Young people set to transform global mental health: action needed for young people

Youth Leaders for the Lancet Commission on Global Mental Health will present key mental health recommendations for young people this week at the World Health Assembly.  The young people initiated and developed the policy brief to global policymakers. 

Chantelle Booysen

I am excited to use this platform as part of the #mymindourhumanity campaign which promotes global mental health for young people. We want to by:

  1. Elevate the voices of youth in health in particular mental health;
  2. Address a high-level plenary that includes policymakers and public officials to get a response to the policy brief;
  3. Collaborate with NCD Child and NCD Alliance so that mental health continues as an active priority.

We call on global mental health advocates to amplify young voices so that we reach the heads of state.
The policy brief is to be launched at the  NCD Child and NCD Alliance side event at the WHA72 on 23 May 2019.

If you are attending the WHA72 in Geneva and are interested in attending contact [email protected]

To get more information on the work of the young leaders click here .

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In six weeks we’ll know if Qedani Mahlangu will be prosecuted

Content is originally written forBhekisisa
After being awarded damages, distraught families want more: the former Gauteng Health MEC must face criminal charges.

The R135‑million in constitutional damages awarded to claimants in the Life Esidimeni tragedy this week — the largest award of its kind in South Africa’s history — could increase to 10 times that amount.

Former deputy chief justice Dikgang Moseneke’s arbitration ruling is also likely to influence future rulings of this kind.

Constitutional damages of R1-million each were awarded to 135 claimants, in addition to funeral-related expenses and R180 000 for shock and psychological trauma.

Moseneke ruled that it was “appropriate relief and compensation for the government’s unjustifiable and reckless breaches” of at least six sections of the Constitution and “multiple contraventions” of the National Health Act and the Mental Health Care Act.

Between October 2015 and June 2016, 1 711 psychiatric patients in Gauteng were transferred from private Life Esidimeni health facilities, for which the state had paid, to largely ill-equipped community organisations with little to no experience in caring for mental health patients.

The move came after the provincial health department ended a 30-year contract with the Life Healthcare private hospital group.

A father speaks out about the terrible conditions his son died in after being removed from state-funded hospital care at Life Esidimeni.

The department ignored repeated warnings from families and civil society organisations that transferring patients to unqualified organisations, which Moseneke referred to as “death and torture traps” in his arbitration ruling, could lead to the death of psychiatric patients.

As a result, 144 patients died, and 1 418 were exposed to “trauma and morbidity” but survived, according to the arbitrator’s report.

Moseneke ruled the sites were “hand-picked” by senior Gauteng health department officials, such as then health MEC Qedani Mahlangu and her head of department, Dr Tiego “Barney” Selebano, with an “irrational and arrogant use of public power”.

All claimants received the same award, regardless of whether their loved ones died or survived.

But the number of claimants is now likely to increase from the original 135, after Moseneke invited those who hadn’t been part of the arbitration — at least 1 350 of those who survived didn’t join — to come forward.

“Not all have joined the process. When they find their voice or way, I trust that the government would choose to meet their claim in terms identical to the award than to set up new litigation of another arbitration process,” Moseneke said in his arbitration award.

Within a day after the ruling, 10 more families and patients had already contacted the arbitrator’s office. “I’ve taken down their details, and sent it through to the mental health director in the Gauteng health department to determine if they qualify for the award,” spokesperson Obakeng van Dyk said.


Historic ruling: Retired judge Dikgang Moseneke said that he hoped the families of affected mental health users, who were not part of the Life Esidimeni arbitration, would come forward and claim the compensation they were due. (Delwyn Verasamy)

In order to qualify, patients should have suffered trauma directly as a result of the transfers and should be able to prove that they or their loved ones were transferred between October 2015 and June 2016.

There have been two major constitutional damages awards in the past, but these were significantly smaller than the Life Esidimeni award and were made in court cases and not by arbitration agreement.

In 2006, the Eastern Cape high court ordered the welfare MEC in the province to pay “Mrs Kate” damages for failing to process and pay her disability grant within a reasonable period”, after the state had taken 40 months to do so.

