THE SCANDAL involving the deaths of nearly 100 so-called ‘mental patients’ deserves more consideration. Missing from the press narrative regarding the tragedy, involving an investigation by Health Ombudsperson Malegapuru Makgoba and the many understatements and obfuscations by Health Minister Elias Motsoaledi, is any criticism of the designated methodology used to commit patients, namely psychiatry.
Until 2002 when the Mental Health Care Act was implemented and then amended in 2004, it was considered acceptable to incarcerate persons for political and socio-economic reasons. Involuntary psychiatric commitment was a hallmark of the apartheid regime. Yet the practice of ‘torture as treatment’ deployed by persons such as Dr Aubrey Levin, aka ‘Dr Shock’, continued long past the transition.
It should be remembered that thousands of SADF conscripts ended up in South African asylums, and many were only dehospitalised in 1994. Despite these amendments outlawing involuntary commitment on specific grounds, psychiatry remains the designated methodology deployed by our health department.
All it takes today is two doctors to commit a patient. There is no obligation for these doctors to even see the patient, and thus involuntary commitment of political dissidents may occur even via remote control. Once inside the system, it is extremely difficult for patients to gain access to what little remains of human agency, both in terms of human rights and decision making.
Despite provisions within the Act, it must be noted the so-called Mental Health ‘review boards’, do not function as personal ombuds as such, and even if they did, the problem arises, that of legal representation.
Bar the existence of the general health ombud, there is still no dedicated and practical ombud system focused on South Africa’s so-called mental institutions, nor an independent watchdog for that matter, and we still lack genuine means by which such persons may safely contest a commitment decision and especially when their rights are infringed.
A psychiatric patient for instance, might appear before a judge or lawfully convened health panel, but in a highly medicalised state, and without a dedicated representative, present, to argue his or her case. The situation is akin to being charged with a crime, in this case in the form of a medical diagnosis, and yet to be cast within a situation where there is no defense against what is essentially the medical dismissal of one’s ideas and behaviour.
A dire state which makes the possession of other rights in the constitution, meaningless.
It is not surprising, and given the many articles on this issue in the foreign press, that South Africa has consistantly failed to provide UN country reports on the status of its psychiatric patients, and by most accounts, has failed to honour its obligations in terms of the Convention on the Rights of Persons with Disabilities (CRPD).
The release of the damning health ombud report is however to be welcomed as one small step towards rectifying this horrendous situation.
Both article 12 of the CRPD convention and article 12 of our own Constitution, guarantee that psychiatric patients have human rights and are also to be considered in possession of ‘psychological integrity’, — an all-important concept when one remembers — whether unconscious or asleep, citizens do not automatically lose the presumption of consciousness, as they did under the past regime.
While the UCT sponsored psychiatric consortium has received massive funding from central government and is currently expanding the Valkenberg facility to twice its size, these funds could be better spent on providing therapies within complementary modalities. Instead Big Pharma is the big winner in a model which provides persons with a diagnosis and then treats the diagnosis instead of the individual.
Mental diseases unlike physical diseases are invented. It takes two persons to have a mental illness. Every year the psychiatric profession vote on what to include in the Diagnostic Statistical Manual (DSM). The same cannot be said of cardiologists and neurologists. Mental illness labels are thus a social construction.
Medical professionals such Dr Aubrey Levin and others, who administered Electroconvulsive Shock Therapy (ECT) to persons suffering from what was then considered a mental illness, namely homosexuality, were never prosecuted by the TRC. The commission failed to investigate the use of ‘torture as treatment’ under apartheid.
Psychosurgery as well as ECT are still considered ‘therapies’ under the current act, which fails to provide for comparative therapies and other treatments. It is time for a commission of inquiry into abuses and gross violations committed by psychiatry under apartheid and for new thinking on this important subject.
Upon the investigation, the Ombud has established that:
- A total of ninety-four (94+) and not thirty-six (36) mentally ill patients (as initially and commonly reported publicly in the media) died between 23 March 2016 and 19 December 2016 in Gauteng Province. This total number of 94 should be seen as a working and provisional number.
- All the 27 NGOs to which patients were transferred operated under invalid licences; therefore, all patients who died in these NGOs died in unlawful circumstances
- The NGOs where the majority of patients died had neither the basic competence and experience, the leadership/managerial capacity nor ‘fitness for purpose’ and were often poorly resourced. The existent unsuitable conditions and competence in some of these NGOs precipitated and are closely linked to the observed ‘higher or excess’ deaths of the mentally ill patients.
- 75 (79.78%) patients died from 5 NGO/hospital complexes (Precious Angels 20, Cullinan Care and Rehabilitation Centre (CCRC)/ Siyabadinga/Anchor 25, Mosego/Takalani 15, Tshepong 10 and Hephzibah 5);
- There were 11 NGOs with no deaths, 8 NGOs with average deaths and 8 NGOs with ‘higher or excess’ death;
- Only 4 Mental Health Care Users (MCHUs) died in hospitals compared to 77 MCHUs deaths at NGOs; in absolute numbers for every 1 death at the hospitals there were 19 deaths at the NGOs but correcting for the total base population the ratio is 1:7. This ratio is very high.
