On the 21st March 2022, we celebrate Human Rights Day. This year, SAFMH commemorates the sacrifices that accompanied the struggle to attain democracy in South Africa and we celebrate our progressive human rights bill globally; one that clearly states, regardless of your demographics or health status, you have the right to life and human dignity.
Five years ago, 144 mental healthcare patients however died in the care of the South African public health system. They died from neglect, starvation, torture and abuse, casting a long shadow over the human rights legislation that should have protected these highly vulnerable individuals. This has come to be known as the ‘Life Esidimeni tragedy’ and is considered to be one of the worst violations of human rights in democratic South Africa. Today, we ask ourselves:
- What is the right to life for persons with mental disorders in our country?
- Where is the State’s protection for people with mental health needs to live a dignified life?
We are extremely concerned that five years on, too many recommendations from the Health Ombuds Report into the circumstances surrounding these deaths have not been implemented. Specifically, Section 18 of the report urgently called for:
- GDOH to provide “sufficient budget” for the design and implementation of a right-based approach to deinstitutionalisation. This means carefully replacing long-stay psychiatric hospitals where mental health care users are isolated with community-based mental health services where mental health care users can live in mainstream society, with any additional support required. An important part of this process involves ensuring the community-based organisations are capacitated, supported, and funded prior to receiving people discharged from psychiatric hospitals. To this end, GDOH was also recommended to develop a capacity building programme for all newly established NGOs within 45 days of the report.
- SAFMH is concerned that none of our Gauteng community-based mental health care affiliate organisations have received any increase in human or financial resources and/or upskilling/training/ongoing support from the GDOH following the report.
- A recent media statement about the increase in admissions at Helen Joseph Hospital for people needing mental health care, GDOH stated that “mental health is our top priority”. We have reached out to GDOH via their media enquiries department on the 10th, 11th and 17th of March to better understand how their vision for mental health as a top priority is being realised by the Department, and if there will be an increase in budget for mental health services in the upcoming year. We are still awaiting a response.
2. The development of information systems with patient registers and a database by which to make evidence-based decisions, monitor and evaluate health care delivery.
- To the best of our knowledge, no such database has been developed. There continues to be poor management of information and
the monitoring and evaluation of services to result in impactful change is unknown.
3. Disciplinary proceedings and a national inquest to “assess for gross misconduct or incompetence in compliance with Disciplinary Code and Procedure applicable to Senior Management Service (SMS) members in the public service.” Furthermore, “appropriate legal proceedings should be instituted or administrative action taken against the NGOs that were found to have been operating unlawfully and where MCHUs died.”
- A national inquest, held online, is still underway. Justice has been slow. It has been “often mired in legal debate and technical mishaps.” Gauteng Health officials continue to deny that the deaths and violations of patients’ human rights could have been predicted, contrary to the mountain of evidence saying otherwise. Five years on, no one has been held fully accountable for the deaths of the patients. To find out more about the evidence, themes and inefficiencies of the inquest, we suggest reading this article.
We will not forget or give up.
As South Africa’s largest and only national mental health advocacy organisation, SAFMH seeks to advocate for and uphold the rights of mental health care users and people living with mental health challenges in our country. This year, we will be engaging in the following activities (among others) to do so:
- Holding GDOH accountable. SAFMH is part of the South African Mental Health Alliance (SAMHA), a consortium of organisations that came together following the Life Esidimeni tragedy to advocate for access to quality mental health care in South Africa. SAMHA’s founding members are SAFMH, the South African Depression and Anxiety Group (SADAG), South African Society of Psychiatrists (SASOP) and SECTION27. SAMHA continues to be operational and continues to engage with GDOH around any concerning decision making (and lack thereof) when it comes to mental health care in the province.
- For example, SAMHA recently intervened to stop the movement of MHCUs to another unknown facility after the contract with the Clinix group came to an end. SAMHA is asking GDOH to provide us with their medium-term plans with budgets for the care of MHCU in need of long-term care. It appears that the long term care of MHCU is managed using a tender process which does not include any consultation with MHCU and their families. We have asked for GDOH to consult MHCU representatives and their families on this important process so that MHCU rights are respected and upheld.
2. Holding the National Department of Health and State accountable. This year, SAFMH, as part of the South African Disability Alliance (SADA), will contribute to a shadow report for the United Nations (UN) to discuss how our national government has been upholding the UN’s Convention of the Rights of Persons with Disabilities treaty, to which South Africa is a signatory.
- A shadow report is information submitted by a consortium of NGOs (in this case SADA) to the treaty monitoring bodies that addresses omissions, deficiencies, or inaccuracies in the official government reports. Such information will be vital in assisting the UN obtain a richer and more accurate picture as to how the state is (or isn’t) upholding the rights for people living with disabilities in South Africa.
- Lobbying for the inclusion of mental health care in health care reforms (e.g., the NHI Bill) while simultaneously working to
ensure that community-based mental health organisations receive adequate funding, training and support in an effort to move
- Nationally, SAFMH presented at the NHI public hearings about the importance of seeing that universal access to health must include mental health care.
- Internationally, we consult on global policy briefings for how to create advocacy and awareness for including mental health in Universal Health Coverage.
- In both outputs, we promoted community-based care as an essential part of population mental health care planning.
This year’s commemoration of Human Rights Month also marks the 25th anniversary of the adoption of the Constitution. South Africa’s constitution is known to be one of the most progressive in the world, enshrining the rights of all people in the country and affirming the democratic values of human dignity, equality and freedom. And whilst we are proud of this, we cannot boast about an equal constitution when we know that there are people in our country who are not afforded the same treatment.
This Human Rights Day, we ask that you join us in calling for the immediate implementation of the recommendations from the Health Ombuds Report into the circumstances surrounding the deaths from the Life Esidimeni tragedy. We also hope you will stand with us in advocating for and upholding the rights of mental health care users and people living with mental health challenges in our country.
Image courtesy of Polina Kova via Pexels