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Nicole

Nicole

Dear Honorable President,

 

RE: FAILURE TO IMPLEMENT LEGAL IMPERATIVES SURROUNDING MENTAL HEALTH CARE IN SOUTH AFRICA

 

First of all, we thank you for your attention. While mental health is certainly an unrecognized and neglected focus area, we note efforts to bring to light the failures in the system. It is our hope that these efforts will serve to realise the rights of people with psychosocial disabilities and intellectual disabilities. Today we wish to bring to the fore the failure to implement the laws and policies of the Republic as they relate to the mental health system with reference to the Life Esidimeni Tragedy and beyond.

 

First of all, we wish to remind you of mental health in the global context and of the international obligations of the Republic:

 

Globally, mental illness is strongly linked to health and social inequalities, and these inequalities affect large groups of people, whether these groups are defined socially, economically, demographically, or geographically. Certain groups in society are more vulnerable to experiencing mental health inequities, including: black and minority ethnic communities, homeless people, victims of violence and abuse, people living with disabilities, women and children. Those with severe mental illnesses are more likely to experience some of the most severe health inequalities. Inequalities in mental health and the dilapidated state of psychiatric facilities have significant ethical implication which involve key bioethics principles of medicine and public health that involves: respect for individuals, justice (equality and fairness), promotion of good, and to do no harm.

 

As a Member State of the United Nations and World Health Organisation, South Africa has an obligation towards the agreements adopted or endorsed at this level to ensure that its citizens’ human rights, health and mental wellbeing are underpinned in all local policies and legislation. At this level, world leaders have committed to recognise prevention and treatment of non-communicable diseases, of which mental, neurological and substance use disorders are included, as health priorities within global development. There can be no sustainable development without mental health and none of the Sustainable Development Goals can be achieved without prioritising mental health.

 

We turn now to national imperatives:

 

Chiefly, the Constitution of the Republic of South Africa (CRSA), Mental Health Care Act and the White Paper on the Rights of Persons with Disabilities as well as the Mental Health Policy Framework and Strategic Action Plan (MHPF) and National Development Plan are concerned with the right of dignity of service users. This is so because dignity is a right from which others flow- there is no real right to access to health care without dignity, for example. Other rights similar in nature are the rights to equality and life. Further applicable rights- those flowing from the aforesaid entitlements- are the rights to freedom and security of person and the right to a clean and healthy environment. We draw your attention to these rights, Honorable President, because they have been neglected, extinguished even, in respect of those among society’s most vulnerable. Applied correctly, the aforesaid instruments can facilitate the realization of each of these legal guarantees.

 

Honourable President, it is clear, the requisite instruments for creating a comprehensive and functional mental healthcare system indeed exist. Unfortunately implementation thereof is woefully inadequate. This was evidenced with both Life Esidimeni as well as within the status quo. The violations of these rudimentary entitlements led to death of some 144 mental health care users and the relapse of many others. Today, atrocities continue to occur throughout the system with death and destruction in the lives of individuals so-situated becoming a raging and rampant problem throughout the country. Applied correctly extant legislation and policy could ameliorate the plight of mental health care users, and South Africa could see a high rate of recovery and successful habilitation/rehabilitation. Unfortunately this is not the case. A comprehensive legal framework is meaningless if it is not implemented correctly, or in some cases at all. Until horror stories of poor or non-existent basic services subside, until mental health care users are able to obtain what is required in order to maintain a high standard of mental well-being, the drafting of the law, policies and plans concerned will remain a moot and futile expenditure of resources and effort.

 

Honourable President- to many mental health care users, the Life Esidimeni tragedy instilled emotions of anger, resentment, disappointment and distrust in the Department of Health, but also in Government in its entirety for failing to protect the lives of the former Life Esidimeni patients from suffering and from death. Many mental health care users are accessing services in the public health care system and are asking themselves “does my life mean as little to Government as the lives of the former Life Esidimeni patients?” The system as it presently stands- despite all of the scrutiny under which it has been placed- represents dereliction of duty on the part of your government and the fact that nobody is being held unaccountable renders the system to a state of wanton neglect.

 

Honourable President, we implore you to implement the obligations to which the state is bound, address the present shortcomings productively and systemically and hold those responsible for the glaring iniquities in the system to account.

 

It is greatly desirous that this communication will be addressed with a sense of urgency and that steps will be put in place to remedy the fatal defects in the system.

 

Yours Faithfully,

 

The South African Federation for Mental Health

 

Contact Details:

 

Nicole Breen

Project Leader: Awareness and Information

South African Federation for Mental Health

This email address is being protected from spambots. You need JavaScript enabled to view it.

011 781 1852

072 2577 938

International Day of Disability is celebrated annually on the 3rd of December. It is the culmination of a month's worth's of activities as it falls on the last day of Disability Rights Awareness Month. This year, the South African federation for Mental health elected to have community-based care as its focus for the occasion. To this effect we have issued a press release. Read it here:

International Day of Disability takes place annually on the 3rd of December. It is an opportunity to engage in activism surrounding the rights of people with disability and to raise awareness surrounding the need for their rights to be realised. While a single day of the year is hardly enough to scratch the surface, it heralds the prospects of making a start in advocating for the rights of people so-situated. People with psychosocial and intellectual disabilities are especially vulnerable as their disabilities are often not well-understood and methods of assisting them are not clearly defined in the minds of the state or society.

