“One out of every 10 people in SA and that is a huge number we can’t ignore,” said Christine Nxumalo, one of hundreds of bereaved relatives who lost a family member in the Life Esidimeni tragedy, an event that has shed light on the unprecedented and continuing mental health crisis facing the country.
As justice remains elusive, hope that the reasons for and the terrible ways in which 144 psychiatric patients died in the public health system’s care in 2016 will emerge in less than two months is growing.
The discharge of 1,300 patients in the care of Life Esidimeni to other facilities or their families will be the focus of a Pretoria high court inquest due to start on July 19. Judge Mmonoa Teffo will preside over the matter, which is set down for 30 days. The case will see public interest law centre Section27 representing 35 bereaved families and will be open to the public.
The inquest follows a two-year process which culminated last week in the launch of an online memorial and advocacy project. The www.lifeesidimeni.org.za site aims to honour those who died and their families, while offering information on mental health, as well as providing a place for people to tell their stories and a forum through which to access help.
Work is still under way to deal with the deaths of those who died of neglect, dehydration, starvation and hypothermia. Many were buried with “natural causes” listed on their death certificates.
“Their lives and stories matter. They are missed and loved by the families and friends left behind. Sadly, the people responsible for this crime remain unpunished. Mental healthcare remains woefully inadequate and government continues to fail them and their families,” said Cassey Chambers, of the South African Depression and Anxiety Group (Sadag), which has spearheaded the launch of the portal along with Section27.
The new online memorial illustrates another government failure. Deputy chief justice Dikgang Moseneke, who presided over the arbitration hearing into the tragedy, said government must create a memorial. It has never been done, so NGOs have created the online tribute instead.
It’s a development welcomed by the Life Esidimeni Family Committee, run by Nxumalo, who speaks on behalf of the bereaved.
“We need everyone in this country to see and hear this story. We must put it out there so people understand what happened, how it happened and why. Or will we just forget and learn nothing? I lost my sister in the tragedy and some mornings I still can’t get up. It’s the manner in which she died that makes it so hard to bear. We all just want answers.”
Those in the field say while the tragedy ranks as the worst trauma they have ever witnessed, the shocking state of mental healthcare remains a reality.
In October 2015, then health MEC Qedani Mahlangu cancelled the Gauteng health department’s contract with Life Esidimeni for the care of the 1,300 patients at psychiatric facilities across the province. Less than a year later she admitted that 36 of the transferred patients had died. Investigations found that patients had not been receiving specialised care and that the number of deaths was higher.
Section27 took up the causes of 60 families and several survivors. An arbitration hearing sat for 43 days, ending with judge Moseneke making several findings and ordering compensation payouts.
The Gauteng health department complied by drawing up a plan for mental healthcare revival in the province, but much still has to be done to implement it properly and funding remains insufficient. The compensation payouts were made.
Section27 lawyer and activist Sasha Stevenson said though implicated officials have publicly apologised, those ordered to appear before their professional health bodies have yet to face disciplinary action.
She believes the arbitration was not in vain, though there is still frustration over “lots of lies that were told and the fact that we didn’t get the full truth and the real story”.
“A lot of people, from high-ups in government to people from NGOs, were subjected to cross-examination. It was an imperfect process, but it couldn’t have been at all pleasant,” she said.
“And the people we represented were a group of disparate individuals and now they are activists who are out there speaking up for themselves and their loved ones.”
We have a right to expect better and for them not to drop the ball. But for me, the jury is out. It would be cruel to put the families through a secondary trauma all over again and have no decent result at the end.
— Human rights activist Mark Heywood
The ultimate success, in her view, has been the spotlight that the case has placed on mental healthcare and the plight of psychiatric patients. This is expected to increase when the inquest goes ahead.
“Obviously there is the fear that it will be a painful and protracted process, but it is the one way to ascertain in court the legal cause of the deaths and if any criminal prosecutions are warranted,” Stevenson said.
But Chambers has a different view. She believes that while settlements were reached and findings were made against government, little else has been achieved.
“We still don’t have enough available beds; there are still medicine shortages. There are still too few psychiatric hospitals and accredited NGOs, and Covid has just made it all a lot worse.”
Human rights activist Mark Heywood, who has been deeply involved with the case, is cautiously hopeful the inquest will have a positive outcome, but has no positive words for what has been done so far.
“This could never have been a cost-saving exercise and we warned that from the start. Now we sit with costs running into millions paid directly from the fiscus. The cost of the arbitration was not made public, but it must run into tens of millions. It was held at an expensive venue with top legal teams — probably cost more than a billion if you include the settlement payouts,” he said.
“Then you have the costs of relocating survivors, the clinicians involved — the costs incurred are utterly shocking and there has been absolutely no accountability for it.”
Heywood described the social cost as ongoing and immeasurable.
“The grief, disrupted lives, death, pain and suffering, trauma — there is no way to put a price on that.”
He is cynical.
“We saw a lot of those involved shedding many tears in front of the media, but I believe they were crocodile tears because nothing has been achieved since. They may blame Covid-19, but they had years to fix things before the pandemic hit,” Heywood said.
Like others involved in the process, Heywood is hesitant to hold out a great deal of hope for the inquest.
“We have a right to expect better and for them not to drop the ball. But for me, the jury is out. It would be cruel to put the families through a secondary trauma all over again and have no decent result at the end.”
But all those working hard to ensure the inquest’s success agree with Heywood’s sentiment that “we have to have hope”.
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