The People’s Health Movement South Africa applauds Health Ombudsman Professor Malegapuru Makgoba’s report into the circumstances surrounding the deaths of mentally ill patients in Gauteng in 2016. The subtitle of the report — “No guns: 94+ silent deaths and still counting” — is highly appropriate in the light of the chilling findings of the investigation.
The revelation that at least 94 mentally-ill patients died after being moved from Life Esidimeni to 27 unlicensed NGOs that did not have the capacity to provide the care they needed is shocking.
The ostensible reasons for this action — to save money and that in this case it was in line with the international trend to deinstitutionalise psychiatric patients — do not justify the wilful mistreatment of long-term mental health patients for short-term gain. They reflect a preoccupation with efficiency ahead of patient rights and social justice.
In March 2016, while the Gauteng health department was under curatorship, the MEC, Ms Qedani Mahlangu, said “We can only commit to South Africans that … we will do everything possible to our powers that we stretch the rand even further, we do things that matter and we eliminate any inefficiency in the system.”
However, it seems that all that mattered to MEC Mahlangu and her senior officials was to reduce costs. Cost-cutting in health care can be life-threatening when it is implemented without regard for human dignity. Ms Mahlangu’s department should have been well-aware of the risks given the extensive literature on this problem. There were also many desperate attempts by families and advocacy groups like the SA Society of Psychiatrists and the SA Depression and Anxiety Group to convince them of the danger. Even litigation failed to convince them. A visit to Ms Mahlangu by the Gauteng People’s Health Movement South Africa to ask questions yielded no satisfactory answers.
Attempts to bring health spending within budget require careful, well-considered cost saving measures that should achieve improved rather than worsened patient care while balancing competing rights. People are not objects to be deployed in the cheapest configuration that suits bureaucrats in an air-conditioned offices. They are living beings entitled to respect and dignity and to have their well-being protected, particularly when illness renders them vulnerable. Discharging long-term psychiatric patients inappropriately is therefore a retrogression in terms of the law, and a violation of their human rights.
The de-institutionalisation of patients with mental health problems relies on careful assessment and the appropriate placement of patients who can live safely in community settings. Even more importantly, it depends on the availability of well-developed and safety-netted programmes of care in the community. Critically, these programmes must be part of a holistic, integrated care and rehabilitation programme. Such programmes do not yet exist in our country.
The Gauteng Department of Health ruthlessly implemented a hasty, cruel, chaotic and seriously unethical plan that effectively dumped already very vulnerable patients out of sight and out of mind in hopelessly inadequate settings — a frank dereliction of ethical obligations and human rights commitments.
The People’s Health Movement South Africa calls for
- The investigation into this shameful episode to continue until its full extent is clear to the nation.
- Full accountability from all those responsible for these deaths—from those who ordered the placements in unregulated settings to those who operated these “homes”. This is critical not only for the relatives and loved ones of people who came to harm but to the nation as a whole
- An explanation from those involved to the country as a whole, and particularly to the relatives and loved ones of those who came to harm.
- Appropriate punitive step.. Ms Mahlangu’s resignation, though welcome, does not absolve her from full accountability. We consider this especially important in the light of the fact that other provinces may be considering similar activities..
Finally, we call for a commitment from the state towards a single, adequately resourced and equitable National Health System that recognises our common humanity and provides high quality health care for everyone according to need, irrespective of social status or means.
South Africa is due to report to the UN on its progress with regard to domesticating the International Covenant on Social, Economic and Cultural Rights, which enshrines the right of access to health care, prohibits discrimination and prioritises human dignity. PHM commits to ensuring that the UN Committee considering the national report interrogates the treatment of mental health patients throughout South Africa so as to ensure appropriate international sanction and oversight to ensure this never happens again.
Issued by People’s Health Movement South Africa.
Date 02 February 2017
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