2023 marks eight years since the Life Esidimeni tragedy. It was a gross human rights violation, a moment of shame for South Africa’s healthcare system, and a stain on the Mental Health Policy Framework 2013-2020, which was meant to have been anchored firmly in human rights.
In the years since Life Esidimeni, human rights defenders and policy makers have worked to understand what could have been done to prevent this and how we can ensure it never happens again.
Much suffering and hardship caused by the Life Esidimeni tragedy was because the voices of mental health care users and their families were disregarded and unheeded. Mental health review boards, if operational and accessible, should protect the rights and dignity of mental health care users and their families. Review Boards should provide a channel for such parties to gain a voice and be supported during painful or distressing personal times” says Leon de Beer, deputy Director of South African Federation for Mental Health (SAFMH).
21 March marks Human Rights Day. Access to quality mental health care and services is a human right. This year the South African Federation for Mental Health (SAFMH) and the South African Human Rights Commission call on all South Africans to play their part in upholding this human right. The Mental Health Care Act states that any person witnessing the abuse, neglect, exploitation, or degrading treatment of a mental health care user is obligated to report this. Mental Health Review Boards are there to help people do this.
- What are Mental Health Review Boards?
The Mental Health Care Act established Mental Health Review Boards to look at the care, treatment and rehabilitation services provided to mental health care users. These Boards are there to protect the rights of mental health care users, especially at times when users are unable to protect their own rights (e.g. during involuntary admissions). Review Boards look at all admissions where a mental health care user is unable or unwilling to consent. They must assess that there were legal and clinical grounds for the mental health care user being admitted without consent, that the admission was in the mental health users’ best interest, and that it was the least restrictive option.
When a mental health care user has been admitted, the Review Board can consider an appeal against the admission if the mental health care user or their family believe that the admission is either too restrictive or the mental health care user should not be admitted. An appeal can be submitted via a MHCA 15 form.
Review Boards also have a responsibility to review the care, treatment and rehabilitation provided by health establishments. They look at specific reports produced by the health establishment (e.g. on seclusion, restraint and electroconvulsive therapy) and at complaints submitted for investigation via a MHCA 02 form.
Another function of the Review Boards is to consider applications of mental health care users who need to be transferred to maximum security facilities and consider periodic reports on the mental health care status of prisoners living with a mental health condition.
- Who can contact a Mental Health Review Board?
Any person can report abuse, neglect, exploitation, or degrading treatment of a mental health care user to the Review Board via a MHCA 02 form. This includes a mental health care user, family members, caregivers, health care providers, and NGOs.
In terms of Section 35 of the Mental Health Care Act, an appeal against further assisted or involuntary care, treatment and rehabilitation can only be submitted by the mental health care user, their spouse, next of kin, parent or guardian, partner, or associate. This must be done within 30 days of receiving the written notice issued by the health establishment.
- Do all Mental Health Review Boards work in the same way?
No. Each Review Board has their own way of working with their own methods to manage reports of abuse or appeals against further care, treatment, and rehabilitation. Review Boards exist across all provinces and each Review Board generally oversees a district.
- How do you contact your Mental Health Review Board?
For a report of abuse, neglect, exploitation or degrading treatment, complete the MHCA 02 form. This is also called a complaint.
- You can email your completed MHCA02 Form to your Review Board. This Mental Health Review Board contact list is in progress and will be updated regularly.
- If your Review Board has an office, you can drop off the completed MHCA 02 Form.
- If you need assistance with completing the MHCA 02 Form, you can call your Review Board for more assistance. This Mental Health Review Board contact list is in progress and will be updated regularly.
- You can report the matter through a community worker or health care provider.
- The composition of all Mental Health Review Boards should include a community member, you can contact the member within your community.
- You can write a general email or letter to your Review Board without completing a MHCA 02 Form explaining the situation. In all instances the Review Board will investigate the content of the report and if required to proceed, may request that you complete a MHCA 02 Form.
For an appeal. This is a legal process that involves the High Court. Such an appeal must be completed on the MHCA 15 Form and sent to the Review Boards. You can either submit this directly to your Mental Health Review Board or to the health establishment who must submit the form to the Review Board within 24 hours of receiving it as there is a limited time frame to consider an appeal. More information on the appeal process and regulations is outlined in the Mental Health Care Act.
- What happens when a mental health care user has been admitted involuntarily for longer than 6 months?
Mental health care users that are admitted for longer than 6 months are further assessed by the Review Boards to consider whether the person should remain in hospital. They also consider the progress the mental health care user has or hasn’t made during their stay.
- Do Mental Health Review Boards only consider cases of abuse which occur in a health establishment?
No. Review Boards investigate abuse, neglect, exploitation and degrading treatment of mental health care users, whether they are in community-based organisations, health clinics or in hospitals.
It is the priority of Review Boards to investigate when mental health care users are unable or unwilling to consent and do not have the option to independently remove themselves from the abusive or neglectful circumstances. Sometimes, in the community, mental health care users remain in an abusive or neglectful situation voluntarily as there is no alternative. Unfortunately, in these instances the Review Board has no power to compel change or report the matter.
- What should you do if you are unable to contact your Mental Health Review Board?
You can contact your Provincial Focal Person for Mental Health Services if you are unable to get in contact with your district board (see the list of contacts here).
Access to mental health services is a human right. Play your part in making sure this human right is upheld.
For media enquiries, please contact:
Michel’le Donnelly – SAFMH Project Leader: Advocacy & Awareness
CELL: +27 (0)79 799 6533
Wisani Baloyi – SAHRC Acting Communications Coordinator
CELL: +27 (0)81 016 8308
Notes to editors
SAFMH is a South African-based non-profit organisation. We believe access to quality mental health care is a human right and strive to make this happen through our advocacy. Are you interested in shifting attitudes towards mental health and mental health care? Please reach out if you are interested in covering more positive messaging around mental health and community-based mental health care in South Africa.
The South African Human Rights Commission is a Chapter 9 institution established in terms of section 181(1)(b) of the Constitution, to strengthen constitutional democracy in the Republic of South Africa. Its mandate is to promote respect for human rights; promote the protection, development and attainment of human rights and to monitor and assess the observance of human rights in the Republic.