness and/or Severe or Profound Intellectual Disabilities. These Guidelines set out requirements for a non-governmental organisation (NGO) to obtain a license to operate a facility caring for people with psychosocial disabilities and people with intellectual disabilities. The Guidelines will be enacted in the wake of the Life Esidimeni tragedy where 144 people lost their lives and where a large number of people remain unaccounted for. The predominating factor catalysing what has been hailed as one of the worst human rights violations in South Africa’s recent history was that the majority of NGO’s to which mental health care users were transferred from Life Esidimeni were either unlicensed or had improperly obtained their licenses. Lack of adequate facilities led to people dying of preventable diseases, starving to death or dying from dehydration. While this may well be hailed as “too little, too late,” there is a growing body of evidence which illustrates the marginalisation and dehumanisation of mental health care users across the country. In light of this, and in light of the fact that there is no way of knowing what will happen to people so-situated in the future, these Guidelines bare careful analysis.
An aspect that is welcomed by the South African Federation for Mental Health (SAFMH) is that the Guidelines are extremely comprehensive and detailed, setting out precisely what needs to be in place for an NGO to qualify for a licence. There is, however, a downside to this in that the requirements are so strict and onerous that the vast majority of NGO’s will not be able to comply with them without considerable additional funding and subsidies. Since no promise is made of this, it is likely that many will have to close their doors, which will be of imminent detriment to mental health care users. It would appear that the state is so preoccupied with safeguarding themselves against future liability that they have not fully taken into account the situation on the ground. The Guidelines can thus be seen as a knee-jerk reaction rather than a clearly thought-out process. It would seem that in compiling these Guidelines, a healthy space for constructive dialogue, where NGO’s can express freely what they need, has not happened to the extent it should have, which has the effect that the Guidelines are somewhat unrealistic in nature.
A major aspect, and one related to the above, that we question is that the Guidelines do not make provision for capacitating NGO’s to comply with the requirements for registration. As articulated, many NGO’s simply do not have the resources to improve their premises to suit the required standards with the effect that they cannot become licensed. Often, there is also a lack of knowledge of national, provincial and municipal law, which can also lead to non-compliance. Given the shortage of supply in these services in relation to the demand, it is submitted that capacity building is vital to ensure that there are enough facilities available. Had government focussed on development rather than simply on process, a chance would have existed that the sector could have been furthered rather than hindered. It is submitted that government could have solved this problem by building in a segment where they made a statement of intent to aid NGO’s in meeting the requirements for obtaining a license.
The service users referred to in the Guidelines provide only for people with mental illnesses and people with severe or profound intellectual disabilities. It therefore does not include people with mild and moderate intellectual disabilities. It is submitted that this is an oversight because such individuals can also require a substantial amount of support and can also become vulnerable to abuse, neglect and exploitation. Because facilities providing for and protecting people so-situated are not included in the Guidelines, this could lead to them operating unlicensed; something which could very quickly become disastrous.
In disability rights, a medical model was previous used. The person was considered a patient and maximal level of integration back into society was not a real consideration. This appears to be the approach adopted by the Guidelines, which refer to discharge reports whereas community-based services are run by NGOs and according to a recovery-model approach. Service users are therefore never admitted (as they would be in a clinical setting) and thus are not formally discharged. Community-based service is based on the equality between staff and services users and not on a professional and patient basis. The multi-disciplinary approach and team set forth in the Guidelines is therefore embedded in the medical model and does not embrace the essence of community-based services at grassroots level. Where daily medical care is not indicated, it should not be a requirement, yet it is in the Guidelines. It is therefore suggested that in drafting these Guidelines, government lacked an understanding of how these services are intended to function.
It is also important to acknowledge the limitations of the Guidelines. They cannot, for instance, altogether curb the existence of unlicensed NGO’s. This is because such facilities can become self-supporting by, for example, charging fees. The shortage in supply of these residential and / or day care services means that many families and caregivers of the targeted groups may simply have no option as to where to send them and may settle for an unlicensed facility, regardless of the fact that it may be deficient in terms of the requirements of the Guidelines. It is submitted therefore, that government was remiss in not including consequences for operating without a license.
The South African Federation for Mental Health (SAFMH) is a non-profit organisation seeking to protect and uphold the rights of people with psychosocial disabilities and people with intellectual disabilities. We call upon all stakeholders- including government- to come together and derive a way in which these Guidelines can come to be a viable yardstick for how facilities operate.
