The Life Esidimeni tragedy must change the dismissive way we treat the mentally ill
Moseneke has struck a blow for this vulnerable group, but criminal prosecution must follow
● Nelson Mandela once said: “A nation should not be judged by how it treats its highest citizens, but its lowest ones.”
In the 1970s mentally ill patients in large mental-health facilities were made to work the fields, were hosed down when soiled, and suffered various other indignities. With that past in mind, how has our mental-health care evolved over the past half century? Judge Dikgang Moseneke, who presided over the Life Esidimeni arbitration hearings, noted with disgust how Life Esidimeni patients were loaded on the back of trucks to be carted off like animals because someone in the Gauteng health department decided that they should be moved to ill-equipped NGOs.
Moseneke painted a picture of how patients clutched their meagre belongings (a characteristic sight among the chronic mentally ill) as they were sent to meet their fate. One can only imagine the fear and anxiety they must have felt. In one fell swoop the Life Esidimeni saga destroyed the lives of so many, as well as the nation’s faith in the mental-health care system.
It’s been two years since the callous transfer of psychiatric patients from the Life Esidimeni facility to inadequate facilities, most of which were operating under illegal licences. Despite attempts by organisations like the Psychological Society of South Africa, the South African Society of Psychiatrists and the South African Depression and Anxiety Group to stop the ill-fated mission, the Gauteng health department persisted.
Just a few months later, the nation began hearing about patient deaths, with numbers escalating by the day. The death toll of 144 to date could well rise as some families are still trying to locate loved ones who were transferred to unknown locations without notification and documentation. Those in charge, qualified health professionals and politicians, claim not to have known or foreseen the disastrous consequences. Yet they were warned repeatedly by various professional groups. How is it then possible to claim ignorance?
The Psychological Society of South Africa welcomed the appointment of Moseneke to chair the arbitration hearings, given his record in human rights and social justice. The judgment and its public pronouncements, compensation awards and recommendations, must be lauded. Moseneke presided over the hearings with compassion and empathy — qualities that were absent when the Gauteng department of health forcibly moved mentally ill patients, some to their deaths. The judge’s approach renewed the faith and dignity of those affected and their families, while also showing the nation what mental-health professionals have been saying for decades, namely that mental-health care must be taken more seriously.
Moseneke was more than fair in his treatment of those responsible for the tragedy. He afforded them sufficient opportunity to explain themselves in the hope of healing some of the wounds. However, some officials refused to take responsibility for their actions, or to show the kind of remorse that would be expected following such a disaster.
This is nothing short of shameful and disgraceful conduct.
Nevertheless, the Psychological Society of South Africa is pleased that this first step of the process has been completed, and it looks forward to the legal and criminal processes to follow.
Prosecution of those involved is essential.
People must be held responsible and accountable for their individual and collective actions, a lesson also for broader maladministration and poor governance in our country.
The compensation that was awarded will neither undo what has happened, nor remove the pain. However, it will go some way to assist families and afford some small redress. No amount of money can be considered enough because you cannot put a price on life. Although mental health problems affect all people without discrimination, those with chronic mental-health problems in long-term care facilities tend to be poorer individuals who are less educated and whose families are less able to assert their legal and social rights.
The order that a monument be erected to honour those who lost their lives in the Esidimeni tragedy needs to be lauded. It will be a powerful symbol, conveying to the world that the mentally ill do indeed have rights, and that the lives of the mentally ill matter. Such a monument could well be the world’s first as a shrine and tribute, not only to the Esidimeni patients but also to the millions around the world suffering mental-health problems, and who need compassion, care and support.
In a tragic irony, it is exactly 40 years since the American Psychiatric Association’s inspection visit to apartheid mental-health facilities in South Africa. But its finding of “unacceptable medical practices that resulted in needless deaths of Black South Africans” (as reported in the American Journal of Psychiatry, 1979), seems to haunt us even further, with the primary variable no longer being race, but rather incompetence and impunity at the highest levels of health administration.
As mental-health specialists we have always lamented the fact that mental health has never been given the priority it deserves. It was only a matter of time before a tragedy like this occurred. However, March 19 2018 will go down in history because Moseneke gave mental health the dignity and importance that the country has thus far failed to give it.
We hope that the deaths of 144 mentally ill people will not have been in vain. And we hope that this will spur our government to look at mental health in a whole new way, one that prioritises the mentally ill and all other vulnerable citizens — just as Mandela wanted us to do.