An important place to begin is to hold government accountable for the execution of its mandate. The state is the primary duty-bearer when it comes to providing the care and support these individuals need both to survive and thrive. Government is responsible for creating structures that allow people with disabilities to lead dignified lives. Unfortunately however, the state has prolifically and chronically failed people with disabilities, leading to social exclusion and poverty. This was evidenced in the Life Esidimeni tragedy and a spate of deaths and assaults of and by psychiatric patients in hospitals across the country, as well as within the community, as the state did not have adequate structures in place to ensure the safety of these individuals. Stripped of even the slightest bit of dignity, such individuals languished up to a point where crises arose, but by then it was too late and state intervention was meaningless.

South Africa has a comprehensive legislative and policy framework for people with psychosocial and intellectual disabilities With the Constitution, Mental Health Care Act, Mental Health Policy Framework and Strategic Action Plan 2013-2020 and White Paper on the Rights of Persons with Disabilities, there is a clear path towards the realisation of the rights of these individuals. Unfortunately the prescripts of these instruments remain largely unimplemented, with the effect that people with psychosocial and intellectual disabilities remain in limbo, often no better off than what they were before these frameworks came into place.

Government has also failed to hold disgraced former Member of the Executive Council (MEC), Quedani Mahlangu, accountable for the deaths of the 144 people in the Life Esidimeni tragedy. These mental health care users died under her watch and no visible action has been taken against her thus far. The African National Congress (ANC) has continued to protect her, even re-electing her to their Provincial Executive Committee earlier this year. Gauteng Deputy Chairperson, Panyaza Lesufi, defended her re-election in an interview, indicating that a) the fact that Mahlangu was no longer an MEC, b) that she was no longer a member of the provincial working committee of the ANC, c) that an inquiry had been held surrounding Life Esidimeni, and d) that the ANC had acted on the recommendations of the Health Ombudsman, was an adequate series of steps taken to hold her accountable. SAFMH maintains that Mahlangu ought to be made to take responsibility for her actions and inactions by the ANC doing more than shuffling her around the ranks of the party. It is truly disheartening that, to date, this has not been the case at all.

One of the essential elements that has been highlighted in policy and legislation is the need for deinstitutionalisation. Deinstitutionalisation occurs when mental health care users are, where possible, removed from the hospital environment and sent to live in communities. Mental healthcare services are then decentralised to provide care at community level. Despite supposed commitment to this process, its execution has largely been a failure. The reality is that, in some provinces there are simply no facilities at all for people with mental disabilities to go to outside of hospitals. In Gauteng, where the Gauteng Department of Health supposedly implemented deinstitutionalisation, this resulted in 144 people losing their lives as they were transferred to non-governmental organisations (NGOs) that were not adequately equipped to care for them and left many people in a state of wanton and tragic neglect. Some of these organisations had their licenses issued to them unlawfully, and others did not receive proper subsidies. Life Esidimeni amounted to a situation worse than Marikana and on par with incidents such as the Sharpeville Massacre and the Soweto Uprising. The state was warned by professionals, civil society and families that the transfer of the patients would have disastrous results, but the warning was cast to the wind and tragedy ensued.

Whilst Life Esidimeni is a poignant example of the state’s failure to take responsibility for mental health care users, it is sadly not the only example. With inadequate infrastructure, a lack of beds, a lack of qualified health care practitioners, inadequate security, stockouts of medications, confusion as to roles and responsibilities of stakeholders such as health care professionals, emergency service technicians and the police in involuntary admissions and human rights abuses happening frequently, a number of hospitals in the country have been identified as facilities in crisis. Despite increased budgetary allocation for mental health for the 2018/2019 financial year, nothing is changing and we are not seeing a purposeful upscaling of mental health services.

Mental health care users are among South Africa’s most disenfranchised members of society and it is unfortunate that our government acts in constant dereliction of duty towards them. The time to act is now, and fast. The South African Federation for Mental health (SAFMH) calls upon the state to urgently intervene and to make full use of its resources in prioritising mental health.

Contact Details

Nicole Breen

Project Leader: Information and Awareness

South African Federation for Mental Health

This email address is being protected from spambots. You need JavaScript enabled to view it.

011 781 1852

072 2577 938

 

16 Days of Activism for No Violence Against Women and Children is celebrated annually between the 25th of November and the 10th of December. it is an opportunity to reflect on the past, examine the present and look towards the future we want to see for women and children in a violence-free society where they are safe and enjoy all of their rights and freedoms. In view of this SAFMH has compiled a press release. It appears below:

 

16 Days of Activism for No Violence against Women and Children is celebrated annually between the 25th of November and the 10th of December. As vulnerable demographics of the population, women and children often bear the brunt of violent activity within our society. This has an indisputable impact on their mental health. As an organisation committed to advocating for the rights of under-served individuals in this regard the South African Federation for Mental Health (SAFMH) wishes to raise awareness surrounding these social ills so as to work towards ameliorating the plight of women and children who are either victims of violence or who find themselves at risk of violence.

