Call for ac­tion on men­tal health­care

The Star Early Edition - - LETTERS - Pro­fes­sor Bernard Janse van Rens­burg

THE crit­i­cal sit­u­a­tion found in state men­tal health hos­pi­tals and the un­ad­dressed is­sues raised in the health om­budsper­son’s re­port in Fe­bru­ary, has led to the provin­cial sub-group mem­bers of the South African So­ci­ety for Psy­chi­a­trists (Sa­sop) pub­lic-sec­tor psy­chi­a­trists’ fo­rum re­port­ing on the state of care in their re­spec­tive re­gions.

The re­sult is ap­palling and acts as a sec­ond call from Sa­sop for an over­haul of the men­tal health­care sys­tem in all the prov­inces.

Lim­popo province and the East­ern Cape suf­fer the most se­vere lack of re­sources. Only six pub­lic-sec­tor psy­chi­a­trists serve the whole of Lim­popo, mainly from gen­eral hos­pi­tals. Hayani hospi­tal, a 390-bed men­tal health spe­cial­ist hospi­tal, where in 2016 a psy­chi­atric nurse was killed by an in-pa­tient, has no psy­chi­a­trist.

Child and ado­les­cent psy­chi­atric care is non-ex­is­tent in the East­ern Cape and Lim­popo, and in all prov­inces psy­chi­a­trists have to ad­mit chil­dren and ado­les­cents un­law­fully into adult psy­chi­a­try wards.

No province has an or­gan­ised com­mu­nity-based psy­chi­atric ser­vice.

The re­port found that Mpumalanga and the North­ern Cape have no pub­lic-sec­tor psy­chi­a­try rep­re­sen­ta­tion while in KwaZulu-Natal a mas­sive spe­cial­ist staffing cri­sis ex­ists whereby only 20 of the 45 spe­cial­ist posts are filled.

With phys­i­cal beds miss­ing, oth­ers not in use due to flood­ing of wards caused by the non-re­pair of dam­aged roofs af­ter a storm in 2015, and no wa­ter or food at some hos­pi­tals such as Umz­imkhulu in KwaZulu- Natal, the most fun­da­men­tal ba­sic hu­man rights of pa­tients are un­der threat.

The East­ern Cape is strug­gling with a dearth of gen­eral hospi­tal beds to ac­com­mo­date acute psy­chi­atric ad­mis­sions and in most re­gions the in­abil­ity to deal with ag­gres­sive be­hav­iour by se­verely men­tally ill peo­ple has re­sulted in long wait­ing lists.

There is an ab­sence of men­tal health di­rec­torates in five of the nine prov­inces and the men­tal health re­view boards are gen­er­ally dys­func­tional in all prov­inces.

Men­tal health re­view boards are key struc­tures pro­vided for by the Men­tal Health Care Act of 2002, to pro­tect the hu­man rights of those pa­tients whose dis­abil­ity or acute ill­ness ren­ders them un­able to stand up for them­selves.

How­ever, there is a gap in this role in that such pa­tients liv­ing in the com­mu­nity may not be per­ceived to re­quire such pro­tec­tion.

The re­port re­vealed a sig­nif­i­cant lack of com­mu­ni­ca­tion and plan­ning re­gard­ing the pro­vi­sion of psy­chi­atric care at all lev­els of the men­tal health­care sys­tem, par­tic­u­larly at dis­trict ser­vices and in gen­eral hos­pi­tals.

Sa­sop called for a com­plete over­haul of the men­tal health­care sys­tem in Fe­bru­ary fol­low­ing the re­lease of the re­port by the health om­bud.

The health om­bud’s re­port rec­om­mended some ac­tion to be com­pleted within 45 days, yet 150 days later it is glar­ingly ap­par­ent that the gen­eral poor ac­cess to both phys­i­cal and men­tal health­care at com­mu­nity level re­mains un­ad­dressed, and no com­pre­hen­sive re­me­dial strat­egy has yet been tabled in Gaut­eng, or else­where.

Our own re­port now serves as a sec­ond call for ac­tion to be taken.

While al­most all the pre­vi­ous Life Esidi­meni pa­tients have been trans­ferred from the NGOs in Gaut­eng back into hospi­tal, we are still await­ing pos­i­tive ac­tion on other im­por­tant rec­om­men­da­tions.

The spe­cific needs and high­est pri­or­i­ties of each province must be ad­dressed. The fail­ure to pro­vide ac­ces­si­ble men­tal health­care will only en­trench the per­va­sive stigma and dis­crim­i­na­tion of the men­tally ill in South Africa. Pres­i­dent of Sa­sop


PSY­CHI­ATRIC SER­VICES SORELY LACK­ING: The Randfontein Care Cen­tre Life Health­care Esidi­meni closed in May last year.

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