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Dear Honorable President,

 

RE: FAILURE TO IMPLEMENT LEGAL IMPERATIVES SURROUNDING MENTAL HEALTH CARE IN SOUTH AFRICA

 

First of all, we thank you for your attention. While mental health is certainly an unrecognized and neglected focus area, we note efforts to bring to light the failures in the system. It is our hope that these efforts will serve to realise the rights of people with psychosocial disabilities and intellectual disabilities. Today we wish to bring to the fore the failure to implement the laws and policies of the Republic as they relate to the mental health system with reference to the Life Esidimeni Tragedy and beyond.

 

First of all, we wish to remind you of mental health in the global context and of the international obligations of the Republic:

 

Globally, mental illness is strongly linked to health and social inequalities, and these inequalities affect large groups of people, whether these groups are defined socially, economically, demographically, or geographically. Certain groups in society are more vulnerable to experiencing mental health inequities, including: black and minority ethnic communities, homeless people, victims of violence and abuse, people living with disabilities, women and children. Those with severe mental illnesses are more likely to experience some of the most severe health inequalities. Inequalities in mental health and the dilapidated state of psychiatric facilities have significant ethical implication which involve key bioethics principles of medicine and public health that involves: respect for individuals, justice (equality and fairness), promotion of good, and to do no harm.

 

As a Member State of the United Nations and World Health Organisation, South Africa has an obligation towards the agreements adopted or endorsed at this level to ensure that its citizens’ human rights, health and mental wellbeing are underpinned in all local policies and legislation. At this level, world leaders have committed to recognise prevention and treatment of non-communicable diseases, of which mental, neurological and substance use disorders are included, as health priorities within global development. There can be no sustainable development without mental health and none of the Sustainable Development Goals can be achieved without prioritising mental health.

 

We turn now to national imperatives:

 

Chiefly, the Constitution of the Republic of South Africa (CRSA), Mental Health Care Act and the White Paper on the Rights of Persons with Disabilities as well as the Mental Health Policy Framework and Strategic Action Plan (MHPF) and National Development Plan are concerned with the right of dignity of service users. This is so because dignity is a right from which others flow- there is no real right to access to health care without dignity, for example. Other rights similar in nature are the rights to equality and life. Further applicable rights- those flowing from the aforesaid entitlements- are the rights to freedom and security of person and the right to a clean and healthy environment. We draw your attention to these rights, Honorable President, because they have been neglected, extinguished even, in respect of those among society’s most vulnerable. Applied correctly, the aforesaid instruments can facilitate the realization of each of these legal guarantees.

 

Honourable President, it is clear, the requisite instruments for creating a comprehensive and functional mental healthcare system indeed exist. Unfortunately implementation thereof is woefully inadequate. This was evidenced with both Life Esidimeni as well as within the status quo. The violations of these rudimentary entitlements led to death of some 144 mental health care users and the relapse of many others. Today, atrocities continue to occur throughout the system with death and destruction in the lives of individuals so-situated becoming a raging and rampant problem throughout the country. Applied correctly extant legislation and policy could ameliorate the plight of mental health care users, and South Africa could see a high rate of recovery and successful habilitation/rehabilitation. Unfortunately this is not the case. A comprehensive legal framework is meaningless if it is not implemented correctly, or in some cases at all. Until horror stories of poor or non-existent basic services subside, until mental health care users are able to obtain what is required in order to maintain a high standard of mental well-being, the drafting of the law, policies and plans concerned will remain a moot and futile expenditure of resources and effort.

 

Honourable President- to many mental health care users, the Life Esidimeni tragedy instilled emotions of anger, resentment, disappointment and distrust in the Department of Health, but also in Government in its entirety for failing to protect the lives of the former Life Esidimeni patients from suffering and from death. Many mental health care users are accessing services in the public health care system and are asking themselves “does my life mean as little to Government as the lives of the former Life Esidimeni patients?” The system as it presently stands- despite all of the scrutiny under which it has been placed- represents dereliction of duty on the part of your government and the fact that nobody is being held unaccountable renders the system to a state of wanton neglect.