The World Health Organisation “WHO” (2002) defines violence as:

 “The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation”

 The WHO and London School of Health and Tropical Medicine (2010) indicate that:

“When directed against women or children, this violence can take a number of forms, including, but not limited to, sexual violence, intimate partner violence, child abuse and neglect, bullying, teen dating violence, trafficking, and elder abuse. The majority of violence against women and children is perpetrated by partners, family members, friends, or acquaintances, so that most violence against women and children takes place in the form of intimate partner violence, family violence, or school violence…”

 

The rates of violence against women and children in South Africa represents a crisis situation.

  • 17% of young women aged 18-24 had experienced violence from a partner within 12 months of a survey undertaken by Stats SA (2017).
  • The survey indicated that 24.4% of women in the poorest households had experienced physical violence.
  • According to the South African Medical Research Council (2017), three women are killed by their intimate partners every day.
  • According to the Institute for Security Studies (no date), in South Africa, one in four women report physical or sexual intimate partner violence.
  • The South African Police Services indicated that in 2017/2018 the reported crime statistics (2017/2018) said that 2930 women were murdered; 691 boys were murdered; 294 girls were murdered and murders of women and children accounted for 19.3% of total murders.

For our purposes the most pertinent question is as to what impact this has on the women and children of our country.  Shapland and Hall (2007) discuss the commonly occurring effects of varying kinds of victimisation which include:

Shock and a loss of faith in society…guilt at having become a victim of crime…psychological effects, including anger, fear and depression, but may for some turn into longer-term depressive effects including sleeplessness, anxiety and constant reliving of the event, and occasionally into PTSD [post-traumatic stress disorder]…

These are dire effects and, given the high propensity for women and children falling victim to these social ills, represent a real danger to a large proportion the population. It is therefore integral that steps be taken to prevent and act on such violence so as to minimise and ultimately eliminate the damage that violence does to individuals so-situated. Interventions can take various forms. At systemic level, further law and policy can be implemented to facilitate specific measures being taken in respect of women and children. The National Action Plan on No Violence against Women and Children is currently being reviewed and it is our hope that this process yields positive results. A top-down approach, however is never truly effective. What needs to happen is that communities need to be sensitised as to what the issues are and just how at-risk these vulnerable demographics are. Community and religious leaders, local government, non-governmental organisations and a spectrum of other parties all have a role to play in ensuring that awareness is raised about the plight of women and children. Concrete steps need to be taken at once to ensure that these segments of society are kept safe. 16 days is hardly enough to proliferate this message, but it is a start. Make your start. #takeyourplace

Contact Details

Nicole Breen

Project Leader: Information and Awareness

South African Federation for Mental Health

This email address is being protected from spambots. You need JavaScript enabled to view it.

011 781 1852

072 2577 938

From the 3rd of November to the 3rd of December is Disability Rights Awareness Month. This year SAFMH has elected to focus on community-based care. This is an area that is chronically under-prioritised but all-important as it is a core component of the deinstitutionalisation process to which South Africa has committed itself. To this effect, SAFMH has compiled a press release on the topic. Read it here:

Disability Rights Awareness Month annually runs from the 3rd of November to the 3rd of December 2018. This represents an opportunity to look back on the past, examine the present and envisage the future we want to see in terms of services for and the realisation of the rights of persons with disabilities. The South African Federation for Mental Health, as an NGO focussing on upholding and protecting the rights of people with psychosocial disabilities and intellectual disabilities, has elected to embark on a campaign surrounding community based care and its associated imperatives such as deinstitutionalisation and the need to prioritise services to individuals so-situated and thus to highlight the plight of these individuals.

It has been internationally recognised that people with psychosocial disabilities and intellectual disabilities should only be institutionalised as a matter of last resort. Hospital environments are restrictive, cost-intensive and by necessary implication limit the ability of patients to exercise their rights. It has been proven time and time again that integration/reintegration into communities aids the recovery of mental health care users through empowerment and allowing them, as indicated, to attain more of their rights than they would be able to in a hospital environment and that, with appropriate support, that such individuals can experience marked and profound positive outcomes. While South Africa has committed to a process of deinstitutionalisation, its government has not adequately built up a system of reintegration into communities and there is often simply nowhere for people with psychosocial and intellectual disabilities to go, meaning that they are warehoused in hospitals, sometimes for decades. The lion’s share of community-based care is provided by non-governmental organisations (NGOs), but they are in most cases not adequately capacitated not adequately subsidised by the state. This was one of the factors leading to the disastrous violation of human rights in the Life Esidimeni Tragedy, in which 144 mental health care users lost their lives while residing at NGOs.

