Screaming in mental anguish, a man frantically tugs at his restraints. Worn white bandages, wrapped tightly around his wrists, are tied firmly to the stretcher he lies on.
Metres away on another stretcher, a man is bound with a leather restraint to a railing.
In a room off a corridor of Helen Joseph Hospital’s emergency department, lying on two stretchers, two men’s hands are tied with red and white security tape to their hospital beds.
In the same room, a man paces frantically up and down. Staff have run out of emergency tape and take turns ensuring he does not escape.
Escapes are frequent.
Outside, in a fenced off courtyard, three psychiatric patients are in a corrugated-iron shack, meant to be used as a storage space for wheelchairs and stretchers.
One of the patients begs passers-by for cigarettes. Another paces about frantically. A third lies asleep on the floor.
The hospital’s emergency department can only assist four psychiatric patients. Last week, 24 were tied to stretchers and wall railings in the unit. In February, 54 psychiatric patients a day were tied to stretchers and walls.
The hospital’s psychiatric ward can accommodate 20 patients. It’s been full for a year.
Helen Joseph Hospital, in Johannesburg’s inner city region, falls within the now closed Charlotte Maxeke Hospital patient drainage system.
The closure, which resulted in the hospital’s two psychiatric wards being shut, means Helen Joseph Hospital is flooded daily with mentally ill patients.
Helen Joseph Hospital serves an area stretching from Cosmo City and Diepsloot to Roodepoort and has now taken on Charlotte Maxeke’s patients from the inner city and Alexandra township.
A hospital source told Sunday Times Daily what had been witnessed last week was “nothing”.
“You should have seen last month. We were up to 54 patients a day. Even that was not as bad as it has been. On occasions we go up to 72 psychiatric patients a day.
“These patients on average spend two weeks in the emergency department.
“It gets so bad we battle to provide life-saving services to victims of violence and car crashes.”
It gets so bad we battle to provide lifesaving services to victims of violence and car crashes.
The source said the emergency department averaged 45 manic aggressive patients a day.
“Repeatedly they set mattresses alight, break stretchers, windows and bed frames and attack staff. They climb into ceilings. They slit their wrists and stab people.
“We don’t have enough staff to control them. We have lost numerous psychiatric patients who simply wander off. That is because we are not designed to look after 45 psych patients at a time.”
The source said the terrible reality was “these patients need to be on ground floors, jailed in rooms with windows not made of glass, burglar bars that cannot be broken, walls they cannot hit their heads on and thick reinforced steel doors which are monitored with well-controlled fire safety escapes.
“This is the reality when it comes to keeping manic aggressive psychotic people safe.
“Unfortunately the department’s stance is that psychiatric patients are a myth, but when in reality they are very real.”
Twenty kilometres away, the situation at Soweto’s Bheki Mlangeni District Hospital is even worse.
Other than Chris Hani Baragwanath, Bheki Mlangeni is the suburb’s only hospital.
Collectively, the two can officially accommodate 181 psychiatric patients.
A Bheki Mlangeni hospital source said 250 psychiatric patients, most of whom abused substances, were admitted monthly to the emergency department, living in the unit for up to 10 days at a time.
The hospital’s emergency department sees up to 4,000 patients monthly.
When Sunday Times Daily visited the hospital’s emergency department on Saturday, three psychiatric patients were being held in a storeroom, another was being restrained by staff and security guards to a chair with three others bound to stretchers.
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Psychiatric patients regularly escape into the emergency room’s ceilings, with patients committing suicide and attacking, injuring and killing other patients and staff.
Attacks on staff by psychiatric patients occur regularly, according to a nurse.
“Patients roam different wards for weeks. Sometimes more than 40 at a time. It makes caring for other patients difficult.”
The source said: “The hospital only has psychiatric beds for 24 patients. Last month we had 30 psychiatric patients in the emergency unit which only has place for 15 patients.
“Every day at least twice a day we go on divert mode. We have to divert patients requiring life-saving treatment to other hospitals because the psychiatric patients occupy our stretchers, break or burn our stretchers, medical equipment, oxygen ports, and escape into ceilings where they hide out for days.
“The situation is an abuse of patients’ rights. There is a dire risk to the lives of other patients and staff. In November a patient committed suicide when he jumped from the building’s second floor, where the psychiatric ward was housed until recently. Two years ago a psychiatric patient killed another patient at the hospital. A psychiatric patient recently stole someone’s car.”
Edwin Zazayokwe, 86, died after he was attacked and stabbed multiple times in the chest with a sharp object, allegedly by a 17-year-old mentally ill patient at Bheki Mlangeni District Hospital.
We cannot cope. We have run out of restraints. Those that we did have were damaged by psychiatric patients.
— Source
The source said since August, six doctors had resigned because of the hospital’s psychiatric patient crisis.
“We cannot cope. We have run out of restraints. Those that we did have were damaged by psychiatric patients.