And in 2005, the department of agriculture and land affairs had to pay constitutional damages to a private company in Benoni, Modderklip Boerdery, after the Constitutional Court ruled that the state had failed to protect Modderklip against the unlawful occupation of its property.

Although the size of the award wasn’t specified, the ruling stipulated that it could not exceed the property’s value, which was less than R1.8‑million.

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A father speaks out about the terrible conditions his son died in after being removed from state-funded hospital care at Life Esidimeni.

Because the Life Esidimeni award is an arbitration award, which is a private agreement between two parties, it can’t set a legal precedent for courts.

But, it will undoubtedly “set a standard”, says advocate Adila Hassim, “because constitutional damages this high have never been awarded before”. Hassim was part of social justice organisation Section27’s legal team that represented 63 of the Life Esidimeni claimants.

Sasha Stevenson, who was also part of the team, agrees: “Because this is such an important and public matter that was decided by the former deputy chief justice, it will have persuasive value to those who are deciding other cases.”

The Life Esidimeni tragedy is also likely to end up in the criminal court. Two parallel criminal investigations — one by the South African Police Service and another by the Special Investigating Unit — have been opened.

Pindi Louw from the National Prosecuting Authority’s Gauteng office confirmed that the office had received 140 inquest dockets from the police for a decision on whether to prosecute.

Mahlangu, Selebano and the director of mental health services at the time of the Life Esidimeni patient transfers, Makgoba Manamela, could all potentially be implicated in charges including murder, attempted murder, culpable homicide, perjury and corruption.

“Deputy director of public prosecutions George Baloyi has assigned a team of prosecutors to work on those documents. They will take between four to six weeks … and will then announce their decision,” Louw said.

The families of Life Esidimeni patients walked out en masse after the testimony of former Qedani Mahlangu at the arbitration.

Moseneke labelled Mahlangu’s and Selebano’s testimonies during the arbitration hearings as “fabricated and patently false”. “All we can hope for is that, one day, the true reason for the conception and implementation of the Marathon Mental Health Project [of which the Life Esidimeni patient transfers formed part] will see the light of day,” he said.

The spokesperson for the Life Esidimeni families, Christine Nxumalo, said, although they accepted the compensation, they still wanted the department to be held accountable. “We see Qedani Mahlangu and her officials as proper traitors, because they didn’t provide us with the answers we asked for in the hearings,” she said.

“You don’t just forgive a traitor. We want to see that justice is done.”

Mahlangu Told Makhura About The Deadly NGOs, Records Show – Bhekisisa

Written for

The tragedy has revealed the Gauteng government’s inner workers, leading one doctor to say, 
‘If this is how things are 
run … God help us all’

It has been called a tragedy. A calamity. A scandal. But this was no accident, no rash decision made under pressure, no force of nature.

It was sheer arrogance, political manoeuvring, incompetence, indifference and possibly greed and corruption that sent nearly 150 of the most vulnerable patients to their deaths.

Some analysts have branded the 
#Life Esidimeni tragedy mass murder.

The department was repeatedly warned against doing so by professionals and organisations with on-the-ground experience. But they were brushed aside.

Civil society and health organisations who spoke out were treated as the enemy.

Opposition politicians were vilified for doing their job. The Democratic Alliance’s Jack Bloom, a long-standing thorn in the side of the ANC in Gauteng, was called a racist and chauvinist when he repeatedly raised questions about the project in the legislature.

“Now we are told nobody — not the MEC, not the officials, not the premier — knew anything about it,” says Mzukisi Grootboom, chairperson of the South African Medical Association (Sama). “For goodness sake, if that is how things are run … God help us all.”

At least one woman was allegedly raped.

And some — between 45 and 62, depending on whose list you check — simply went missing. No one knows whether they’re dead or alive.

Finally, there are people like Guy Daniel Kanza. His family has been searching for him since he was removed from a Life Esidimeni facility in Waverley in northern Johannesburg in 2016.

His name appears on no Gauteng health department list. He is just gone.