Our campaign is entitled “Community Based Care: The Imperatives” and will serve to raise awareness of the following issues:

  • South Africa’s commitment to deinstitutionalisation and the need for community-based care to be suitable, appropriate and to provide an environment conducive to continued recovery of mental health care users
  • The continued lack of accountability from government, specifically the continued state protection of former MEC Quedani Mhlangu, and how failure to implement law and policy contributes to the plight of mental health care users, as was seen during the Life Esidimeni tragedy
  • The need for SASSA to allow people with psychosocial and intellectual disabilities to successfully apply for grants so that these individuals can live in their communities
  • The need to prioritise community-based care
  • Community-based care as a component of the recovery model
  • The need to apportion adequate resources to community-based care
  • Challenges surrounding licensing of NGO’s at community-based level
  • Obligations of government in ensuring community-based care is properly provided, specifically:
    • That a consultative process needs to be undertaken to develop mental health services and resources at community level
    • That the shortfalls in resources needed to adequately facilitate deinstitutionalisation policy requirements must be addressed
    • That NGO’s need to become more widely recognised as key partners in the delivery of mental health services and to be respected and treated as such
    • That government needs to recognise that without the upscaling of and provision of community-based services, South Africa’s commitment towards deinstitutionalisation will never be realised
    • That South Africa requires more consistent and more comprehensive subsidisation of community-based services, with adequate increases and timely payment of subsidies to ensure continuity in community-based mental health service delivery.

The campaign will be constituted of several activities. These include press releases, opinion pieces, a policy brief on community-based care, an open letter to the President on failings surrounding community-based care, a submission to the President on the impact failure to implement the White Paper on the Rights of Persons with Disabilities has on people with psychosocial disabilities and intellectual disabilities and activities on social media. It is our intention to paint a comprehensive picture of the situation in which people with psychosocial and intellectual disabilities find themselves and also to propose solutions for duty-bearers to consider in their work around such individuals. The goal is to inspire a call to action and to catalyse positive change in the lives of people living with these conditions.

It is our hope that our campaign will adequately serve what we view as an extremely important purpose. People with psychosocial disabilities and intellectual disabilities are among South Africa’s most vulnerable and it is integral that their rights are protected. The community-based care imperative is one of the most vital components of recovery and a determinant of quality of life. There is no reason that people in this position should be denied the right to live in their communities and to become accepted and productive members of society. Steps must be taken to facilitate this forthwith and we urge government to take the necessary steps to do so.

 

Contact details:

Nicole Breen

Project Leader: Awareness and Information

South African Federation for Mental Health

This email address is being protected from spambots. You need JavaScript enabled to view it.

011 781 1852

072 2577 938

The South African Federation for Mental Health has published a study on "Young People and Mental health in a Changing World: Snapshots and Solutions." The theme of the study was so-chosen as it is the theme selected by the World Federation for Mental Health for World Mental Health Day. The study discusses a total of 14 themes, each dealing with an issue faced by young people and affecting their mental and then proposes policy interventions whereby protective shields can be built around young people in respect of these issues. Read it here.

Mental Health Awareness Month is celebrated each October with World Mental Health Day on the 10th of October. These are two of the most important commemorative occasions for people with mental illness, psychosocial disability and intellectual disability as they serve to draw attention to the challenges faced by individuals so-situated and to highlight what needs to be done to give them a better future. This is a time of opportunities for human rights advocates- a time to strive for the realisation of the rights of these individuals and to hold duty-bearers accountable for issues that prevent them from accessing that to which they are entitled. To this effect, SAFMH has drafted a press release on the topic. It appears below:

October is annually celebrated as Mental Health Awareness Month, with the 10th of October being World Mental Health Day. These are two of the most important commemorative occasions for people with mental illnesses and mental disabilities and those advocating for their rights as they represent an opportunity to interrogate how such individuals are situated and to make some suggestions as to how their circumstances could be bettered.

Each year, the South African Federation for Mental Health (SAFMH) elects to support and focus on the theme chosen by the World Federation for Mental Health (WFMH). This year, the theme is “Young People and Mental Health in a Changing World.” With a clear multitude of dimensions, this subject creates space for a great deal of analysis and awareness-raising, and SAFMH has undertaken to conduct an array of activities in this regard.

In its lead-up to World Mental health Day, the World Federation for Mental Health has articulated the following:

Imagine growing up in our world today. Constantly battling the effects of human rights violations, wars and violence in the home, schools and businesses. Young people are spending most of their day on the internet – experiencing cyber crimes, cyber bullying, and playing violent video games. Suicide and substance abuse numbers have been steadily rising and LGBTQ youth are feeling alone and persecuted for being true to themselves. Young adults are at the age when serious mental illnesses can occur and yet they are taught little to nothing about mental health.

According to the World Health Organisation (WHO) 10%-20% of all children and adolescents have some type of mental illness, with 50% of these disorders occurring by the age of 14 years and 75% by the age of 20. The WHO further cites neuropsychiatric conditions as the worldwide leading cause of disability in young persons, and highlights that young people so-situated face challenges with both access to rudimentary basic services such as to education and health care as well as social challenges in terms of discrimination, isolation and stigma.

The internationally and constitutionally recognised right of access to information, combined with innovation and the mushrooming World Wide Web, means that there is an immense wealth of information available to young people that was never there before. With the world quite literally at their fingertips, young people can locate just about anything that is of interest to them. This has the ability to both help and hurt: young people with mental illnesses and mental disabilities or those with friends or family members so-situated can find out how to cope with these issues, stigma on their part can be dispelled through acquisition of knowledge and they can gain the ability to self-advocate or to advocate on behalf of others. The benefits are thus undeniable. The negative flipside, however, is that for all the valuable resources out there, there is also a great deal of false information on the internet, which can lead to poor decision-making on the part of the young person, confusion, despair and can perpetuate stigma on the part of the young person. It is unfortunate that such a font of information has to contain such harmful things, but due to virtually anyone being able to propagate a stance on the internet it is unavoidable.