- When the MEC of Health made announcement on 13 September 2016, 77 patients had already lost their lives.
- At the time of writing the Report, 94 patients had died in 16 out of 27 NGOs and 3 hospitals.
- 95.1% deaths occurred in the NGOs from those directly transferred from LE Health Care Centre.
- Available evidence by the Expert Panel and the Ombud showed that a ‘high-level decision’ to terminate the LE Health Care Centrecontract precipitously was taken, followed by a ‘programme of action’ with disastrous outcomes/consequences including the deaths of Assisted MCHUs. The Ombud identified three key players in the project: MEC QedaniDorothy Mahlangu, Head of Department (HoD),Dr. Tiego Ephraim Selebano and Director Dr. Makgabo Manamela at times referred to as ‘dramatis personae’ in the text. Their fingerprints are ‘peppered’ throughout the project. The decision was reckless, unwise and flawed, with inadequate planning and a chaotic and ‘rushed or hurried’ implementation process.
- Several factors in the ‘programme of action’ were identified by the (Expert Panel, OHSC Inspectors, Ombud and Ministerial Advisory Committee) that contributed and precipitated to the accelerated deaths of mentally ill patients at the NGOs. The transfer process particularly, was often described as ‘chaotic or a total shamble’;
- The Gauteng Mental Health Marathon Project, as it became known was: done in a ‘hurry/rush’; with ‘chaotic’ execution; in an environment with no developed, no tradition, no culture of primary mental health care community-based service framework and infrastructure;
Human Rights Violations.
There is prima facie evidence, that certain officials and certain NGOs and some activities within the Gauteng Marathon Project violated the Constitution and contravened, the National Health Act and the Mental Health Care Act (2002). Some executions and implementation of the project have shown a total disregard of the rights of the patients and their families, including but not limited to the Right to Human dignity; Right to life; Right to freedom and security of person; Right to privacy, Right to protection from an environment that is not harmful to their health or well-being, Right to access to quality health care services, sufficient food and water and Right to an administrative action that is lawful, reasonable and procedurally fair.
The Ombud established that the following decisions/actions were negligent or reckless by the Department of Health:
- Overcrowded NGOs which are more restrictive, is contrary to the deinstitutionalization policy of the MHCA and MH Strategy and Policy.
- Transfer of patients to far-away places from their communities, is contrary to the policy of deinstitutionalization.
- Transfer of patients to NGOs that were ‘not ready’, that were ‘not prepared properly for the task’.
- Transfer of patients without the provision of structured community mental health care services is contrary to the Mental Health policy.
- NGOs without qualified staff and skills to care for the special requirements of the patients.
- NGOs without appropriate infrastructure and not adequately financially resourced.
- NGOs without safety and security.
- NGOs without proper heating during winter, some were described as ‘cold’.
- NGOs without food and water, where patients became emaciated and some died of ‘dehydration’.
- Grant and sign licences without legal or delegated authority.
Universal Health Coverage is likely to become the backbone on which the health development agenda beyond 2015 will be constructed. To avoid unintended effects, Universal Health Coverage should keep away from committing seven sins and should try to practice seven virtues.
Extraordinary opportunity for South African patient advocates to participate in the South African National Health Assembly (NHA) in alliance with the National Health Insurance Coalition. The People’s Health Movement (PHM) is hosting the event. The importance is linked to the National Department of Health’s proposed a 10-point plan to transform the health system and this includes the National Health Insurance (NHI). The NHI is in need of civil society engagement and citizen participation. This is a great opportunity to participate and learn and engage around how this process will affect you, your patients and our health system. It is also an ideal space to make inputs into how you see the NHI working and to place your best ideas on the table for discussion. Registration form National Health Assembly 5-9 July 2012 NB THESE DATES INCLUDES THE GLOBAL, PEOPLE’S HEALTH ASSEMBLY, A SERIES OF HEALTH FOCUSED EVENTS!!!.
PHM will facilitate this engagement and re-frame the mainstream discussion around the NHI while working to achieve universal coverage in South Africa.
Who will be attending: Participants will include grassroots activists from communities around South Africa, policy makers, interested citizens, government officials and interested delegates from PHM Global countries (such as India, Thailand and Latin America) who are interested in taking part in the NHA.
WHEN: 5th July 08:30 -18:30 (Thursday) and 6th July 08:30 -13:00pm (Friday).
WHERE: University of the Western Cape, Bellville, Cape Town.
WHAT: The upcoming National Health Assembly will play a catalytic role in rebuilding, re-energizing and unifying health civil society in South Africa and the broader global health community. Using the proposed NHI as a platform, the National Health Assembly is thus an ideal event from which to build momentum and mobilise civil society engagement in the NHI process and towards universal coverage in South Africa.
Overall objective of the NHA is to mobilise a mass movement promoting the right to health for all and a progressive NHI .