A father speaks out about the terrible conditions his son died in after being removed from state-funded hospital care at Life Esidimeni.

 

Sama, a fierce critic of the department of health and often the politicians in charge, has long warned that there are problems across the public health system.

“When we raise concerns, it is not because there is a political decision to question government,” Grootboom says. “It’s is because we are dealing with patients and have an obligation to represent them. We work in the poor communities.”

However, Sama’s remarks are rarely embraced by the government. “We should be treated as allies, as government’s eyes and ears on the ground. Yet, we’re treated as troublemakers,” Grootboom argues.

Had it not been for the work of civil rights groups like Section27 and professional bodies like the South African Depression and Anxiety Group (Sadag), more lives would undoubtedly have been lost. It could have taken years for the disaster to come to light.

“The failures were quite simply due to government’s persistent failure to heed the advice of experts, families and everyone else who could see that this was going to end in disaster,” Charlene Sunkel, who represents both the South African Federation for Mental Health and South African Mental Health Advocacy Movement, told Bhekisisa.

“Civil society often has the experience and knowledge that government officials lack and the government would do well to pay more attention to how this expertise could positively influence and inform their processes.”

Grootboom says the disastrous failures that led to patient deaths are the culmination not only of failing health systems but because there is also no way to address problems once they are raised. “We often see that politicians announce there will be an intervention. Then it is as if the job is done.”

The families of Life Esidimeni patients walked out en masse after the testimony of former Qedani Mahlangu at the arbitration.

The question left unanswered during the past two months’ arbitration hearings in Johannesburg is why the terrible trio of Qedani Mahlangu, the MEC in charge during the Life Esidimeni project, the head of her department, Barney Selebano, and the director of mental health, Makgoba Manamela, were so adamant to push through the transferrals of patients. Was blind resistance to their critics’ advice the only factor, or was there corruption, greed and political gain involved?

Gauteng Premier David Makhura connected financial irregularities to the payment of NGOs and vowed that the government would continue to investigate the reasons for Mahlangu’s decision. The Special Investigating Unit is investigating possible corruption related to project, he said.

But did Makhura know the details of Mahlangu’s plan and, if so, why did he not prevent the tragedy from happening?

Not one of the health department’s senior leaders took personal responsibility and instead claimed that no one in government works in a silo, and the department, therefore, needs to take collective responsibility. Mahlangu alleged her senior staff never informed her of the details of the project, while Selebano and Manamela claimed the exact opposite — that their boss bullied them into it.

“At the start of the arbitration hearings, we had very high expectations to help us answer our questions of why, why why,” says Sadag’s Cassey Chambers. “But we were very disappointed and frustrated by Manamela, Selebano and Qedani’s testimonies. Both at their stall tactics, blaming everyone else — even NGOs like us who were trying to help and doing the work that they should have been doing.”

A teary and clearly frustrated Health Minister Aaron Motsoaledi, who referred to Mahlangu’s behaviour as “criminal conduct”, took the stand on Wednesday. “I have been asked why I don’t fire MECs,” he said. “But I cannot do that. The premier hires and fires MECs.”

Mahlangu’s tone-deaf appearance at the hearings certainly made it easy to cast her as the pantomime villain. She has done nothing to endear herself to either the patients’ families or the public, who have taken to social media to vent their anger against the former MEC.

One by one, officials drove the nails into her political coffin and distanced themselves: from the expedient (officials in the department trying to shift the blame) to the factual (a credible Barbary Creecy dismantling Mahlangu’s defence as MEC for finance) and the political (Makhura and an emotional Motsoaledi).

“There was a clear intention that officials wanted to hide this from the minister and the premier. But for what reason?” Motsoaledi asked.

“When I read the ombudsman report about how people were bundled in vans and tied with sheets, and how they are chosen … like cattle at an auction…” Motsoaledi said, unable to finish his sentence.

“For human rights to be breached in such a manner that is reminiscent of our apartheid era in our democracy is very painful that’s why I feel personally betrayed.”