 

Honourable President, we implore you to implement the obligations to which the state is bound, address the present shortcomings productively and systemically and hold those responsible for the glaring iniquities in the system to account.

 

It is greatly desirous that this communication will be addressed with a sense of urgency and that steps will be put in place to remedy the fatal defects in the system.

 

Yours Faithfully,

 

The South African Federation for Mental Health

 

Contact Details:

 

Nicole Breen

Project Leader: Awareness and Information

South African Federation for Mental Health

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

011 781 1852

072 2577 938

International Day of Disability is celebrated annually on the 3rd of December. It is the culmination of a month's worth's of activities as it falls on the last day of Disability Rights Awareness Month. This year, the South African federation for Mental health elected to have community-based care as its focus for the occasion. To this effect we have issued a press release. Read it here:

International Day of Disability takes place annually on the 3rd of December. It is an opportunity to engage in activism surrounding the rights of people with disability and to raise awareness surrounding the need for their rights to be realised. While a single day of the year is hardly enough to scratch the surface, it heralds the prospects of making a start in advocating for the rights of people so-situated. People with psychosocial and intellectual disabilities are especially vulnerable as their disabilities are often not well-understood and methods of assisting them are not clearly defined in the minds of the state or society.

An important place to begin is to hold government accountable for the execution of its mandate. The state is the primary duty-bearer when it comes to providing the care and support these individuals need both to survive and thrive. Government is responsible for creating structures that allow people with disabilities to lead dignified lives. Unfortunately however, the state has prolifically and chronically failed people with disabilities, leading to social exclusion and poverty. This was evidenced in the Life Esidimeni tragedy and a spate of deaths and assaults of and by psychiatric patients in hospitals across the country, as well as within the community, as the state did not have adequate structures in place to ensure the safety of these individuals. Stripped of even the slightest bit of dignity, such individuals languished up to a point where crises arose, but by then it was too late and state intervention was meaningless.

South Africa has a comprehensive legislative and policy framework for people with psychosocial and intellectual disabilities With the Constitution, Mental Health Care Act, Mental Health Policy Framework and Strategic Action Plan 2013-2020 and White Paper on the Rights of Persons with Disabilities, there is a clear path towards the realisation of the rights of these individuals. Unfortunately the prescripts of these instruments remain largely unimplemented, with the effect that people with psychosocial and intellectual disabilities remain in limbo, often no better off than what they were before these frameworks came into place.

Government has also failed to hold disgraced former Member of the Executive Council (MEC), Quedani Mahlangu, accountable for the deaths of the 144 people in the Life Esidimeni tragedy. These mental health care users died under her watch and no visible action has been taken against her thus far. The African National Congress (ANC) has continued to protect her, even re-electing her to their Provincial Executive Committee earlier this year. Gauteng Deputy Chairperson, Panyaza Lesufi, defended her re-election in an interview, indicating that a) the fact that Mahlangu was no longer an MEC, b) that she was no longer a member of the provincial working committee of the ANC, c) that an inquiry had been held surrounding Life Esidimeni, and d) that the ANC had acted on the recommendations of the Health Ombudsman, was an adequate series of steps taken to hold her accountable. SAFMH maintains that Mahlangu ought to be made to take responsibility for her actions and inactions by the ANC doing more than shuffling her around the ranks of the party. It is truly disheartening that, to date, this has not been the case at all.

