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