Another positive surrounding present times is that there are a variety of networks of support available to young people online. With the ability to reach out and to communicate the difficulties one may be experiencing, it is possible to be provided with direct positive support from friends, family, professionals as well as lay strangers who have knowledge on such matters. This can be of immense help to young people affected by mental illnesses or mental disability, who often feel isolated and alone. This too, however, has a negative converse. In as much as there may be helping hands available online, there are also those who wilfully commit harm such as in instances of cyberbullying. According to a global online study conducted by YouGov (2015), it was found that over 60% of teens found cyberbullying worse than face to face bullying and that one fifth of teens involved in the survey had been cyberbullied at some stage. A broad spectrum of sources link cyberbullying to depression, self-harm and suicide among young people.

The internet and its associated attributes and risks is by far not the only change the landscape for young people has undergone. Phenomena such as HIV and AIDS, high rates of orphaning, modern-day political instability and current economic recession all affect such individuals. Conventions and constitutions may exist for their protection, but poor implementation and troubled circumstances render the living situations of young people untenable and this is difficult to cope with. While social issues such as these maybe much talked about, it does not appear that government is taking particular steps to address these social issues in the context of mental health specifically. This is extremely problematic because without proper psychosocial support traumatic lived experience can be transformed into something annihilating.

SAFMH is a non-governmental organisation (NGO) serving to uphold and protect the rights of people with mental illnesses, psychosocial disability and intellectual disability. Our activities for the month of October include the publication of a study on the topic at hand, a policy dialogue on the subject, the filming and publication of lived experiences among young service users, a social media campaign and the publication of press releases and opinion pieces on various aspects of the topic. It is our hope that our endeavours to raise awareness on these matters will serve as a call to action on the part of duty-bearers, parents, friends and young people themselves to embrace the positive aspects of modern technology while disregarding and obviating the negatives. It is a call to protect the mental health of young people and ensure that the negative ramifications of the harmful aspects of modern times are ameliorated. We ask that government embark on awareness campaigns to highlight the importance of young people’s mental health considering the changes to our society and for other roleplayers, including young people themselves, to become educated in internet safety, the need to ensure that their activity on the internet is not harmful to young people and to become sensitised to social issues and how they affect the mental health of young people.

For more information and enquiries contact:

 

Nicole Breen

Project Leader: Information and Awareness

South African Federation for Mental Health

011 781 1852

072 2577 938

 

The use of Marijuana has been a hotly contested topic for decades. Users of the substance have wanted the autonomy to take it on the basis of their right to privacy. On the 18th of September 2018, the Constitutional Court ruled on the matter, indicating that the use of Marijuana is legal within the home in South Africa and ordered that the law be amended to give effect to this ruling. While supportive of the realisation of the right to privacy, SAFMH wishes to issue a warning to users of the substance on the basis of the fact that research suggests it can have a negative effect on the mental health of a person. As such, we have released a press release on this subject. It appears below.

 

PRESS RELEASE: The need to ensure responsible marijuana use in view of its legalisation

SEPTEMBER 2018

On the 18th of September 2018, The Constitutional Court of the Republic of South Africa gave judgment legalising the private use of marijuana. The Court has given Parliament 24 months to correct what they deem to be defective legislation, specifically certain provisions of the Drugs and Drug Trafficking Act 140 of 1992 and the Medicines and Related Substances Control Act 101 of 1965. People ascribing to a specific religion, those in physical pain, as well as those who use the substance recreationally, will undoubtedly welcome the judgement. The South African Federation for Mental Health (SAFMH), however, wishes to issue a warning to those making use of the substance as it could induce symptoms of mental illness and indeed mental illness itself.

We wish to firmly indicate that no matter your standpoint on the issue of marijuana usage, the risks associated with the use of a mood and mind-altering substance cannot be discounted. If you are a person with a mental illness, are genetically predisposed to mental illness or have experienced paranoia, delusions, hallucinations, depression or other recognisable symptoms of mood beyond the normal range, it is essential that you contact a doctor to discuss the use of this product before simply using it. While SAFMH would never discount the value of an item that can ease pain or the practice of which constitutes a religious rite, the dangers associated with the use of marijuana simply cannot be ignored. SAFMH therefore feels that it is extremely important that current and potential users take note of the risks associated with marijuana usage.

The body of knowledge surrounding this subject is considerable. The Royal College of Psychiatrists (2017), for instance, describes how the use of marijuana can lead to the aforesaid symptoms, rendering a user twice as likely to develop a psychotic disorder such as Schizophrenia or Bipolar Disorder. They discuss the onset of both short and long-term psychosis as a consequence of marijuana use. They illustrate that just as people can feel positive effects such as relaxation, there are also glaring negatives which can be extremely dangerous for a person both physically and mentally. The College also highlights that, should a person make use of marijuana in their younger years, there is a growing risk of developing mental illnesses later on in life.