One of the essential elements that has been highlighted in policy and legislation is the need for deinstitutionalisation. Deinstitutionalisation occurs when mental health care users are, where possible, removed from the hospital environment and sent to live in communities. Mental healthcare services are then decentralised to provide care at community level. Despite supposed commitment to this process, its execution has largely been a failure. The reality is that, in some provinces there are simply no facilities at all for people with mental disabilities to go to outside of hospitals. In Gauteng, where the Gauteng Department of Health supposedly implemented deinstitutionalisation, this resulted in 144 people losing their lives as they were transferred to non-governmental organisations (NGOs) that were not adequately equipped to care for them and left many people in a state of wanton and tragic neglect. Some of these organisations had their licenses issued to them unlawfully, and others did not receive proper subsidies. Life Esidimeni amounted to a situation worse than Marikana and on par with incidents such as the Sharpeville Massacre and the Soweto Uprising. The state was warned by professionals, civil society and families that the transfer of the patients would have disastrous results, but the warning was cast to the wind and tragedy ensued.

Whilst Life Esidimeni is a poignant example of the state’s failure to take responsibility for mental health care users, it is sadly not the only example. With inadequate infrastructure, a lack of beds, a lack of qualified health care practitioners, inadequate security, stockouts of medications, confusion as to roles and responsibilities of stakeholders such as health care professionals, emergency service technicians and the police in involuntary admissions and human rights abuses happening frequently, a number of hospitals in the country have been identified as facilities in crisis. Despite increased budgetary allocation for mental health for the 2018/2019 financial year, nothing is changing and we are not seeing a purposeful upscaling of mental health services.

Mental health care users are among South Africa’s most disenfranchised members of society and it is unfortunate that our government acts in constant dereliction of duty towards them. The time to act is now, and fast. The South African Federation for Mental health (SAFMH) calls upon the state to urgently intervene and to make full use of its resources in prioritising mental health.

Contact Details

Nicole Breen

Project Leader: Information and Awareness

South African Federation for Mental Health

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

011 781 1852

072 2577 938

 

16 Days of Activism for No Violence Against Women and Children is celebrated annually between the 25th of November and the 10th of December. it is an opportunity to reflect on the past, examine the present and look towards the future we want to see for women and children in a violence-free society where they are safe and enjoy all of their rights and freedoms. In view of this SAFMH has compiled a press release. It appears below:

 

16 Days of Activism for No Violence against Women and Children is celebrated annually between the 25th of November and the 10th of December. As vulnerable demographics of the population, women and children often bear the brunt of violent activity within our society. This has an indisputable impact on their mental health. As an organisation committed to advocating for the rights of under-served individuals in this regard the South African Federation for Mental Health (SAFMH) wishes to raise awareness surrounding these social ills so as to work towards ameliorating the plight of women and children who are either victims of violence or who find themselves at risk of violence.

The World Health Organisation “WHO” (2002) defines violence as:

 “The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation”

 The WHO and London School of Health and Tropical Medicine (2010) indicate that:

“When directed against women or children, this violence can take a number of forms, including, but not limited to, sexual violence, intimate partner violence, child abuse and neglect, bullying, teen dating violence, trafficking, and elder abuse. The majority of violence against women and children is perpetrated by partners, family members, friends, or acquaintances, so that most violence against women and children takes place in the form of intimate partner violence, family violence, or school violence…”

 

The rates of violence against women and children in South Africa represents a crisis situation.

  • 17% of young women aged 18-24 had experienced violence from a partner within 12 months of a survey undertaken by Stats SA (2017).
  • The survey indicated that 24.4% of women in the poorest households had experienced physical violence.
  • According to the South African Medical Research Council (2017), three women are killed by their intimate partners every day.
  • According to the Institute for Security Studies (no date), in South Africa, one in four women report physical or sexual intimate partner violence.
  • The South African Police Services indicated that in 2017/2018 the reported crime statistics (2017/2018) said that 2930 women were murdered; 691 boys were murdered; 294 girls were murdered and murders of women and children accounted for 19.3% of total murders.

