Call for action on mental healthcare
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
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PSYCHIATRIC SERVICES SORELY LACKING: The Randfontein Care Centre Life Healthcare Esidimeni closed in May last year.