Fichter and Moss - writing for the Psychiatric Times (2017) - noted that the use of marijuana is common among mental health care users, who have claimed that it assists them in managing their symptoms. These authors discuss how mental health care users frequently use marijuana for illnesses such as Post-Traumatic Stress Disorder, anxiety disorders, insomnia and schizophrenia. While this may be the case, we reiterate that given no absolute clarity, a person with the propensity for mental illness should not make the attempt to self-medicate.

The South African Federation for Mental Health is a non-governmental organisation serving to protect and uphold the rights of people with mental illness, psychosocial disability and intellectual disability. We are bound to note with concern the fact that evidence suggests a nexus between marijuana use and mental illness. Even in the face of the opinion of some that its use may be safe and may actually improve symptoms of mental illness, we cannot escape the idea of the chance that it may have adverse effects. As an advocacy body (not a medical organisation), we cannot pronounce on the biological effects of the substance. We would however not wish for any mental health care user to leave to chance the possibility that they may make themselves unwell. We would therefore strongly advise that mental health care users, those with a genetic predisposition for mental illness and those who have experienced adverse effects of the substance to consult a doctor before commencing with or continuing with its use.

The Government of the Republic of South Africa is enjoined to protect those within its borders. While there can be no legal injunction precluding those who may be vulnerable to potential negative effects of marijuana, there ought to be research undertaken as to its effects on people so-situated and education provided to all relevant parties. One vulnerable life tarnished or lost is too many. We do not want to extinguish some rights in the name of others. We simply cannot afford to take the chance.

Enquiries:

Nicole Breen

Project Leader: Information and Awareness

South African Federation for Mental Health

This email address is being protected from spambots. You need JavaScript enabled to view it.

011 781 1852

072 2577 938

 

The 10th of September is World Suicide Prevention Day. This represents an important opportunity to reflect on past interventions surrounding this cause, to examine present ones and to look towards what we want to see in the future. Prolifically an area both neglected and stigmatised in our country- with no real state-implemented initiatives to curb this phenomenon- suicide needs to be taken seriously because of the damage it does- both to the person tragically committing suicide and the people left behind. While globally there has been a move to prioritise suicide, at home this is not the case. SAFMH has published a press release on the topic which appears below:

 

Statistics on suicide provide that:

 

  • Some 800 000 people, according to the World Health Organisation (WHO) die on account of suicide on an annual basis. This amounts to one individual every 40 seconds.
  • Accounting for 1.4% of all deaths across the world, indicates the WHO, suicide is ranked the 18th leading cause of death.
  • Among young people, however, is the 2nd leading cause of death according to the WHO- a real cause for concern and a great pity.
  • In its analysis, the WHO also discusses the prevalence of suicide at global level and highlights that 79% of suicides took place in low and middle income countries in 2016- a fact that should be of great concern in South Africa as it falls into the latter of the two categories.
  • It highlights that for every completed suicide, there may be over 20 attempted suicides.
  • Groups particularly at risk were identified in the Mental Health Action Plan 2013-2020 (MHAP) and included “lesbian, gay, bisexual and transgender persons, youth as well as other vulnerable groups of all ages based on context.”
  • The MHAP further highlights that in terms of suicidal ideation and self-harm that the young and the elderly are particularly at risk.
  • It discusses how “suicide rates tend to be underreported owing to weak surveillance systems, a misattribution of suicide to accidental deaths, as well as its criminalization in some countries.”
  • The New York Times (2013) reported fairly extensively on the rising suicide rates in older persons.
  • Interestingly, according to a WHO publication titled “Preventing Suicide a Global Imperative” (2014), in higher income countries 3 times the amount of men die by suicide than women but in lower and middle income countries, the ratio is 1.5:1.
  • The reason for men having a higher completion rate than women, several authors surmise, is that men utilise more lethal means than their counterparts.

 

The MHAP is a roadmap towards the rights of mental health care users. The plan prioritises suicide prevention and urges states to make concerted efforts to decrease its prevalence. It illustrates that there is a need for multi-sectoral collaboration to ameliorate the plight of the suicidal people and discusses reducing access to means of self-harm (for instance firearms and toxic medicines), ensuring that the media reports responsibly on issues (i.e. that suicide is not sensationalised), that concrete steps are taken to protect people at high risk of suicide (the categories identified above) as well as that mental disorders are identified early and properly managed. The MHAP sets numerous global targets in this regard, that is:

 

  • “80% of countries will have at least 2 functioning national, multisectoral promotion and prevention programmes in mental health (by the year 2020)”
  • “The rate of suicide in countries will be reduced by 10% (by the year 2020)”
  • “Develop and implement comprehensive national strategies for the prevention of suicide, with special attention to groups identified as at increased risk of suicide…”

 

“Preventing Suicide a Global Imperative” extrapolates on how to develop a national response to suicide (ie: a prevention strategy). It makes the suggestions of use of “surveillance, means restriction, media guidelines, stigma reduction and raising of public awareness as well as training for health workers, educators, police and other gatekeepers.”

