South Africa has no guidelines on how to care for the mentally ill
A medical professional on Tuesday painted a grim picture of the state of mental healthcare in South Africa‚ saying professionals were not well-equipped to deal with the sector.
“We have no programme guideline for mental healthcare‚” said psychiatrist Dr Lesley Robertson. “There is no national programme guideline in the way that we have guidelines for TB‚ HIV or sexually transmitted infections‚ etc. There is nothing to tell us in detail what to do with a mentally ill patient. This results in more confusion‚ from a district director’s perspective‚ of what they should actually do‚” Robertson added.
She was testifying before the South African Human Rights Commission‚ which is probing the status of mental healthcare nationally‚ following the scandal around scores of patients who were transferred from Life Esidimeni to unlicensed NGOs‚ where 143 died.
“The mortality of people with mental illness worldwide is about 2.5 times that of the general population‚” said Robertson. “People with mental illness die 10 to 20 years earlier [than average]‚ and a lot of it is because of high medical problems – it is more difficult for people with mental illness to access care.”
Robertson explained that mental-health problems at times make it difficult for patients to describe their other medical symptoms‚ and therefore‚ they took longer to get care.
While the national department of health had earlier testified that it was not promoting the deinstitutionalisation of mentally ill patients‚ Robertson suggested that this testimony was not true.
She stressed that deinstitutionalisation had started in the 1990s‚ and the removal of the Life Esidimeni patients was just one example.
“What we witnessed in 2016 was actually a termination of the contract and the closure of the last 2‚000 beds. This was not the beginning of deinstitutionalisation‚” said Robertson.
“The emphasis on reducing the beds and sending people [back into] the community‚ I think‚ comes from a misunderstanding of the Mental Care Act and perhaps some confusion in the legislation.”
Robertson said that while the Act was unequivocal that people should be accessing community-based care for mental illness‚ this was because it wanted to prevent overly restrictive and unnecessary involuntary care.
“But we don’t have powers for the mental health review board to ensure that people who are living in the community are able to access care at the community level which is appropriate for the severity of their illness‚” she said.
“This has led to the massive confusion that primary care can cope with all these patients. The Act also says that tertiary services are for tertiary hospitals and specialised hospitals – so the implication is that you don’t need a tertiary-level specialist at a community centre.”
This‚ Robertson said‚ had resulted in a mismatch‚ where patients were sitting in communities‚ while specialists sat in specialised hospitals and were inaccessible. These hospitals are difficult to access not only because of their positioning‚ but also because of their difficult administration procedures.
Robertson spoke with good authority about the burden faced by medics who attend to community-based facilities‚ as she is one of them.
She treats 5‚500 outpatients in community-based facilities‚ while another psychiatrist she knew treats about 8‚000 in Ekurhuleni.
Scores more of people with severe mental illness were not on the system and were not receiving the medical attention they needed‚ she said.