Without ID, with­out fam­ily

Gaut­eng health plans to re­move 1 726 state psy­chi­atric pa­tients from pri­vate care ... but where to?

CityPress - - News - SU­SAN COM­RIE in­ves­ti­ga­tions@city­press.co.za

Zibu­siso Ng­wenya (19) was three years old when he was di­ag­nosed with autism. “Zibu­siso has never been able to live a nor­mal life like other peo­ple,” his fa­ther Joseph ex­plains in an af­fi­davit. “He just be­comes an­gry with­out warn­ing. He will of­ten de­stroy things like win­dows, tele­vi­sions or other items in the house.

“Zibu­siso has on nu­mer­ous oc­ca­sions at­tempted to jump out of the win­dows of our home. We live on the 10th floor.”

Joseph Ng­wenya is one of 13 fam­ily mem­bers – mostly par­ents – of in­tel­lec­tu­ally dis­abled and chronic psy­chi­atric pa­tients who filed af­fi­davits just be­fore Christ­mas in the South Gaut­eng High Court.

The af­fi­davits form part of an ur­gent in­ter­dict ap­pli­ca­tion brought by the SA De­pres­sion and Anx­i­ety Group (Sadag), the SA Fed­er­a­tion for Men­tal Health and the SA So­ci­ety of Psy­chi­a­trists.

To­gether with the fam­i­lies, they are de­mand­ing to know what will hap­pen to pa­tients like Zibu­siso af­ter the Gaut­eng de­part­ment of health made a de­ci­sion to re­move 1 726 state pa­tients from Life Esidi­meni’s four pri­vate hos­pi­tals by the end of March.

An­nounc­ing the de­ci­sion in Oc­to­ber, Gaut­eng health MEC Qedani Mahlangu said: “As a de­part­ment, we want to re­duce psy­chi­atric pa­tients at fa­cil­i­ties by dis­charg­ing all those who are re­spond­ing well to treat­ment, in­te­grate them back into com­mu­ni­ties and af­ford them treat­ment at their re­spec­tive homes.”

The plan is con­tro­ver­sial – from April 1, only pa­tients un­der 18 will be al­lowed to re­main at Life Esidi­meni. The 526 most se­vere cases will be trans­ferred to state psy­chi­atric hos­pi­tals Weskop­pies and Sterk­fontein, de­spite these fa­cil­i­ties hav­ing wait­ing lists of their own. The re­main­ing 1 200 pa­tients will ei­ther be sent home to their fam­i­lies or to NGOs.

In­ter­nal records show that of the 1 973 pa­tients cur­rently in Life Esidi­meni, 532 have lived at Life Esidi­meni for 10 years or more. Al­most half (773 pa­tients) no longer have any con­tact with fam­ily, 474 have no iden­tity doc­u­ments, and 217 fall into the cat­e­gory “with­out ID, with­out fam­ily”.

For now, the court ac­tion is tem­po­rar­ily on hold – the de­part­ment agreed to stop dis­charg­ing any pa­tients un­til the end of Jan­uary and to con­sult with Sadag and the other ap­pli­cants on the plan.

But this is only tem­po­rary – on Wed­nes­day, the de­part­ment con­firmed that the dead­line of March 31 re­mained in place.

Money is the prob­lem

In 2014/15, the de­part­ment paid Life Esidi­meni R323.7 mil­lion – roughly 1% of its R31.5 bil­lion bud­get – to care for 2 378 pa­tients. The de­part­ment had planned to slowly re­duce this num­ber of pa­tients un­til 2020, but fi­nan­cial pres­sures in­ter­vened.

“Dur­ing the past three years, the de­part­ment has been un­der tremen­dous fi­nan­cial con­straints,” wrote Dr Bar­ney Sele­bano, the head of the de­part­ment of health, in a let­ter to Life Esidi­meni in Septem­ber, an­nounc­ing the de­ci­sion to can­cel the con­tract.

“The re­ha­bil­i­ta­tion and dis­charge of men­tal health­care users to ei­ther their homes or NGOs, ear­lier than was the prac­tice be­fore, is now an un­avoid­able pri­or­ity of the de­part­ment.”

The de­part­ment says the plan is in line with its pol­icy of treat­ing psy­chi­atric pa­tients in the least re­stric­tive en­vi­ron­ment pos­si­ble. But in court pa­pers, Sadag claims Sele­bano said the de­part­ment “didn’t look at the pro­files of pa­tients, we only looked at cost”.

