OPEN LETTER TO PRESIDENT ON MENTAL HEALTH

DEAR Honourable President,

First of all, we thank you for your attention. While mental health is certainly an unrecognised and neglected focus area, we note efforts to bring to light the failures in the system. It is our hope that these efforts will serve to realise the rights of people with psychosocial disabilities and intellectual disabilities.

Today we wish to bring to the fore the failure to implement the laws and policies of the republic as they relate to the mental health system with reference to the Life Esidimeni tragedy and beyond.

First of all, we wish to remind you of mental health in the global context and of the international obligations of the republic:

Globally, mental illness is strongly linked to health and social inequalities, and these inequalities affect large groups of people, whether these groups are defined socially, economically, demographically or geographically.

Certain groups in society are more vulnerable to experiencing mental health inequities, including: black and minority ethnic communities, homeless people, victims of violence and abuse, people living with disabilities, women and children.

Inequalities in mental health and the dilapidated state of psychiatric facilities have significant ethical implications which involve key bioethics principles of medicine and public health that involves respect for individuals, justice (equality and fairness), promotion of good, and to do no harm.

As a member state of the UN and the World Health Organisation, South Africa has an obligation towards the agreements adopted or endorsed at this level to ensure that its citizens’ human rights, health and mental well-being are underpinned in all local policies and legislation.

At this level, world leaders have committed to recognising prevention and treatment of noncommunicable diseases, of which mental, neurological and substance use disorders are included, as health priorities within global development. There can be no sustainable development without mental health and none of the Sustainable Development Goals can be achieved without prioritising mental health.

The Constitution of South Africa, the Mental Health Care Act and the White Paper on the Rights of Persons with Disabilities as well as the Mental Health Policy Framework and Strategic Action Plan (MHPF) and National Development Plan are concerned with the right of dignity of service users.

This is because dignity is a right from which others flow – there is no real right to access to health care without dignity. Others are the rights to equality and life. Further applicable rights are the rights to freedom and security of person and the right to a clean and healthy environment.

We draw your attention to these rights, Honourable President, because they have been neglected, extinguished even, in respect of those among society’s most vulnerable. Applied correctly, the aforesaid instruments can facilitate the realisation of each of these legal guarantees.

Honourable President, it is clear that the requisite instruments for creating a comprehensive and functional mental healthcare system do indeed exist.

Unfortunately, implementation thereof is woefully inadequate. This was evidenced with both Life Esidimeni as well as within the status quo.

The violations of these rudimentary entitlements led to the deaths of 144 mental health care users and the relapse of many others. Today, atrocities continue to occur throughout the system with death and destruction of individuals becoming a raging and rampant problem throughout the country.

Applied correctly, extant legislation and policy could ameliorate the plight of mental health care users, and South Africa could see a high rate of recovery and successful habilitation/rehabilitation. Unfortunately, this is not the case. A comprehensive legal framework is meaningless if it is not implemented correctly, or in some cases at all.

Honourable President, we implore you to implement the obligations to which the state is bound and hold those responsible for the glaring iniquities in the system to account.