Department meltdown hurts mental health
• Patients in Gauteng battle to access psychiatric care amid hiring freeze
The inferno that has devastated the Bank of Lisbon building and claimed the lives of three firefighters is symbolic of the meltdown in Gauteng’s health services.
A form of gutting of the provincial department of health’s offices happened three months before the fire, when furniture and computers were removed by the sheriff of the court. An official told the DA’s Jack Bloom that it was “a blessing in disguise” that the sheriff had the computers.
Gauteng spokesperson Thabo Masebe said: “We hope we will be able to stabilise the finances and ensure that the department continues to function and render services….”
But at the coalface, a picture emerges of the failure of service delivery at public health facilities across the board, manifesting in miscommunication between management and health-care professionals, enormous queues and waiting lists, frozen posts, and a fear of speaking out.
Most health professionals interviewed for this article asked not to be named.
“We are not allowed to speak to the press; you have to go through our legal department,” said a senior clinician. “There is a very strong culture of ‘don’t betray us to the press’.
“They won’t fire me for speaking to the media. What they will do is when I order things for my staff or need assistance, I won’t get it. There will be consequences for my staff and my department. That is what I am worried about.”
Katharine Frost is the director of the Ububele Educational and Psychotherapy Trust, a community-based mental health training institute on the edge of Alexandra. Her organisation works with more than 4,000 people a year.
She arrives late for our appointment as she was at Edenvale Hospital with a mother and her sick baby, who was turned away from a clinic twice before she called an ambulance and had him taken to hospital.
“The baby has been compromised of oxygen and is now on a ventilator. He is eight months old. They can’t find a bed for him at the ICU [intensive care unit] at the Gen [Charlotte Maxeke Hospital]. They don’t have beds,” says Frost.
“So he is at Edenvale now, where they don’t have the facilities … I have also just seen a psychotic mom, and they don’t have any psychiatric services there.
“This takes its toll on us and on the people working for the state. The paediatrician has to be part of making decisions about whether babies live or die.
“To have that level of control and helplessness in systems that are failing people and to have repeated experiences of that over and over is very, very hard.”
Community psychiatry and psychology clinics are worst hit by the freeze on hiring.
Unlike a hospital ward, where waiting lists get longer and longer, in a community clinic, if a post is frozen the clinic doesn’t function.
The World Health Organisation estimates that SA has the sixth-highest rate of suicide in Africa with about 11.6 of every 100,000 people committing suicide.
“At the moment we have a rash of suicidal new moms,” Frost says, adding that it is due to a combination of psychiatric illnesses, postnatal depression and a cascade of poverty and domestic violence.
“At Chris Hani Baragwanath, where I did my internship in the children’s unit, every therapist or intern had a day on call for suicides. There are so many that they have a dedicated psychologist to see adolescents who have attempted suicide.”
According to the SA Depression and Anxiety Group, the average age for attempted suicides is decreasing. Some hospitals see up to 10 teens daily.
In areas where grinding poverty is widespread — including Alexandra, Soweto, Coronationville and Westbury — rat poison is widely used, sometimes as a call for help and often with a fatal outcome.
Speaking at a psychology conference recently Dr Megan Jones, a clinical psychologist at Tara Psychiatric Hospital in Sandton, described the “pain we face when we try to make the best of a bad job”.
“We place children in desperate need of therapy on a six-month [or longer] waiting list, and perhaps later see these children for a short-duration therapy in order to work through the waiting list.
“However, what is clinically indicated — and might actually make a difference – is for each child to be seen in long-term, twice-weekly therapy, and for this to start as soon as possible after the referral is made.”
A psychologist working at another Johannesburg hospital, who does not want to be named, says: “As health professionals not able to intervene effectively, we carry guilt, impotence and secondary trauma.”
Ntshediseng Tlooko describes what it is like to work as a clinical psychologist at a Johannesburg metro clinic, where the mental health department is a small, multipurpose room in a house.
The door doesn’t close properly, the phones are cut because the bill hasn’t been paid, a medicine refrigerator in the room makes a constant shrieking noise, and throughout therapy sessions people knock at the door. In this environment, a 50-minute psychotherapy session often becomes reduced to a 20-minute session.
State mental health services are compromised by eroding facilities, unsustainable caseloads and frozen posts.
Gauteng Health deputy director-general Pinkie Baloyi says a freeze in hiring and services happens when budgets have been spent in the previous financial year. This is no longer an issue, she adds.
“This misrepresentation continues to create uncertainty and unnecessary havoc.”
But according to Circular No 18 of 2018, signed by Gauteng health department head Prof Mkhululi Lukhele on May 4, the department’s hiring freeze is still in place, although “critical posts” will be considered.
Masebe says there has been an intervention by the Gauteng executive council to fill critical clinical posts. More than 1,000 posts have been advertised in the past few months.
Prof Cora Smith, chief clinical psychologist at the Charlotte Maxeke Johannesburg Academic Hospital, is engaged with senior management to convert community posts to critical posts, but posts remain frozen.
“I think there must be a more focused, discriminatory position taken where certain posts are declared acutely important posts – critical posts,” she says.
A community psychologist on the East Rand says the response to a detailed motivation for an addition to her team was an abrupt: “No budget.”
Clinicians at hospitals and clinics say there is a disconnect between the management of Gauteng health department and mental health-care workers. “This is what happened with Life Esidimeni, where every doctor on the ground warned the department not to move the patients and they did it anyway,” a clinician says.
Psychologists and psychiatrists employed by Gauteng health say because its management is new, there is no institutional memory — and they don’t respond to feedback.
“Nobody is listening,” a psychiatrist says.
“Life Esidimeni is just one example. It’s happening all over the country.”
AS HEALTH PROFESSIONALS NOT ABLE TO INTERVENE EFFECTIVELY, WE CARRY GUILT … AND SECONDARY TRAUMA