 

In many instances, when a person is feeling suicidal, they feel isolated and as though they cannot seek help. This may be- as is all too often the case- that adequate help is not available. It may also, however, be as a result of actual or perceived stigma. Suicide is a taboo in many societies and people may be concerned that feeling suicidal is a display of weakness. In a move to implement prevention strategies there should thus also be a means through which stigma can be dispelled.

 

If the MHAP is anything to go by, South Africa is far, far behind in the interventions it should have implemented by this time- to the gross detriment of those who are suicidal. This represents a failure on the part of the state to take positive steps towards preventing suicide. On this basis, the South African Federation for Mental Health calls upon government to put measures in place to prevent and reduce suicide in terms of how it is guided by international obligations. This is one social ill we cannot allow to slip through our fingers. We also call on upon loved ones of those who are suicidal or have completed suicide to educate themselves about the phenomenon and to try and approach it with kindness and empathy instead of judgment. While one day of the year is not sufficient to fully explore the issues or to alter fixed mind-sets within society, it is a start. Let us all work together to prevent suicides throughout the Republic.

 

The South African Federation for Mental Health is a non-governmental organisation seeking to uphold and protect the rights of people with mental illness, intellectual disability and psychosocial disability. For more information and enquiries contact:

 

Nicole Breen

Project Leader: Information and Awareness

This email address is being protected from spambots. You need JavaScript enabled to view it.

011 781 1852

072 2577 938

 

 

Life Esidimeni shone a spotlight on the mental healthcare system in South Africa, but what is the way forward?

What is set to change? How will this change be brought about?

All of these questions give rise to a need to explore the system as it currently stands and to question not only the circumstances surrounding Life Esidimeni, but also other areas of the system that appear to be crumbling.

The following will serve to illustrate some of the blockages with which mental healthcare users are faced.

 On March 19 2018, the families of the victims of the Life Esidimeni tragedy each accepted an amount of R1.2 million compensation from the state.

This was hailed as a watershed moment and the arbitration leading up to this point was deemed a success.

While officials involved in the series of tragic events were questioned and asked for explanations, to this day it remains to be seen who will truly be held accountable and how this will come about.

It is also still unclear what exactly the reasons behind the termination of the Life Esidimeni contract were, as evidence given during the arbitration hearings indicated that cost cutting and savings had possibly not been the main drivers behind the process after all.

Subsequent to this, the government published policy guidelines for the licensing of residential and/or daycare facilities for persons with mental illness and/or severe or profound intellectual disabilities.

These guidelines set out requirements for an non-governmental organisation to obtain a licence to operate a facility caring for people with psychosocial disabilities and people with severe or profound intellectual disabilities.

Stringent in nature, they seek to ensure that all facilities are licensed according to a set of strict criteria.

The difficulty with these guidelines is that they are so stringent that virtually no community-based organisation will ever be able to comply with them.

The guidelines are thus another bottleneck, in and of themselves, containing no capacitation plan and no accompanying document setting out how they are going to be implemented.

A further difficulty that has arisen from the Life Esidimeni tragedy is that there has been a loss of trust in non-governmental organisations on the part of both the government as well as the general public.

Non-governmental organisations as a whole are painted with the same brush as those organisations at which the Life Esidimeni victims died, and this is having the effect that they are struggling to obtain subsidies and funding.

This poses an immense challenge because, at present, non-governmental organisations are the only option for community-based care and community-based care is the only answer to propositions of deinstitutionalisation, as outlined in the South African Mental Health Policy Framework and Strategic Action Plan 2013-2020.

While the community-based model is sound and steeped in evidence-based research, poor understanding has led to ultimately catastrophic outcomes.

This has the effect that people believe the system cannot work.

A likely effect of this is that, once again, those with, inter alia, psychosocial disabilities will go back to being warehoused in hospitals that are either state hospitals or private hospitals the state contracts to care for patients, when these people could, given the availability of the necessary community-based resources, function well outside of them and have the opportunity to be integrated into and live as part of the community.

There is thus the concern that a state-heavy model of rehabilitation could bring about certain challenges such as the provision of treatment inappropriate to the needs of mental healthcare users, needless expenditure of resources and restrictions imposed upon them that violate their fundamental rights.

The Life Esidimeni Tragedy came across to many as a revelation – never before had the mental healthcare system been under so much scrutiny.

It seemed that before the tragedy, nobody had ever thought about the lot of persons with mental illness. Since Life Esidimeni, other areas of the system have also come under analysis.

Of late, it has been revealed that, in fact, the problem lies not only in “deinstitutionalisation gone wrong” but in the heart of the institutions themselves.

Shocking details have come to light, for instance, in the Eastern Cape, wherein atrocities in several hospitals have reportedly been found to have taken place.

With a damning report from the South African Society of Psychiatrists surrounding poor hospital records having been kept, deaths not having been properly reported, inappropriate use of below-par seclusion rooms and general poor standard of patient care, Tower Hospital has been identified as a facility in crisis.

In the psychiatric unit at Cecilia Makiwane Hospital, staff and patients are reportedly put at risk every day due to staff shortages.

A former mental healthcare user is reportedly seeking compensation from the hospital in the courts after having been assaulted by a patient at the facility.

