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This World Mental Health Day SAFMH is focusing on Mental Health First Aid. SAFMH Deputy Director Leon de Beer spoke to Voice of America about the topic of Mental Health First Aid and why it is important. 


3 October 2016



The South African Federation for Mental Health would like to express our sadness at the reports that another former patient of Life Esidimeni, Nombulelo Mthembu, has passed away. Nombulelo is now the 37th patient who has died since the Gauteng Department of Health transferred 1300 psychiatric patients from the Life Esidimeni Healthcare Centres.

The Gauteng Department of Health’s response to her death, by saying that her patient files and medical records did not come with her when she was moved and that this contributed to her death, is simply not acceptable. The Department had a responsibility to plan and oversee the cancellation of the contract with Life Healthcare, as well as the relocation process of the patients. If they did not receive all of the patient’s files, they should have taken this up with the responsible parties immediately and not allowed these patients to be moved to new facilities that did not know what their condition was or what type of care they would require. The former patients of Life Esidimeni have been let down by the duty bearers who were responsible for their care, and their rights to dignity and quality healthcare have been violated.   

SAFMH welcomes the investigation by the Health Ombudsman, but while the investigation is taking place it is essential that the remaining patient’s wellbeing remains a priority. October is commemorated as Mental Health Awareness Month, and as we begin this month SAFMH would like to call on the Gauteng Department of Health to show that mental healthcare users are a priority and that their care and wellbeing is taken seriously. We urge the Department to immediately implement steps to ensure that there are no further deaths, and that all the patients who have been transferred to new facilities receive the quality care that is their right.



Marthé Viljoen

Programme Manager: Information & Awareness

SA Federation for Mental Health

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October is commemorated as Mental Health Awareness Month, and this year the South African Federation for Mental Health is focusing on the topic of Dignity in Mental Health: Psychological and Mental Health First Aid for All.

In South Africa, dignity is seen as a basic human right for all citizens, which is protected in our Constitution. When someone suffers a physical injury at home, work or school, they can generally depend on being treated with sympathy and receiving first aid treatment until they can receive professional medical help. However, when someone experiences a mental health problem or crises in these same settings, they are often stigmatised and treated as if their symptoms or experience does not qualify as a real health crises. Being treated in this way is a violation of a person’s basic human rights. SAFMH is calling on all sectors of society to make training and implementation of mental health first aid a priority, to ensure that those experiencing psychological distress are always treated with dignity and receive the assistance they require. 

Physical first aid is a concept that most people today are aware of, and most businesses, schools and organisations make it a priority to have someone on staff who is trained to administer basic first aid in the case of an emergency. Mental health first aid is a relatively newer concept, and it focuses on providing support and assistance to someone suffering a traumatic event or other mental health problem.

Car accidents, domestic violence, rape, violent crime, or natural disasters are just a few of the traumatic events that someone may be exposed to in their lifetime. In a country such as South Africa, with high rates of violent crime, domestic abuse and poverty, these traumatic events are unfortunately all too common. Studies have shown that the rates of mood and anxiety disorders, substance use, general psychological distress, social needs and impairments in social functioning increase among those exposed to crisis events.

Although psychological and mental health first aid is a relatively unknown term in South Africa, it is a potentially lifesaving skill that we all need to have. Learning how to provide basic mental health first aid will enable people to provide support to distressed individuals in the same way as they do in physical health crises. Highlighting and teaching mental health first aid skills to all will also make a significant contribution to pulling mental health out of the shadows, and ensuring that mental health care users are treated with the respect and dignity they deserve.


What is Mental Health First Aid?

Psychological and mental health first aid is the help offered to a person showing early signs of a mental health problem, experiencing a worsening of an existing mental health problem or in a mental health crisis. The first aid is given until appropriate professional help is received or until the crisis resolves.

The aims of mental health first aid are to:

1. Preserve life where a person may be at risk of harm

2. Provide help to prevent the mental health problem from becoming more serious

3. Promote recovery of good mental health

4. Provide comfort to a person with a mental health problem/in a time of crisis

Mental health first aid will typically be offered by someone who is not a mental health professional, but rather by someone in the person’s social network (such as family, friend or work colleague) or by someone who may come into contact with potentially vulnerable individuals on a daily basis, such as a teacher, police officer, or social worker.

During Mental Health Awareness Month, SAFMH will be focused on educating people about the benefits of mental health first aid, and calling on government, schools and businesses to make mental health first aid training a priority to ensure that South African’s mental health is taken care of in the same manner as their physical wellbeing. SAFMH would also like to encourage all levels of society to address the stigma associated with mental ill-health so that dignity is promoted and respected and more people are empowered to take action to promote mental wellbeing.



Marthé Viljoen

Programme Manager: Information & Awareness 

SA Federation for Mental Health

This email address is being protected from spambots. You need JavaScript enabled to view it.



In the mental health sector there are many words and phrases that are used every day, the meaning of which may not be clear to people outside of the mental health field. Below are a list of words and phrases that may be frequently heard when discussing mental health.



Deinstitutionalisation is the process of downsizing or replacing long-stay psychiatric hospitals with smaller community-based alternatives for the care of people with mental disorders or disabilities. Deinstitutionalisation is not limited to the reduction of psychiatric hospitals, instead it includes the provision of alternative mental health services, such as residential facilities.  

Deinstitutionalisation consists of three processes:

1.   The relocation of mental health care users from psychiatric hospitals to alternative facilities in the community

2.   The diversion of potential new hospital admissions to alternative facilities

3.   The development and upscaling of alternative community services

Often the greatest challenge faced in deinstitutionalisation is to creating adequate and accessible community resources. If community services are not available to replace psychiatric hospital services, mental health care users will not receive the care and treatment they need and the process will fail. When the deinstitutionalisation process is well managed, including community services being upgraded and being able to provide adequate treatment and support, this change greatly improves the lives of mental health care users.



