Mental healthcare in spotlight
Community psychiatrist says more needs to be done to ensure mentally ill patients are not left behind and are given the care they need
CHALLENGES affecting the delivery of mental healthcare in the country yesterday came under the focus at the national hearing on the status of mental healthcare in South Africa.
The two-day hearing comes as the Life Esidimeni Arbitration hearings are presently under way in Park Town, Johannesburg.
This following the deaths of more than 100 mentally ill patients under the watch of the Gauteng department of health.
The patients died after they were moved from Life Esidimeni facilities into illegal and ill equipped NGOs across the province.
This after the department terminated its long running contract with Esidimeni citing de-institutionalisation and cost cutting.
Dr Lesley Robertson a community psychiatrist testified at the hearing that de-institutionalisation was not a new policy and that patients have been deinstitutionalised for years.
Robertson said what the country witnessed with the Esidimeni tragedy was the termination of a contract and not the beginning of de-institutionalising.
She said there is a misconception that community based care is cheaper than institutionalised care.
Robertson said there’s been no development of community based metal healthcare parallel to de-institutionalisation.
She said for example there is one psychiatrist for every 8000 people in Ekurhuleni.
Robertson said there is confusion with regards to the Mental Health Act.
She said while the Mental Health Act promotes community based care, in reality it’s different.
“We have a mismatch where we have patients sitting in communities and we have our specialists sitting in specialised hospitals that are remote and difficult to access, if the patient doesn’t fit the hospital requirement then they don’t get care,” she said.
She said the access to care suitable to the patient simply isn’t there.
To make matters worse, Robertson said the lack of mental health programme guidelines like those for TB, HIV and other illnesses is problematic.
“There is nothing in detail to tell us what to do with mental health patients.
The lack of national programme guidelines inhibits the implementation of the policy and the delivery of mental healthcare in the country,” she said.
She said the fact that psychiatric nurses cannot prescribe medicines also negatively impacts on the provision of mental healthcare.
She said infrastructure is also a problem.
“Consultation rooms are not big enough and corridors are not confidential enough,” she said.
Robertson said there is a tendency to address mental health when it disrupts or presents in an unacceptable behaviour and that more needs to be done to ensure that mentally ill patients are not left behind and are given the care they need.
The South African Society of Psychiatrists’ Prof Janse van Rensburg also testified about the shortage of psychiatrists and specialists, saying the country is not training nearly enough of what is required.
He said for the solution the state might need to look at the academic part of it.
He also spoke about the freezing and filing of posts and how it impacts mental healthcare.
Van Rensburg said multiple areas need to be strengthened to improve the delivery of mental healthcare services including increasing resources for mental healthcare.
Under the access to rural mental health campaign, chairperson of the RuRESA Shannon Morgan said there was little or no access to mental healthcare for those in rural areas where people are often forced to travel long distances to access care.
Morgan also called for the inclusion of mental health users in changing the situation.
TRAGEDY: Dr Lesley Robertson, a community psychiatrist testifying at the Life Esidimeni arbitration hearings said there’s been no development of community based metal healthcare parallel to de-institutionalisation.