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.



Marthé Kotze – [email protected]

Programme Manager Information & Awareness

SA Federation for Mental Health

011 781 1852

Mental Health – A Glaring Light on 36 Deaths in Gauteng- Comment

stx-depressionThe sad and disturbing deaths of 26 mental health patients during relocation to another facility.  Bringing the total of mentally disabled deaths in Gauteng to 36 over recent months.

The Department of Health has launched an investigation into the deaths stating that the cause and appropriate people responsible are to be held accountable for the tragedy of some of some of our societies most venerable people.

We want to know why the money was pulled and what the department and the province is going to do to take action against this deplorable state of mental health in Gauteng.


This article was originally published by Bhekisisa, the Mail & Guardian’s Centre for Health Journalism. To read more health stories from across Africa, go to

Life Esidimeni patient deaths are a wake up call that came too late

South Africa is reeling from the news that 36 mental healthcare patients have died since March after they were relocated from Life Healthcare’s Esidimeni facility to nongovernmental organisations in Gauteng.

The question many are asking is: “How could something like this happen?”

The question we should be asking is: “Why did it take 36 deaths before anyone reacted to this tragedy?”

In October last year, the South African Federation for Mental Health issued a statement expressing concerns about Gauteng health MEC Qedani Mahlangu’s  announcement that the provincial government would be terminating its contract with private hospital group Life Healthcare. As part of this, almost 2 000 patients at Life Esidimeni would be discharged or moved to various community-based NGOs. This would take place between October 2015 and March 2016. No prior preparation seemed to have taken place.

The reasons for our concern were simple: there were not enough community NGOs to absorb such a large number of patients. Mental health NGOs that did offer residential facilities were already full and their resources overstretched. Many of the residents of Life Esidimeni needed high-level, specialised care. Even if organisations did have beds available, the NGOs approached to take the patients in did not, in most instances, have the staff or resources to provide this.

The family members of the patients held a march to protest against the relocation. The federation, along with public interest law organisation Section27, the South African Depression and Anxiety Group and the South African Society of Psychiatrists, approached the Johannesburg high court for an interdict to stop the relocations until better provisions had been made.

This failed and the relocations continued.

Then family members began to say that they had not been told where patients had been moved to and that patients were dying after being moved out of the Life Esidimeni facilities.

And now we find ourselves here. It has taken the deaths of 36 vulnerable people for the government and society to wake up and realise that something is wrong with the way we treat mental healthcare users.

The deaths are a disgrace and raise questions about whether the value of human life is being placed at the centre of decisions about where to cut costs.

Mental health has not been a priority in the general health agenda or budgets. The 2015 Rural Mental Health Campaign report notes that there has never been any systematic tracking of mental health expenditure. Only three of the nine provinces were able to report mental health care budgeting in a 2007 World Health Organisation report, which may offer the most comprehensive data available. At the time, the Northern Cape, Mpumalanga and the North West spent an average of about 5% of health budgets on mental health care, largely on specialised psychiatric facilities.

It is not surprising that, when budgets need to be cut, mental health is often the first to be put on the chopping block, although we know that these service users are among the most vulnerable.

People living with psychosocial and intellectual disabilities are often marginalised because of the stigma and discrimination attached to these conditions. This stigma and discrimination frequently leads to human rights violations. In a 2013 federation surveyconducted among 140 mental health service users, 50% of those surveyed in Gauteng, KwaZulu-Natal and the Western Cape reported being emotionally, verbally or physically abused. A large number of those experiencing human rights violations don’t report it or don’t know how to. Others who do report abuses often find authorities unresponsive.

In response, the federation has implemented its Mental Health Watch reporting system, which allows people living with mental illness and their families to report abuses by SMS, WhatsApp, email and post.

The South African Human Rights Commission had been made aware of the Life Esidimeni victims’ plight before the deaths but remained silent while healthcare service users’ constitutional rights were being threatened.

Despite assistance offered by the federation and others to ensure the Esidimeni patients’ transitions were conducted in a dignified, patient- centred manner, the Gauteng department of health implemented the relocations with little to no consultation and with no respect for the rights of these individuals or consideration of their vulnerability.

It took the deaths of so many people to act as a wake-up call for action. It is paramount that mental healthcare users or persons with mental disability be involved in decision-making or supported decision-making about all aspects of their lives. As far as possible, service users must make their own decisions. In instances where a per- son is unable to participate in mak- ing a decision, a caregiver or support person should respond on behalf of the person.

The disability sector’s slogan “Nothing about us without us” must always be applied.

Our society needs to focus on the protection and wellbeing of the individuals who once called Life Esidimeni their home to ensure that the places they are moved to can also be called home — where they can be happy, loved, cared for and safe.

The fate of the remaining Life Esidimeni patients now lies in the hands of duty bearers legally obligated to protect their rights and prevent more deaths.

Charlene Sunkel is the advocacy and development programme manager of the South African Federation for Mental Health. Marthé Viljoen heads the federation’s awareness and information programme.