For our purposes the most pertinent question is as to what impact this has on the women and children of our country.  Shapland and Hall (2007) discuss the commonly occurring effects of varying kinds of victimisation which include:

Shock and a loss of faith in society…guilt at having become a victim of crime…psychological effects, including anger, fear and depression, but may for some turn into longer-term depressive effects including sleeplessness, anxiety and constant reliving of the event, and occasionally into PTSD [post-traumatic stress disorder]…

These are dire effects and, given the high propensity for women and children falling victim to these social ills, represent a real danger to a large proportion the population. It is therefore integral that steps be taken to prevent and act on such violence so as to minimise and ultimately eliminate the damage that violence does to individuals so-situated. Interventions can take various forms. At systemic level, further law and policy can be implemented to facilitate specific measures being taken in respect of women and children. The National Action Plan on No Violence against Women and Children is currently being reviewed and it is our hope that this process yields positive results. A top-down approach, however is never truly effective. What needs to happen is that communities need to be sensitised as to what the issues are and just how at-risk these vulnerable demographics are. Community and religious leaders, local government, non-governmental organisations and a spectrum of other parties all have a role to play in ensuring that awareness is raised about the plight of women and children. Concrete steps need to be taken at once to ensure that these segments of society are kept safe. 16 days is hardly enough to proliferate this message, but it is a start. Make your start. #takeyourplace

Contact Details

Nicole Breen

Project Leader: Information and Awareness

South African Federation for Mental Health

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

011 781 1852

072 2577 938

The South African Federation for Mental Health (SAFMH) would hereby like to invite suitably qualified and experienced parties to bid for the delivery of an evaluation project on behalf of SAFMH and the National Department of Health (NDoH).

Over the past four years, SAFMH has implemented a self-advocacy development programme in the Northern Cape, Mpumalanga, the Free State, Limpopo and Kwazulu-Natal in partnership with NDoH, aimed at establishing community-based advocacy groups and activities, following a nationally-coordinated model.

We would like an independent M & E specialist to conduct an in-depth evaluation of the project, with the aim of a) providing an assessment of the effectiveness of the methodology followed and b) to make recommendations about improvements and potential amendments to future methodologies aimed at the empowerment of mental health care users at community level and the development of advocacy activities.

The closing date for this bidding process is Monday, 10 December 2018 at 16:00. All bids need to reach SAFMH no later than this date and time.

Please contact us on This email address is being protected from spambots. You need JavaScript enabled to view it. to request the bid documentation.

From the 3rd of November to the 3rd of December is Disability Rights Awareness Month. This year SAFMH has elected to focus on community-based care. This is an area that is chronically under-prioritised but all-important as it is a core component of the deinstitutionalisation process to which South Africa has committed itself. To this effect, SAFMH has compiled a press release on the topic. Read it here:

Disability Rights Awareness Month annually runs from the 3rd of November to the 3rd of December 2018. This represents an opportunity to look back on the past, examine the present and envisage the future we want to see in terms of services for and the realisation of the rights of persons with disabilities. The South African Federation for Mental Health, as an NGO focussing on upholding and protecting the rights of people with psychosocial disabilities and intellectual disabilities, has elected to embark on a campaign surrounding community based care and its associated imperatives such as deinstitutionalisation and the need to prioritise services to individuals so-situated and thus to highlight the plight of these individuals.

It has been internationally recognised that people with psychosocial disabilities and intellectual disabilities should only be institutionalised as a matter of last resort. Hospital environments are restrictive, cost-intensive and by necessary implication limit the ability of patients to exercise their rights. It has been proven time and time again that integration/reintegration into communities aids the recovery of mental health care users through empowerment and allowing them, as indicated, to attain more of their rights than they would be able to in a hospital environment and that, with appropriate support, that such individuals can experience marked and profound positive outcomes. While South Africa has committed to a process of deinstitutionalisation, its government has not adequately built up a system of reintegration into communities and there is often simply nowhere for people with psychosocial and intellectual disabilities to go, meaning that they are warehoused in hospitals, sometimes for decades. The lion’s share of community-based care is provided by non-governmental organisations (NGOs), but they are in most cases not adequately capacitated not adequately subsidised by the state. This was one of the factors leading to the disastrous violation of human rights in the Life Esidimeni Tragedy, in which 144 mental health care users lost their lives while residing at NGOs.

