Mental health and legal factors are discussed here in terms of legislation, challenges, and the Life Esidimeni tragedy.
1. Mental health legislation
South Africa has a Mental Health Care Act (2002), along with a mental health policy framework that expires in 2020. The Act aimed to integrate mental health into primary care; however, this has not been fully put into practice, with a continued over-reliance on psychiatric hospitals.
While a key recommendation of the Mental Health Care Act was the development of mechanisms to oversee involuntary admission and practices, a large number of forced treatments and detentions continue to take place at many mental health care facilities.
Also, while the Mental Health Care Act led to the establishment of Mental Health Review Boards (the Review Boards were meant to allow for appeal and review of involuntary care in order to protect mental health care users from inappropriate involuntary care), they have been found to be ill-equipped to deal with the number of appeals against involuntary treatment that arise. In some provinces these Review Boards are also not functioning effectively.
3. Life Esidimeni tragedy
Structural inequalities were exposed in the Life Esidimeni tragedy, which forced policy-makers to acknowledge how irresponsibly mental health care was being managed in facilities. The tragedy involved the discharge of over 1400 mental health patients (between Oct 2015 and June 2016) due to the termination of a care contract at psychiatric facilities in Gauteng. The poorly managed deinstitutionalisation process meant that patients were transferred to community-based mental health organisations and carers without introducing the necessary measures for the continued care of those who required long-term support. Many NGOs where patients were transferred to for care did not have the capacity or specialised care required for taking care of the patients.
A total of 144 people lost their lives as a result of this process. The tragedy highlighted how people with mental illnesses were being mistreated in South African mental health facilities, while their liberties and rights were being violated. It led to calls for stronger accountability measures and implementation of laws to defend human rights and safeguard people with mental health conditions from neglect and abuse. A review of the Life Esidimeni tragedy conducted by the South African Health Ombudsman found that the Gauteng Mental Health Review Board had been found to have been ‘moribund, ineffective and without ‘authority and withoutindependence’.
“[The] Life Esidimeni crisis put a spotlight on the care the government thinks we deserve”
– Mental Health Care User, Cape Mental Health