Life Esidimeni tragedy: psychiatrists call for urgent review
THE South African Society of Psychiatrists (Sasop) calls for the urgent review and overhaul of the entire mental health care system in Gauteng.
Their statement released yesterday is in direct response to the investigative report issued by the Health Ombud, Malegapuru Makgoba, on the circumstances surrounding the deaths of mentally ill patients in the care of non-governmental organisations (NGOs) contracted by the Gauteng Health Department after ending its agreement with Life Esidimeni Hospital.
Sasop president Bernard Janse van Rensburg says immediate intervention is required.
“We are convinced that unless there is a particular and significant commitment by the political principals of the national and Gauteng departments of Health to make the necessary resources and funds available now to restructure the system, that it will not be possible to address the extent of the current crisis.
“The current situation is a direct result of accumulating years of neglect, delay and failure to prioritise mental health-care services in Gauteng as well as in other provinces.”
He says that it is of great significance that the Health Ombud’s first major report has put such emphasis on the need to prioritise mental healthcare services in South Africa and on the importance of preserving the human rights of mental health-care users, who are often the most vulnerable.
Janse van Rensburg says Sasop calls for the correct and differential licensing of NGOs – those that are able to provide safe residential care only, those who can provide psycho-social rehabilitative and nursing care services in addition, as well as those who can provide daycare services for patients..
“Of equal importance will be to capacitate all district hospitals, such as South Rand Hospital and others, in the different districts in Gauteng, to provide appropriate primary psychiatric services, including initial 72-hour assessment services.
“Such community- and district-based facilities must be supported by multidisciplinary specialist community psychiatry teams consisting of psychiatrists, psychologists, psychiatric nursing professionals, social workers and occupational therapists.”
He says the dedicated teams must work closely with the specialist acute inpatient units in general referral hospitals, while all current specialist acute units on secondary or tertiary levels, must be equipped to provide at least 40 acute beds allowing for voluntary and involuntary mental health care.
“Currently, the three acute psychiatric inpatient units on the Wits academic circuit operate under significant pressure due to incomplete and delayed renovations.
“In some cases, patients are currently nursed in areas intended for half such numbers, as a result of all the respective construction projects now already being disproportionately delayed for several years.
“Sterkfontein Psychiatric Hospital, for example, also experiences the impact on its staff and facilities of having to admit some of the ex-Life Esidimeni transfers, including a more extended waiting list of forensic observation cases.”
Janse van Rensburg says Sasop would like to emphasise the need for the identification and costing of the required facility and staffing interventions that must be in place.
“These components are being addressed in the existing policy of the National mental health policy framework and strategic plan for 2013-2020, which Sasop supports in full since its publication in 2013.
“However, these principles now require realistic plans of action and the confirmed allocation of resources to implement integrated mental healthcare services in all regions.”
The principles that need to be implemented include residential and daycare community-based facilities and programmes providing a range of care-treatment-and-rehabilitation services with a full-time multi-disciplinary team available:
l Primary mental health-care services in districts.
l Acute psychiatric units in secondary, tertiary and central general hospitals – back-to-back with specialist community psychiatry service l Specialised psychiatric beds He says while Sasop is still disturbed about the unnecessary loss of life of some of the most vulnerable members of a group of mental health-care userse, Sasop has already re-committed itself to further support, and where possible to facilitate the recommendations made by the Health Ombud.
These will include continuing to work closely with Section 27, Sadag and the SAMHF.
“We believe that the remaining Life Esidimeni Hospital patients, currently still in unlawful NGOs, should in the interim actually be transferred back again and accommodated in facilities such as those operated by Life Esidimeni Hospital, as a safe temporary ‘holding space’ until the detail and logistics of the implementation of a proper deinstitutionalisation process could be established.”