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
Youth Day 2018
People ask why certain people get depressed but others don’t? Even if they in the same circumstances, etc.
How do we even know when someone is depressed? What are the warning signs? The symptoms?
How come certain people “recover” from their depression and others don’t? Can people even recover from a mental illness?
Are there even answers to these questions?
In my very young age, I myself didn't know the answers to these questions and neither did my parents.
Mental illness was a whole new world we never tapped into, knew nothing about nor thought of it but it arrived suddenly to my world, and oh, did it arrive with a storm. How do we deal with this, we thought. But no one was there to explain and understand.
This makes one feel extremely alone and lost, just how I felt, when depression sunk in and took over my life. This is how those with mental illness feel. But remember, we need answers to these questions…
Some sort of mental illness affects so many of our youth and yet so many of us no know nothing about it. How do we manage such a horrific illness with no information or knowledge?
Warning signs can be fatigue, sadness, numbness, loss of appetite/ overeating, lack of interest, etc, but everyone can be so different in the way they deal with their mental illness and what signs they show. This what makes detecting mental illness so difficult.
I think in our society so many of us shy away and stigmatize mental illness, especially in the youth. We often say, “Oh its just a phase in the teens or it’s just their hormones” but many of time it’s a bigger issue , one that we don't recognise nor take seriously but so many of our youth succumb to.
Schools these days are putting huge strain on our children, and a lot of the time they just not coping! We need to take notice, wake up and deal with the strain this has put on our youth.
We need to start talking about it, take notice and see how our future generation is really doing,
Talk with your children, your students, your family and get to really know them. Keep an open door policy, take what they say seriously, don’t brush off anything, take care, and don’t take them for granted, remember, 1 person commits suicide every 16.2 minutes.
Maybe if everyone took notice and opened their eyes to mental health we would have more answers to these questions. We would know how to deal with mental illness better and see the warning signs.
We could just be saving lives.
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%.