Watch: Motsoaledi breaks down on the stand

For now, Mahlangu’s political career is over — at least as far as public office is concerned. While South Africa has the dubious track record of rewarding scandal-ridden politicians, anger over her transcends the ANC factions, and she will have to take the fall for government’s worst human rights failure since the end of apartheid.

Makhura has probably done enough to survive the political fall-out. At the hearings, he was the opposite of Mahlangu — he accepted personal accountability and came across as humble and sincere. Crucially, the family members of patients warmed to him.

But the premier’s insistence that he was misled by his former MEC is disputed by Bloom. Makhura repeatedly testified that he did not know patients were being sent to NGOs. Bloom produced the Hansard record of the Gauteng legislature sitting on 15 March 2016, where the premier was greeted by the speaker and answered questions. Later in the same session, the written record reflects, Bloom raised specific concerns about the NGOs. “I speak to mental health NGOs, and they tell me that there are no the facilities [sic] that, it simply has not been done.”

Mahlangu explicitly mentioned NGOs several times in the sitting. “The NGOs have hired the staff,” she said, and then, astonishingly, admitted some had not been licensed. “They have also been given licences.”

What set these proceedings apart from many others into government failings is the warmth, compassion and incisiveness of retired chief justice Dikgang Moseneke, who presided over the hearings. “We finally felt like someone was listening to us. We need more people like the justice in our country’s leadership,” Chambers says.

The testimonies ended on Wednesday. The final legal arguments in the Life Esidimeni arbitration are expected to be delivered on February 8 and 9. An arbitrator will then announce a compensation package for the victims’ families. 

SAFMH Calls On Government To Show Commit To Mental Health Care

Every year the 3rd of December is commemorated as International Day of Persons with Disabilities (IDPD). As part of the Disability Month activities that have been taking place over the past few weeks, Government has been drawing attention to the fact that this year marks the 20th Anniversary of the Release of the White Paper on an Integrated National Disability Strategy and the 10th Anniversary of the Ratification of the UN Convention on the Rights of Persons with Disabilities. Although the fact that these policies have been part of the South African disability sector for many years now is indeed something to be celebrated, the SA Federation for Mental Health (SAFMH) feels it is important to acknowledge all the ways that these and other policies, like the Mental Health Policy Framework and Strategic Action Plan (MHPF), are not being implemented, and are currently failing persons with mental disabilities as a result.

On IDPD last year, which was declared a day of mourning for those who lost their lives as a result of the Life Esidimeni tragedy, SAFMH and the South African Mental Health Advocacy Movement (SAMHAM), delivered a report regarding the state of Mental Healthcare in Gauteng, specifically focusing on the issues that had unfolded with Life Esidimeni, to the Gauteng Department of Social Development. The aim of the report was to show how a better implementation of the MHPF was needed to improve the services and care offered to mental health care users. In the report, SAFMH made the some of the following recommendations:

  • Mental health services need to be prioritised and developed with an equal level of (high) importance across all provinces in SA, and across rural and urban areas
  • Services and resources at community level should be developed in consultation with mental health care users, their families, NGOs and other key partners to ensure that the development of such services are done in an informed and collaborative way
  • The prioritisation/resourcing/implementation/monitoring of the Mental Health Policy Framework and Strategic Action Plan at provincial level is essential, and provincial Departments of Health need to be held accountable for failure to do so
  • Savings generated through budget cuts in tertiary Psychiatric Care Facilities (such as what happened with the termination of the Life Esidimeni contract) need to be transferred to support community-based care
  • Government needs to address the widely pervasive shortfalls in resources needed to adequately facilitate deinstitutionalisation policy requirements
  • There is a need for NGOs to become more recognised as key partners in the delivery of mental health services and to be respected and treated as such. Government needs to recognise that without the upscaling of and provision of community-based services SA’s commitment towards deinstitutionalisation will never be realised
  • SA requires more consistent and more comprehensive subsidisation of community-based services, with adequate increases and timely payments of subsidies to ensure continuity in community-based mental health service delivery
  • There is a need for more family empowerment programmes to ensure that MHCUs who return to their homes are able to receive the support they require from their families and those family members are sufficiently equipped with the necessary skills to help them take care of mental health care users within their homes

Not only was there no response to the report or any of its findings or recommendations, but since then the scale of human rights abuses that mental health care users faced has was sadly highlighted in the Ombudsman’s report on Life Esidimeni, which was released two months after the SAFMH report.