An assault charge has also been in the news for having been brought against Fort England Hospital itself, as a response to abuses by nursing and security staff.

Deteriorating conditions and faltering management make it likely that this practice will continue if not increase in prevalence.

In Gauteng, there have been a spate of reported deaths among mental healthcare users in hospitals, the most recent of these having taken place at Thelle Mogoerane Hospital in Vosloorus where a patient fell to his death after breaking through burglar bars.

In brief, the situation has not changed, the treatment of people with psychosocial disabilities continues to have deleterious effects on their well-being and very little is being done to ensure they are adequately cared for.

Mental healthcare users so-situated continue to suffer with no tangible solution in sight.

The government’s attempts to regulate residential care and daycare facilities represent a concerning level of ignorance as to what will benefit mental disabilities and with psychosocial disabilities, and the emergence of other horrifying acts against these individuals in other parts of the country give credence to the notion that it is not only the mental healthcare users in Gauteng that were, and are, being failed on all fronts by duty bearers.

Much must be done – and fast – to save lives.

The month of July is Psychosocial Disability Awareness Month. A psychosocial disability is when a mental illness becomes pervasive and interferes in a person's functioning, thus preventing them from being able to claim their rights or to participate in society. People with psychosocial disabilities face a number of challenges including poor access to basic services and exclusion. For the awareness month, SAFMH has elected to launch a campaign called "Blockades in an Era of Continuum." We are doing so because although the legal and policy framework exists to provide a cohesive basket of services to people so-situated, this is not reflective of reality. To this effect, we have compiled a press release. Read it here:

 

PRESS RELEASE: PSYCHOSOCIAL DISABILITY AWARENESS MONTH

 

The month of July is annually celebrated as Psychosocial Disability Awareness Month. This month, as with any commemorative occasion, is an opportunity to reflect on the past, examine the present and look forward, deciding what we want to see for the people concerned.

 

According to a report of the United Nations High Commissioner for Human Rights, an individual with a psychosocial disability is described as “a person…who, regardless of self-identification of diagnosis of a mental health condition, face[s] restrictions in the exercise of their rights and barriers to participation on the basis of an actual or perceived impairment.” This description discusses pervasiveness and poor access to the services to which those affected are entitled. It explicitly states that such individuals lack agency within society and that they are rendered voiceless- forced to accept the treatment meted out to them. It includes “perceived impairment”, which refers to disenfranchisement due to stigma and oppression, regardless of the capacities of the person. This should not be the reality of people so-situated- in fact, South Africa has a comprehensive legal framework set up to preclude such exclusion and entrapment. The reality, however, is starkly different, with law and policy seemingly viewed as an ideal as opposed to an imperative. This has the effect that people with psychosocial disabilities continue to languish, left in peril.

 

People with psychosocial disabilities- whether in hospitals, community-based settings or with their families- require a certain standard of care and a basket of services available to them. What they require in order to recover must necessarily be provided to them in accordance with the prescripts of the Constitution. Despite this imperative, lack of prioritisation means that no heed is paid to the fact that the system needs to flow smoothly, allowing the mental health care user to move from one part of it to another. There is no consistency in terms of that which is provided and no semblance of utilisation of a model designed to facilitate recovery.

 

The theme the South African Federation for Mental Health has elected to pursue for our 2018 Psychosocial Disability Awareness Month Campaign is “Blockades in an Era of Continuum”- this theme was selected because of the bottlenecks faced by people with psychosocial disabilities in accessing that which government is enjoined to provide. The campaign will aim to start the conversation around the extant challenges in South Africa today, contrasted with how law and policy ought to be implemented. It will have a focus on the challenges in the full complement of services- from hospital care, to community-based care, to family care. It will deal with the construct of stigma within the community as well as among duty-bearers, the lack of clarity surrounding the roles of those responsible for caring for people with psychosocial disabilities, and the challenges in integrating people with psychosocial disabilities into the community. Finally, it will discuss what the expectations of an ideal mental healthcare system are.

 

SAFMH is a non-governmental organisation (NGO) which advocates for and raises awareness about the rights of mental healthcare users. We are constituted by 17 mental health societies which provide direct services to persons including those with psychosocial disabilities. We call upon the state to prioritise matters concerning mental health and to ensure that the system can work on a continuum such that patients can remain stable and recover. We urge the state to embark on a proper and considered process of deinstitutionalisation absent of irregularities and to adopt the recovery model for people with psychosocial disabilities and other mental health concerns. In addition, we urge the state to provide education and training to people with psychosocial disabilities and the general public so that they will understand the rights to dignity, equality, freedom and security of the person, access to healthcare, access to food and water and other associated rights as they relate to people so-situated.

 

People with psychosocial disabilities are prolifically vulnerable and near-universally neglected. The need to remove these blockades is desperately urgent. Psychosocial Disability Month may not be a panacea for this social ill, but it is an opportunity to raise awareness about these issues. It is time for the system to #takeitsplace and provide adequately for people with these illnesses.

 

Enquiries:

 

Nicole Breen

Project Leader: Information and Awareness

South African Federation for Mental Health

011 781 1852

072 2577 938