Government has long-since required licenses from NGO’s in order for them to obtain subsidies. This is a necessity when signing service level agreements with the state. This imperative is thus not new. While the Guidelines have certain troubling issues, they are the best we have and it is time to take up the cudgels and make the best of the situation. Nothing can undo the monumental tragedy that was Life Esidimeni, but the state has made the effort to ward of this kind of human rights violation in the future. It bears criticism, but it also bears hope, and it is our hope that the Guidelines will serve to catalyse at least some kind of positive change in the future.
Project leader: Awareness and Information
Tel: 011 781 1852- ext 201
The 30th of March is World Bipolar Awareness Day. As with any commemorative occasion, it represents the opportunity to reflect on the past, to examine the status quo and also to make a determination as to what needs to be done in the future. People with Bipolar Disorder- as with all mental illnesses and psychosocial disabilities- have found themselves chronically discriminated against with tarnished perceptions imposing limitations on all facets of life. Indeed, prevailing social stigma remains rife among the public at large, which significantly diminishes the chance of a person so-situated from living as a productive member of society.
According to the World Health Organisation (WHO), Bipolar Disorder is a prevalent condition, with figures indicating it affects between 40 and 60 million people worldwide. Much research has been done surrounding the disorder and the combination of medication and therapy has shown good outcomes for affected persons. Notwithstanding this, Bipolar Disorder can become severe- even disabling- and there are many challenges individuals so-situated face- with the resultant unjustifiable limitation of their right to employment.
South Africa has ratified the International Covenant on Economic, Social and Cultural Rights. The right to work is espoused in this treaty. Importantly, this instrument details that this right extends to everyone, meaning that people with illnesses and disabilities are included in this catchment. In the event that an individual’s Bipolar Disorder constitutes a disability, the Convention on the Rights of People with Disabilities also becomes relevant. This treaty has also been ratified by South Africa and highlights the need to mainstream people with disabilities into all spheres of society. The Constitution of the Republic of South Africa provides for the rights to dignity and equality- all of which are required for the realisation of the right to employment.
The mere fact that a person suffers from an illness or disability, therefore, does not mean that they ought to by necessary implication be unemployed or considered unemployable. That this is the case in the Republic is contained in the Basic Conditions of Employment Act which makes provision for what is known as reasonable accommodation. This concept denotes making justifiable allowances for an employee with an illness or a disability who can still fulfil the inherent requirements of their job provided certain adjustments are made. This excludes instances where the accommodation would lead to unjustifiable hardship or restrictions upon the employer. Under these conditions, it is wholly possible that an individual- such as one with Bipolar Disorder- can flourish in a work environment. Stigma attaches the intrinsic notion that these individuals are guaranteed to be unstable and unable to successfully fulfil the tasks attached to their job description without the requisite evidence to substantiate this. Challenges need not be barriers if only there is empathy.
Reasonable accommodation can take many forms and its requirements differ from person to person. These may include incremental increases in workload when a person returns from sick leave; flexible working hours; the breaking up of tasks; ensuring a working environment is quiet; reassignment to an alternative position; changes to supervisory methods; time off for medical treatment and collection of medication and many others. These are not intended for the employee to end up with a diminished output, but simply to create a conducive environment for the employee to fulfil his or her obligations to the organisation.
The South African Federation for Mental Health (SAFMH) is a non-governmental organisation seeking to advocate for and uphold the rights of people with psychosocial disabilities and people with intellectual disabilities. This year, the organisation will be raising awareness about the right of such individuals to employment. On this World Bipolar Awareness Day, SAFMH calls upon employers, prospective employers and other stakeholders to ensure that the right of people with Bipolar Disorder to work is upheld and that proactive steps are taken to facilitate the realisation of this right. Government departments and other stakeholders are encouraged to educate both employers as well as current and future employees with Bipolar Disorder on the right to work and to reasonable accommodation in the workplace.