Today the number of people known to have lost their lives as a result of the Life Esidimeni tragedy stands at 143, and with the arbitration hearings currently taking place, more disturbing details emerge on a daily basis of the gross neglect and abuse that the patients suffered at the hands of those who were responsible for their care. Despite the severity of these claims, those responsible for the project, such as former MEC Qedani Mahlangu, have been using every method to try an avoid testifying at the hearings.

Celebrating the existence of legislation and policies aimed at improving the lives of those living with mental and physical disabilities, while not prioritising the implementation of these legislations and policies, leads to a system that values the lives of persons with disabilities in word but not indeed.

Government has not been able to ensure that those responsible for the tragic and preventable deaths of Life Esidimeni patients face justice, nor has Government been able to ensure that the MHPF and other important legislation is implemented in a timeous and correct fashion. Until such important things start taking place, IDPD will remain a reminder of the horrific treatment and abuse that vulnerable persons with mental disabilities experienced because of Government’s lack of action.

SAFMH will continue to put pressure on provincial government departments to commit towards developing a plan to implement and monitor the allocation of resources for the successful implementation of the MHPF in all provinces. SAFMH will also be hosting the Movement for Global Mental Health Summit from 8-9 February 2018, which will provide mental health care users with the opportunity to share their experiences and lead the call for improved mental health care services in line with the Sustainable Development Goals.

SAFMH calls on Government to prioritise the implementation of legislation like the MHPF and the UNCRPD and to recommit to upholding the rights of persons with mental disabilities.

Statement from the South African Mental Health Advocacy Movement (SAMHAM) on IDPD–

We as mental health care users (MHCUs) have historically been living our lives in silence while decisions have been made about our lives without our participation. Our lives have value and our views and opinions matter, and we can help to create a society where people celebrate diversity. We want to see an end to the complete disregard for our fundamental human rights – when we speak, we demand to be listened to and when decisions are being made that affects us, we demand to be involved in making those decisions. Contrary to common beliefs, we as MHCUs can add value to society and we can achieve recovery to our full potential, provided our rights are respected and protected.

 

FOR ENQUIRIES INFORMATION PLEASE CONTACT:

Marthé Kotze – [email protected]

Programme Manager Information & Awareness

SA Federation for Mental Health

011 781 1852

Truth Over Justice – Life Esidimeni Arbitration

On Monday, October 23rd during the arbitration hearings in the tragedy at Life Esdimeni, a family member of one of the victims suggested that amnesty is given to the NGOs.

The Life Esidimeni tragedy claimed the lives of 141 patients from the facility. They were moved to NGOs who falsified documentation and left the patients in an appalling condition and left to die

This was suggested in the hopes of “getting answers” in the words of Christine Nxumalo, whose sister died at the notorious Precious Angels NGO facility. She further suggested that the officials not be held criminally liable for giving false testimony they made at the arbitration.
Further, she stated that everything that was said in the hearing by Precious Angels founder, Ethel Ncube Nxumalo “I can tell you that everything she said was a lie”

Christine’s sister was reported to have died on 17th of August 2016 while in a statement from the Founder of Precious Angels. This contradicts a paramedics report showing she actually passed away two days earlier on the 15th August.

While she critical of the department and their actions she wants answers and the truth rather than prosecution for the sake of the families. While she is still waiting on answers from the SAPS on an open case and autopsy report from them.
Going further Christine had said that on numerous occasions they had contacted the Health Department to warn them of the implications of ending their contract with Life Esidimeni. To which they received no response from the department.

This has raised the question over truth over Justice with the obvious moral complex involved. Yet, this would allow for all the answers to be given to the families and the full story finally told of what transpired over the months leading to the deaths of 141 mentally ill patients.

 

Timeline of events

Image Credits: www.ewn.com