In mental health, mention is often made of “upscaling mental health services.”

Upscaling means to improve the quality, value, or rating of a specific product or service.

In the mental health context, upscaling of services as part of the deinstitutionalisation process refers to community organisations, such as NGOs, support groups or residential facilities, receiving funding and resources in order to improve their facilities, hire or train more staff, and improve the services they are able to offer. The upscaling of community based mental health services is in line with the Mental Health Policy Framework and Strategic Action Plan, and is an integral part of the deinstitutionalisation process.



A non-governmental organisation (NGO) is a not-for-profit organisation that is independent from the state. NGOs perform a variety of functions, depending on their focus area. They may bring citizen concerns to Government, advocate and monitor policies, provide statutory services to clients, or advocate for change in certain areas.  NGOs are a highly diverse groups of organisations focusing on a wide variety of issues, such as human rights, health or environmental issues, or religious causes. NGOs are usually funded by donations but some avoid formal funding and are run by volunteers.

Although NGOs may receive subsidies or support from Government, they are NOT a part of Government. NGOs are independent organisations that help Government to deliver community based services. NGOs provide Government with a cost—effective way of delivering services to communities and providing them with services and support.







The Board and Executive Committee of the South African Federation for Mental Health would like to express sadness and outrage at the report that 36 psychiatric patients transferred from the Life Healthcare Esidimeni facilities earlier this year have died while in the care of NGOs selected by the Gauteng DOH. This information, which was disclosed on Tuesday by the Gauteng Health MEC in an oral reply to questions by DA Shadow Health MEC Jack Bloom, show the level of mistreatment of mental health care users in Gauteng.

The psychiatric patients were relocated to 122 NGOs after the department cancelled its contract with Life Healthcare which looked after almost 2000 patients. At the time of the cancellation of the contract, the Gauteng Department of Health claimed that terminating the contract was part of the process of deinstitutionalisation, and that the money saved from the contract would go towards upscaling other mental health services, all of which it claimed was in line with the National Mental Health Policy Framework. It is now clear however that the Gauteng Department of Health has disregarded its commitment to the National Mental Health Policy Framework, as the primary goal of the policy is to ensure that mental health care users are able to live with dignity and receive quality healthcare services. 

When the termination of the Life Esidimeni contract was announced towards the end of 2015, SAFMH raised concerns over the fact that deinstitutionalisation (or downscaling of institutionalised care) ideally needs to go hand in hand with the upscaling of community based care and that this had not been done adequately to ensure that there were NGOs and facilities available that could accommodate the Life Esidimeni patients by March 2016. SAFMH also raised concern that the specialised services and high levels of support that the patients needed would not be provided, and that the relocation process was not receiving the necessary attention and resources to ensure a seamless transition for the patients.

On numerous occasions SAFMH offered assistance and input to the Gauteng Health Department as part of this process, however this offer of assistance was never taken up. The Department committed to engaging with patients, families and stakeholders throughout the relocation process, however this also never took place.

SAFMH would like to call for the creation of an independent commission of inquiry to investigate the exact cause of death of the 36 patients, as well as the way that the Life Esidimeni contract cancellation process was planned, managed, and administered, including the lack of transparency in communication with patients, their families and stakeholders. SAFMH feels it is important that full responsibility for the deaths of these mental health care users not be placed solely at the hands of the NGO sector. The Department of Health was responsible for the decision to terminate the Life Esidimeni contract, as well as for the process of finding suitable NGOs to house the patients and the smooth running of the relocation process.

If some of the 122 NGOs that patients were moved to were not adequately able to care for those patients, then this is something that the Department should have confirmed before the relocation process began. If there were not enough facilities or NGOs available that could provide the high levels of specialised care that the Life Esidimeni patients required, then the relocation of patients should have been stopped until such a time as adequate residential facilities were available for all 2000 patients. The majority of NGOs and organisations that work in the mental health field are dedicated to providing good quality care to their residents, however they are also bound by the limited resources that they have available.

SAFMH would also like to question what role the Mental Health Review Board has played in this process, as the Review Board is supposed to monitor cases of abuse and discrimination and ensure that incidents such as these do not take place. After the first reported death of a Life Esidimeni patient as part of the relocation process, a proper investigation should have been done and steps taken to prevent any further loss of life or trauma to the patients and their families.   

The SAFMH Board would like to call on the Gauteng Department of Health to immediately employ measures to prevent further deaths, at any costs, as well as immediately starting a process of intensive upscaling for NGOs. Government needs to show its commitment to implementing the Mental Health Policy Framework by ensuring that something like this never happens again, and by providing mental health care users in Gauteng as well as the rest of South Africa with the services and care that are their legal right. SAFMH would also like to reaffirm our commitment to work alongside Government and other partners to find solutions to this crisis and to try and prevent any further loss of life. 

As part of our advocacy efforts to raise awareness for mental health SAFMH gathers life stories from families and mental health care users, to try and empower people by giving them a voice. We would like to invite the families of Life Esidimeni patients, or other affected persons, to share their stories with us, so that we are aware of the challenges they have/ are facing, and we can use this information to advocate for better treatment and care of mental health care users.



Marthé Viljoen

Programme Manager: Information & Awareness

SA Federation for Mental Health

This email address is being protected from spambots. You need JavaScript enabled to view it.

011 781 1852



Join SAFMH as we celebrate World Mental Health Day, with a complimentary presentation on mental health and dignity in the workplace on Friday the 7th of October. 

For more information or to RSVP contact 

Marthé Viljoen

+27 (0)11 781 1852

This email address is being protected from spambots. You need JavaScript enabled to view it.