Esidimini must be seen within broader context of psychiatric abuse

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.

Health Ombud Esidimeni Report findings

Key Findings

Upon the investigation, the Ombud has established that:

  1. 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.
  2. 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
  3. 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.
  4. 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);
  5. There were 11 NGOs with no deaths, 8 NGOs with average deaths and 8 NGOs with ‘higher or excess’ death;
  6. 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.
  7. When the MEC of Health made announcement on 13 September 2016, 77 patients had already lost their lives.
  8. At the time of writing the Report, 94 patients had died in 16 out of 27 NGOs and 3 hospitals.
  9. 95.1% deaths occurred in the NGOs from those directly transferred from LE Health Care Centre.
  10. 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.
  11. 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’;
  12. 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.

Negligent/Reckless Decisions/Actions

The Ombud established that the following decisions/actions were negligent or reckless by the Department of Health:

  1. Overcrowded NGOs which are more restrictive, is contrary to the deinstitutionalization policy of the MHCA and MH Strategy and Policy.
  2. Transfer of patients to far-away places from their communities, is contrary to the policy of deinstitutionalization.
  3. Transfer of patients to NGOs that were ‘not ready’, that were ‘not prepared properly for the task’.
  4. Transfer of patients without the provision of structured community mental health care services is contrary to the Mental Health policy.
  5. NGOs without qualified staff and skills to care for the special requirements of the patients.
  6. NGOs without appropriate infrastructure and not adequately financially resourced.
  7. NGOs without safety and security.
  8. NGOs without proper heating during winter, some were described as ‘cold’.
  9. NGOs without food and water, where patients became emaciated and some died of ‘dehydration’.
  10. Grant and sign licences without legal or delegated authority.

Involuntary commitment of author for Rushdie comments

It appears that  author ZP Dala has been taken to a mental institution in reprisal for her comments about Salman Rushdie during the Time of the Writer Festival in Durban recently.

ZP DalaDala expressed admiration for Rushdie’s “literary style” and was subsequently attacked the next day, hit in the face with a brick and called “Rushdie’s bitch” by a group of men.

Rushdie himself responded on Twitter at the time, coming out in support of Dala.

Now, according to PEN America, the shocking news has come about that Dala has been put under “extreme pressure” by members of the Muslim community in Durban to “renounce her statement about Rushdie’s work” and “to make a public vow of religious loyalty to Islam”.

When she refused, she was apparently admitted to a mental institution.

PEN America has called for Dala’s “immediate and unconditional release” and has also called on President Jacob Zuma and the South African Authorities to “ensure Ms Dala’s safety and to prevent reprisals against her freedom of expression and thought”.

PEN America executive director Suzanne Nossel, who was visiting South Africa and had contact with Dala, says in a statement: “Harassment, efforts to elicit forced and false confessions, and ‎the denial of liberty are gross infringements of freedom of expression. In expressing her views on Mr Rushdie’s work Ms Dala was engaging in intellectual discourse, an essential lifeblood of any free society.

“It is up to South African authorities and all those in positions of leadership to vindicate her rights and freedoms and take action against those who have sought to deny them.”

Books LIVE is attempting to get in touch with Dala to corroborate the story.

Rushdie, Neil Gaiman, PEN South Africa president Margie Orford, and others have expressed outrage on Twitter

Apartheid Dr Shock, court shown graphic evidence

Aubrey Levin, a former South Africa Defence Force chief psychiatrist who used electroshock therapy to “cure” homosexual soldiers during the apartheid regime, is on trial in Canada for allegedly sexually assaulting 10 male patients.

A Calgary court was shown graphic video Thursday that was recorded by a man who says he was sexually assaulted by former forensic psychiatrist Dr. Aubrey Levin.

Levin is on trial, accused of sexually assaulting 10 male patients.

The court was shown two videos that were secretly recorded by one of the patients who claim to have been sexually assaulted by Levin.

The man, identified as R.B., was on probation at the time the videos were taken and had been ordered by a court to see Levin twice a month.

The man said he had told authorities about previous assaults and no one believed him, so he bought a spy watch and brought it to his appointments.

Both videos show Levin undoing the man’s belt and jeans and fondling the man. In the second video, the psychiatrist had both hands on the man’s genitalia for about 10 to 15 minutes.

Earlier Thursday, court heard from the man’s lawyer, who turned the tapes over to police after viewing them.

After Levin was arrested, nearly two dozen other former patients came forward with abuse allegations.

Mary Maddock signs Cape Town declaration against psychiatric assault

A GROUNDBREAKING declaration calling for an end to all forced and coerced psychiatric procedures and for the development of alternatives to psychiatry was signed at Cape Town ’s Robben Island Gateway in a ceremony held on Monday, March 24.

Members of MindFreedom International and local and international psychrights activists gathered to witness the historic occasion in which Mary Maddock, founder of MindFreedom Ireland, handed over the document to Moosa Salie of the World Network of Users and Survivors of Psychiatry.

The declaration recognizes South Africa’s contribution to the struggle and the need to eliminate all forms of torture and coerced treatment. A spokesperson said: “South Africa has an admirable Bill of Rights, especially article 12 which grants all citizens the right to security in and control of the body, as well as bodily and psychological integrity”, but he cautioned against being too upbeat about current legislation, “Although South Africa has ratified the UN convention on the Rights of the Disabled which includes all those given psychiatric labels, notions such as self-ownership and the right to refuse treatment have yet to be incorporated in national legislation.

“We renew our fight today, against discrimination, injustice and for human rights in order to empower and improve the quality of life for those considered different or maladjusted, and others marginalized and disadvantaged by society, including those labeled with psychiatric disorders,” declares the groundbreaking document which follows on last years Declaration of Dresden opposing the use of forced electroshock, also known as Electro Convulsive Therapy (ECT) which is increasingly being used in poor and developing countries.

As more countries develop psychiatric services there is a significant increase in involuntary hospitalizations, forced treatment and drugging to conform to the biomedical model of human behaviour.

MindFreedom made news headlines when it assisted psychiatric patients fleeing detention in the United States under laws which have resulted in the incarcaration of people with different religious and political beliefs. The Declaration also follows last week’s ISAD conference in the city, sponsored by the pharmaceutical industry.