Specific objectives are to:
- Agree on an agenda and priorities for building universal access to quality health care among health activists in South Africa;
- Build a coalition of health and social justice organisations that can work together towards realizing this agenda;
- Plan a campaign to realize the agenda and priorities agreed by the NHA
- Assess plans for the NHI and agree on a way forward to ensure that it realises the fundamental rights to health of all through a progressive Family Medicine approach;
- Examine specific health issues in SA, including primary care, disability, sexual & reproductive justice and others;
- Consider ways to assist with the implementation of other aspects of the government’s 10-point plan with particular attention to those areas where civil society has key roles to play.
Workshop & Plenary sessions:
Starts each day 2 hour plenary. Participants can select which sessions they would like to attend under the below themes. These will be facilitated by PHM but hosted by partner organisations and groups involved in the NHI Coalition.
National Health Assembly Themes:
- Social determinants of health ( e.g. food, sanitation, water, work conditions)
- Equitable and comprehensive health care
- Political and economic implications for health system transformation
HOW: To register, complete attached registration form and send to firstname.lastname@example.org before July 5th, 2012.
Registration Fees (Includes Access to Sessions, AGM & Lunch for 2 days):
Student/Unemployed Rate: R60.00
Standard Fee: R100.00
Student Fee: R60
This is real SA logic, we are building hospitals in neighbourhoods and refusing to employ the locals, then when the locals get upset, we shoot them, thereby putting them in hospital and creating work for the people who are already employed
The newly formed National Health Insurance Coalition (NHIC) gives civil society voice on National Health Insurance
National Health Insurance holds the potential to drastically improve health care across South Africa; civil society is organising to secure its success
Key members of civil society recently formed the National Health Insurance Coalition (NHIC) to collectively respond to and help develop National Health Insurance (NHI). The NHIC also intends to jointly endorse key submissions on NHI, encourage civil society participation in the NHI policy process and launch an advocacy campaign, among other things.
This week, the NHIC published a discussion document to facilitate exchange over the Green Paper on NHI. On 7 – 8 December 2011 the Department of Health (DoH) held an international consultation on NHI, during this consultation the NHIC held a successful side meeting to discuss the way forward.
NHIC comes at a crossroads in the development of NHI. The DoH has published the Green Paper on NHI, invited commentary and signaled an eagerness for input from civil society. The next step will be for DoH to publish a White Paper on NHI.
Engagement and dialogue from civil society are crucial during this stage of the NHI policy development process. In this moment of contingency NHI’s failure or success may depend on our efforts; collective action and public debate are the fulcrum, we must use them now. Together we bring a more forceful voice to the debate, and can ensure that NHI achieves its potential to be a major step toward quality health care for all.
Members of coalition and signatories to the discussion document include: People’s Health Movement South Africa (PHM-SA), SECTION27, Treatment Action Campaign (TAC), Black Sash, Rural Health Advocacy Project (RHAP) Rural Rehab, Rural Doctor’s Association of South Africa (RuDASA), Passop, EarthLife Africa, Africa Health Placements (AHP).
Durban — International health leaders in Durban for the global climate talks have called on negotiators to push for the most ambitious commitments possible, warning that the direction of current negotiations risks the lives of billions of people around the globe.
Over 200 leaders from more than 30 countries have issued a Declaration and Call to Action following a Global Climate and Health Summit.
“No-one is immune from the health impacts of climate change; people in developed and developing nations are all at risk,” said Dr Hugh Montgomery from Climate and Health Council, UK.
“Without bold action by governments, climate change will magnify existing health crises,” said Dr Rajendra Niadoo, from Nelson R. Mandela Medical School in Durban.
Doctors, nurses, public health experts, health and medical scientists, medical students, and health officials from major international health organizations are meeting in Durban to try and influence negotiations by raising awareness about the health risks of climate change and the health benefits of climate action.
“Strong climate policy is an investment in people’s health,” said Fiona Armstrong of the Climate and Health Alliance, Australia.
The delegates have called for a fair, ambitious and binding global treaty, and urged all countries to commit to immediate strong climate action to protect and promote health.
“If governments agree to delay for another decade, history will judge Durban as a moment of global political malpractice,” said Josh Karliner, Health Care Without Harm.
“I’m a 21 year old medical student, and these negotiations have been carrying on my entire life. If we don’t reach a legally binding agreement on climate change soon, the protection and promotion of public health will be seriously undermined, world-wide.” said Nick Watts of the International Medical Students Association.
Delegates agree the urgent replacement of fossil fuel-based energy with clean renewable energy is vital, saying fossil fuels cause “immense harm” to both climate and health, and urge negotiators to commit to equitable contributions to a green climate fund to assist adaptation and mitigation strategies to support human health.
They have themselves committed to action to cut emissions in the health sector, and have urged health professionals worldwide to engage in advocacy for climate action, to help prevent unprecedented loss of life and human suffering.
- For more information visit www.climateandhealthcare.org
- Download the Durban Declaration on Climate and Health
- Download the Durban Global Climate and Health Call to Action