Mental health patients awaiting trial could in future have psychiatric observations in private hospitals as the public sector continues to buckle under pressure that has resulted in some waiting up to two years before having such examinations.
Health minister Joe Phaahla said apart from contracting psychiatrists from the private sector to complement staff, his department was negotiating with some of the private hospitals in Gauteng to accommodate these patients as provincial health departments are continuously crippled by shortage of psychiatric beds.
“We are doing everything we can with a limited capacity to bring in more private psychiatrists to do the observations. But the problem then becomes, can we find a bed, particularly for state patients that need to stay longer? That is why we are talking to some of the private hospitals in Gauteng which are underutilised and have spare capacity to assist to reduce pressure. Negotiations to access those beds are continuing ... We must just agree on the price.”
“I’ve been informed there are possibilities where there could be agreement to acquire some additional beds.”
Phaahla, who spoke to TimesLIVE Premium after his budget vote speech in parliament on Tuesday where he tabled his R60bn budget, said apart from limited funding, bed shortages at public hospitals had also been made worse by increased drug use and the demand for psychiatric observations by defence lawyers.
“Unfortunately one has to accept that this problem is not going to be sorted out in the short term. We have seen an increase when somebody has committed a crime, mental illness is put up as a defence by lawyers. That trend has been increasing, especially serious crimes.
“Once the legal team puts up mental illness in their defence the judges have no option but to get that person observed. The more this is used as a defence, the more pressure is put on our mental health facilities and the more we try to catch up.”
Phaahla said the building of a psychiatric hospital in Mpumalanga would help relieve this pressure and fast-track the backlog of assessments.
While observations of forensic psychiatric patients in the Western Cape takes up to 14 months, in Gauteng it takes up to two years.
Deputy health minister Sibongiseni Dhlomo said while services were starting to stabilise in South Africa after the Covid-19 pandemic, the mental health burden had increased.
“Our focus, post the Covid-19 pandemic, is a growing burden of mental health in the country. We have seen how a physical illness impacted negatively the mental health of people, including those without pre-existing mental health conditions.”
He said the national health department was finalising the review and update of the national mental health policy framework and strategic plan 2023-30, which lapsed in 2020, and guides provinces on mental health promotion, prevention and treatment.
“The 12 action areas and eight key strategic objectives of the plan will guide us as we further strengthen the mental health system in a manner that promotes integration of mental health into the general health services environment as envisaged by our mental health legislation,” he said.
Dhlomo said the plan would address, among other things, upstream risk factors for mental health such as poverty, substance abuse and gender-based violence and unemployment.
“We plan to do more to increase public knowledge on mental health issues including early signs of mental illness, avoiding preventable risk factors, early help seeking behaviour for mental illness symptoms and where people should go for help and treatment. We know that unlike other disciplines that require mostly sophisticated technologies to diagnose and treat illnesses, mental health requires mostly human resources to diagnose, care, treat and rehabilitate mental illnesses.”
As part of upskilling health professionals, since 2019 the department has trained 2,393 doctors and nurses on basic mental health skills.
The department has also approached the National Treasury to contract private mental healthcare professionals “to complement the existing staff and render mental health services at primary healthcare”.
“Provinces have used this indirect grant to contract psychiatrists, psychologists, occupational therapists, social workers and registered counsellors to render mental health services at primary health care.
“The contracted clinical psychologists and psychiatrists also conduct forensic mental observations of accused referred by the courts in terms of the Criminal Procedure Act.”
To date, 40 out of the 336 hospitals have a mental health unit, and out of the 24 specialised psychiatric hospitals, 14 were designated to admit state patients, while 10 had a capacity to conduct forensic mental observations.
But the EFF rejected Phaahla’s budget, saying under his leadership, public health care was at its “worst status this country has ever witnessed”.
EFF MP Naledi Chirwa said patients continued to die at the gates of hospitals.
“Newborn infants die in their hundreds in hospitals, like we saw at Chris Hani Baragwanath. Thousands of young mothers are raising permanently paralysed children because of avoidable negligence in our hospitals. Healthcare workers are overworked and underpaid. Ambulance services don’t exist. People don’t even call for them any more because they don’t show up.”
Chirwa urged the department to prioritise primary health care, prevention and education.
“Increase and fill out all vacancies of healthcare staff, and ensure that there is at least one healthcare facility in every ward across the country that is open for 24 hours and seven days a week,” she said.
DA’s Michele Clarke said patients were forced to suffer because of public healthcare sector’s inability to address the multiple failures, including lack of funding, poor staff morale and a low staff-to-patient ratio.
“These failures are rooted in dereliction of the philosophy and ethics of ubuntu, including poor management due to cadre deployment. The national health insurance will not be alpha and omega quick fix to the myriad of problems faced in the public health system. The health environment is on life support and needs urgent intervention to supply quality universal health care to citizens of this country.”
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