Something is deeply wrong with South Africa’s mental health care system.
The latest tragedy to grab the headlines is the death of 35-year-old psychiatric patient Lerato Molme, who died of burn injuries in June 2024 in a fire at the George Mukhari Academic Hospital (GMAH). As a punishment, he was confined to an unheated isolation room wearing only underwear and under strict supervision by staff.
There is no doubt that management is ultimately responsible for the failures that occur in its course. But there is also something deeply troubling about the apparent ease with which lower-ranking employees either abused or turned a blind eye to the transgressions of their colleagues. GMAH is a teaching hospital affiliated to Sefaku Makgatu University of Health Sciences. It is responsible for helping to train the next generation of healthcare professionals and must be an example of professionalism, care and compassion. The Ombudsman’s report reveals that this is not the case.
The most disturbing aspect of the human rights abuses revealed by the investigation into Muhammad’s death is that we have seen this picture before. Ten years ago, 144 state mental patients died after the Gauteng Health Department moved them from the private living Esidimeni facility, where many had lived comfortably for years, to an unlicensed, non-governmental NGO.
Such competent leadership is sorely lacking in the public health sector and there is clearly no political will to institute the kind of safeguards necessary to end the abuse of mental health patients once and for all.
There they died of neglect, deprived of food, warmth and essential medicine. In the following years the nation was regularly exposed to the grim details revealed by the Health Ombudsman’s inquiry into their deaths, an inquiry into the state of mental health care in South Africa and a report by the South African Human Rights Commission. Politicians wringed their hands and feigned grief, but the sea change that health advocates and grieving families so desperately hoped would emerge from the tragedy never materialized.
The disorder that led to the deaths of Mohammed and the life-threatening patients is not limited to Gauteng. A Health Ombudsman investigation into the care of psychiatric patients at the Northern Cape Mental Health Hospital, findings published last year, revealed an equally insensitive view of the plight of some of the community’s most vulnerable people. Patients were exposed to dangerously cold conditions in the middle of winter, when temperatures regularly drop below freezing, left in the care of unsupervised staff and forced to use toilets that oozed sewage from showers.
There are clear resource constraints: provincial health departments allocate an average of only 5% of their budgets to mental health care, and many facilities suffer from dilapidated infrastructure and staff shortages. But as “tree schools” that have achieved high matriculation pass rates despite a lack of classrooms have repeatedly demonstrated, competent and dedicated leadership can overcome infrastructure and staffing bottlenecks.
Such competent leadership is sorely lacking in the public health sector and there is clearly no political will to institute the kind of safeguards necessary to end the abuse of mental health patients once and for all.
Former President Nelson Mandela wrote in his autobiography: A long way to freedomA nation should not be judged by how it treats its high citizens, but how it treats its lowly citizens. He was, of course, referring to the apartheid government’s systematic oppression of black citizens. But he could also point to today’s government and its cold indifference to people with mental health conditions.
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