Our campaign is entitled “Community Based Care: The Imperatives” and will serve to raise awareness of the following issues:

  • South Africa’s commitment to deinstitutionalisation and the need for community-based care to be suitable, appropriate and to provide an environment conducive to continued recovery of mental health care users
  • The continued lack of accountability from government, specifically the continued state protection of former MEC Quedani Mhlangu, and how failure to implement law and policy contributes to the plight of mental health care users, as was seen during the Life Esidimeni tragedy
  • The need for SASSA to allow people with psychosocial and intellectual disabilities to successfully apply for grants so that these individuals can live in their communities
  • The need to prioritise community-based care
  • Community-based care as a component of the recovery model
  • The need to apportion adequate resources to community-based care
  • Challenges surrounding licensing of NGO’s at community-based level
  • Obligations of government in ensuring community-based care is properly provided, specifically:
    • That a consultative process needs to be undertaken to develop mental health services and resources at community level
    • That the shortfalls in resources needed to adequately facilitate deinstitutionalisation policy requirements must be addressed
    • That NGO’s need to become more widely recognised as key partners in the delivery of mental health services and to be respected and treated as such
    • That government needs to recognise that without the upscaling of and provision of community-based services, South Africa’s commitment towards deinstitutionalisation will never be realised
    • That South Africa requires more consistent and more comprehensive subsidisation of community-based services, with adequate increases and timely payment of subsidies to ensure continuity in community-based mental health service delivery.

The campaign will be constituted of several activities. These include press releases, opinion pieces, a policy brief on community-based care, an open letter to the President on failings surrounding community-based care, a submission to the President on the impact failure to implement the White Paper on the Rights of Persons with Disabilities has on people with psychosocial disabilities and intellectual disabilities and activities on social media. It is our intention to paint a comprehensive picture of the situation in which people with psychosocial and intellectual disabilities find themselves and also to propose solutions for duty-bearers to consider in their work around such individuals. The goal is to inspire a call to action and to catalyse positive change in the lives of people living with these conditions.

It is our hope that our campaign will adequately serve what we view as an extremely important purpose. People with psychosocial disabilities and intellectual disabilities are among South Africa’s most vulnerable and it is integral that their rights are protected. The community-based care imperative is one of the most vital components of recovery and a determinant of quality of life. There is no reason that people in this position should be denied the right to live in their communities and to become accepted and productive members of society. Steps must be taken to facilitate this forthwith and we urge government to take the necessary steps to do so.

 

Contact details:

Nicole Breen

Project Leader: Awareness and Information

South African Federation for Mental Health

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

011 781 1852

072 2577 938

SAFMH was represented at the Global Ministerial Mental Health Summit held in London, UK from 9-10 October 2018, that brought together the world's political leaders, innovators, persons with mental health conditions, policy makers and civil society to share the most effective and innovative approaches to mental health and psychosocial disabilities.

The Summit hosted 6 workstreams to showcase innovations from across the globe and work to develop consensus statements to be delivered to political leaders: Children, Young People and the Now Generation; Caring Societies: creating the conditions for inclusion, prevention and wellbeing; The Economics of, and Investment in, Mental Health Finance; A Just Society: supporting societal shifts, tackling stigma and discrimination, creating inclusive societies; Mental Health Services around the World; and Research and the Future of Mental Health.

The workstreams’ recommendations were presented to the Ministers of Health present at the Summit – click HERE for the recommendations.

The Ministers of Health, themselves, signed a declaration in commitment to prioritise mental health in their respective countries – click HERE for the Global Declaration.