“This has been escalated to every level possible, yet nothing is done because mentally ill patients are seen as a financial burden and not people who desperately need help.”
Feuds are developing with Baragwanath Hospital psychiatric staff, whom Bheki Mlangeni staff accuse of failing to assist.
“We are Soweto’s smallest hospital yet our big sister hospital has abandoned us.”
Despite a commission of inquiry into the Life Esidimeni tragedy, in which 144 psychiatric patients died from neglect in facilities contracted to the provincial health department in 2016, the care of Gauteng’s psychiatric patients has seemingly worsened.
The continued closure of Charlotte Maxeke Hospital is driving the crisis, claim medical sources. The situation is so dire that across almost all of Gauteng’s state hospitals, psychiatric patients are routinely housed in emergency departments, including resuscitation rooms, with staff often unable to treat patients requiring emergency assistance.
Staff are forced to subdue violent psychiatric patients by tying them to stretchers and wall railings.
“What we have to do to protect these patients is inhumane,” said the Helen Joseph Hospital source.
“But if we don’t they will either kill themselves, other patients or us.”
A Hillbrow woman, asking not to be named, said seeing her father tied to a stretcher in Helen Joseph Hospital had been heartbreaking.
“He is not well and cannot be looked after at home. We have tried but he is sick. His head is the problem.
“We brought him here to get him help, but he is not getting the help he needs. The doctors say they are trying their best, but there are so many patients like him here. They say there is no bed space and he must just wait.
“Seeing him tied up like this, as though he is some kind of criminal or an animal, is wrong. They should put him in a place where it is safe for him and where he can get help.”
Some family members, however, appeared relieved to have at least some sort of support from the hospitals.
A family member of a patient at Bheki Mlangeni, who asked not to be named, said they had limited knowledge of the psychiatric issues they are faced with. “My son has a mental (illness) problem. I don’t know how to assist him because he has mood swings and other types of behaviour that I don’t know how to cope with. This hospital at least helps us.”
Another family member reiterated the sentiment: “My son suffers from depression. I’m scared that he will commit suicide, but at least if he is at a hospital, they will take care of him.”
What we have to do to protect these patients is inhumane. But if we don’t they will either kill themselves, other patients or us.
— Helen Joseph Hospital source
Gauteng health department spokesperson Kwara Kekana said in the last five years, five mental health patients at Gauteng’s state-run psychiatric hospitals had committed suicide, while 48 receiving treatment at state hospitals not fully designated as psychiatric hospitals had killed themselves.
Gauteng should, according to national health department standards, have 3,134 acute psychiatric beds, but only has 1,813.
Data Kekana provided show that as of January there were beds for only 432 acute mental health patients in state hospitals not fully designated as psychiatric hospitals.
Gauteng’s dedicated state psychiatric hospitals are Weskoppies in Pretoria and Sterkfontein in Johannesburg.
Collectively they have 559 patients.
Kekana said across all the province’s public hospitals there was an increase in demand for acute psychiatric beds.
“This is as a result of the upsurge of the burden of mental health diseases, compounded by Covid-19 pandemic and substance abuse.”
She said the severe bed deficit was worsened by a shortage of long-term beds at contracted and NGO-run residential facilities.
“Patients who should be managed at these facilities occupy the limited acute beds.
“Due to the limited number of acute beds very ill mental healthcare users have to be managed as outpatients. [Patients] are shunted from one hospital to another by emergency services and police in search of a bed.”
She said Charlotte Maxeke Hospital’s closure had put pressure on hospitals such as Helen Joseph, Baragwanath and Bheki Mlangeni, especially their emergency departments.
“Management of patients at emergency departments is a major challenge. There is a huge safety risk for both patients and staff.”
Management of patients at emergency departments is a major challenge. There is a huge safety risk for patients and staff.
— Kwara Kekana, Gauteng health department spokesperson
She said the department’s business case to Treasury, for additional budget to increase staff posts and refurbish psychiatric wards, had been approved.
“Posts for eight hospitals have been advertised.”
Kekana said a submission to deal with infrastructure challenges to improve capacity was also approved.
Dr Nokuthula Mdaka, Wits department of psychiatry lecturer and the SA Society of Psychiatrists southern Gauteng subgroup chair, said bed shortages had crippled assistance to psychiatric patients, with staff shortages and infrastructure challenges having a major effect.
On Friday, speaking to Sunday Times Daily after a media briefing on Charlotte Maxeke hospital, Gauteng health DDG Dr Freddy Kgongwane said while the department was burdened by patients requiring psychiatric care, the services provided was “satisfactory”, adding that substance abuse was a big problem.
“It’s satisfactory. We have 36 hospitals and more than 300 clinics in the province. However, if you zoom in to the demand of psychiatric help, there has been an increase in demand for services in Gauteng. I think Covid-19 expanded the demand in Gauteng. Substance abuse has been one of the main challenges. We often find that there is congestion because of substance abuse and they have to detox. But we can’t conclude that.”
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