Bipolar Disorder is a diagnosis, but it need not be a sentence. There is no reason why capable members of society should be precluded from entering and remaining in the labour market. Should employers be willing to take the necessary steps where required, employees with this disorder can add immense value to an organisation. Let the awareness raised by this day be carried over to every day of the year and let people with this condition be empowered and capable of transcending stigma and negative perceptions. #takeyourplace
For Inquiries Contact:
Project Leader: Information and Awareness
Tel: 011 781 1852
South African Human Rights Day is celebrated every year on the 21st of March. A symbol of our troubled history, this commemoration addresses inherent and deeply-rooted discrimination against people who have been oppressed for centuries. While the advent of Constitutional Democracy has seen changes in law and policy intended to emancipate those who have been marginalised, social stigma looms large in the lives of many residing in the Republic today. Pervasive and pernicious, this societal phenomenon is dehumanising and diminishes one’s quality of life. While there exists a firm commitment to achieving substantive equality, efforts in practice to truly achieve this in the lives of the most vulnerable have been disparate and much remains to be done in order for this to be realised. Pertinent examples of groups remaining in peril are people with psychosocial disabilities and people with intellectual disabilities. A rudimentary example of this is that the right to work of people so-situated is largely curtailed or simply extinguished. This violates their rights to inherent dignity and that they are equal before the law. This is patently unconstitutional and contrary to the prescripts of international law.
The right to work is espoused in detail in the International Covenant of Social, Cultural and Economic Rights. It states that every person has the right to gain a living through work they choose and accept. It also details that states must make opportunities available for people to gain skill sets in order for them to become employable. It is important to understand that this right extends to everyone and is not exclusive to those without a disability. A legal instrument which augments the notion of equality within the workplace is the International Convention on the Rights of Persons with Disabilities, which has as part of its focus the mainstreaming of people with disabilities into all societal environments. Nationally, and in addition to the aforesaid Constitutional entitlements, a protective shield is created for people with psychosocial disabilities and people with intellectual disabilities by legislation such as the Labour Relations Act, the Basic Conditions of Employment Act, the Employment Equity Act, the Promotion of Equality and Prevention of Unfair Discrimination Act and others. Despite this; and as indicated; implementation on the ground is poor, resulting in people so-situated suffering the effects of unemployment and unfair labour practices.
According to the 16th Commission for Employment Equity, only 1.2% of the workforce are people with disabilities in comparison with the target of 2%. This figure is unacceptably low and represents a failure on the part of duty-bearers to respect, protect and fulfil the rights of people with disabilities in the workplace. People with psychosocial disabilities and intellectual disabilities constitute a significant portion of this demographic and suffer under the hand of flagrant present-day disadvantage despite our legal framework.
People with psychosocial disabilities and people with intellectual disabilities have long-since been considered incapable and capricious. This is highly prevalent among potential employers who are of the view that they will have to make unreasonable allowances for such individuals when, in fact, the law prescribes purely their reasonable accommodation. Stigma against people so-situated is entrenched in others from a young age and it carries over to all decisions made about them, including whether they have the capacity to become part of the workforce. This is despite a growing body of empirical evidence that such individuals can excel in a conducive environment and become dependable workers. In addition to the effects of stigma, work-readiness is a significant challenge for people with psychosocial disabilities and people with intellectual disabilities, with woefully inadequate availability of opportunities available for higher education and training accommodating the needs of such individuals. This is in spite of the fact that it has been shown that people with psychosocial disabilities and people with mental illness and intellectual disabilities can very successfully cultivate new skills when education is provided.
The South African Federation for Mental Health (SAFMH) is a non-governmental organisation seeking to advocate for and uphold the rights of people with psychosocial disabilities and people with intellectual disabilities. This year, the organisation will be raising awareness about the right of such individuals to employment. On this Human Rights Day, SAFMH calls upon employers, prospective employers and other stakeholders to ensure that the right of people with psychosocial disabilities and people with intellectual disabilities to work is upheld and that proactive steps are taken to facilitate the realisation of this right. Government departments and other stakeholders are encouraged to educate people who, themselves, have psychosocial disabilities and intellectual disabilities, as well as their families and caretakers, surrounding their right to employment
Human Rights Day is not only an opportunity to reflect on the past, but also a chance to examine the status quo and how it can be changed for the better. People with psychosocial disabilities and people with intellectual disabilities are wholly deserving of opportunities to realise their right to work and the accompanying rights to dignity and equality through entering into the workforce- and should not be denied this right on account of stigma and discrimination. #takeyourplace
For Enquiries Contact:
Project Leader: Information and Awareness
Tel: 011 781 1852