The de­part­ment cur­rently pays Life Esidi­meni R320 per state pa­tient per day.

For sev­eral years, the gulf be­tween what the de­part­ment bud­gets and what it spends has widened. In 2014/15, it over­spent its Life Esidi­meni bud­get by R72 mil­lion, which was red-flagged by the Au­di­torGen­eral.

The ques­tion NGOs and fam­ily mem­bers now want an­swered is what will hap­pen to those pa­tients who can­not go home.

In a writ­ten re­sponse in the Gaut­eng Provin­cial Leg­is­la­ture in Novem­ber, Mahlangu said the de­part­ment would cre­ate an ad­di­tional 1 784 beds by re­open­ing old wards in ex­ist­ing psy­chi­atric fa­cil­i­ties and ren­o­vat­ing dis­used build­ings.

City Press tracked down two of the build­ings Mahlangu iden­ti­fied: the old nurses’ res­i­dence at the Transvaal Me­mo­rial In­sti­tute op­po­site Con­sti­tu­tion Hill and the Dan Pien­aar crèche in Park­town.

Both build­ings are derelict and in des­per­ate need of ren­o­va­tions.

Built at the turn of the 20th cen­tury, Dan Pien­aar is badly run down. The wooden bal­cony is slowly col­laps­ing un­der the weight of aban­doned fur­ni­ture, and paint peels off walls in rooms lit­tered with bro­ken and aban­doned chil­dren’s toys.

Yet ac­cord­ing to the de­part­ment, 38 pa­tients could be housed here from April.

The for­mer nurses’ res­i­dence op­po­site Con­sti­tu­tion Hill is worse. Three of the four floors are flooded by a burst pipe – wa­ter pours through cracks in the ceil­ing, the walls are cov­ered in mould, and elec­tri­cal ca­bles have been ripped out, leav­ing the bot­tom floor dark, flooded, and eerily quiet, ex­cept for the sound of run­ning wa­ter. The de­part­ment wants to move 151 pa­tients here. Ren­o­va­tions were sup­posed to be com­pleted by Jan­uary, but de­spite the dead­line loom­ing, ren­o­va­tions have not started and the de­part­ment has still not re­leased the names of the NGOs that will take over and run these build­ings.

Dr Mvuy­iso Talatala, pres­i­dent of the SA So­ci­ety of Psy­chi­a­trists, worked at Sterk­fontein for many years and said they had tried to place pa­tients with NGOs, but the or­gan­i­sa­tions were un­able to cope with the high level of care these pa­tients needed.

“Th­ese are the most se­verely ill pa­tients,” said Talatala. “We have tried to place peo­ple with NGOs in the past – we would pre­fer that – but many of them re­turned the pa­tients to us.”

The first meet­ing to chart a way for­ward was held on Wed­nes­day, and al­though all par­ties com­mit­ted to work to­gether, cor­re­spon­dence filed as part of the in­ter­dict ap­pli­ca­tion shows deep dis­trust be­tween them, with the de­part­ment ac­cus­ing the NGOs of be­ing “dis­hon­est” and act­ing with “se­lec­tive moral­ity”.

Mahlangu has as­sured fam­i­lies that “no pa­tient will be thrown on the streets”, but the NGOs have in­di­cated that if there is no agree­ment they will con­sider ask­ing the courts to in­ter­vene.

PHO­TOS: LEON SADIKI

ABAN­DONED The old nurses’ res­i­dence at the Transvaal Me­mo­rial In­sti­tute is flooded on three floors, parts of the ceil­ing are miss­ing and elec­tri­cal wiring has been ripped out. MEC Qedani Mahlangu told the pro­vin­cial leg­is­la­ture that this build­ing would be able to house 151 psy­chi­atric and in­tel­lec­tu­ally dis­abled pa­tients by the end of March DERELICT De­spite the run-down state of the build­ing, there are signs – such as these shoes and piles of clothes – that peo­ple were liv­ing in the old nurses’ res­i­dence un­til re­cently BARELY FUNC­TION­ING The boiler room is one of the few things still func­tion­ing at the old nurses’ res­i­dence. Ren­o­va­tions were sup­posed to start in Oc­to­ber and be com­pleted by Jan­uary, but work has not be­gun and the de­part­ment has not said who will pay for the im­prove­ments or which NGOs will be asked to take over the care of pa­tients FLOODED Water from a burst pipe on the third floor pours down the stair­case, through cracks in the ceil­ing and down the bed­room walls

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