As of March 2016, over 2,000 mentally ill and disabled patients (including about 200 youth) will be without services. Life Esidimeni staff will be without employment.
According to a Department of Health's media release on the subject, the contract termination is in line with the Mental Health Care Act 17 of 2002, which seeks to treat mental health care users in the least restrictive environment. Chapter Two of the Act is cited as reason for this service termination: care, treatment and rehabilitation services must be provided in a manner that facilitates community care of mental health care users, respects human dignity and privacy and develops every mental health care user's potential to be integrated in the community.
Life Esidimeni is a care facility with a wide range of patients from youth with autism and mental handicap, to adults with schizophrenia, impulse control disorder and temporal lobe epilepsy. The Mental Health Care Act 17 of 2002 was created to regulate mental health care to ensure the best possible treatment and rehabilitation services are made available to all citizens. Life Esidimeni caters specifically to patients without the resources or income to enable private treatment, or home-based care in accordance with the Act, as well as the South African Bill of Rights.
On Saturday, 14 November, Life Esidimeni held a meeting for family members of their RandWest Centre to announce the closure. Hundreds of families attended and emotions ran high. "We didn't just dump our loved ones here," said one father. "There are very few resources and this was the only place that would take them in and care for them. We do not have the money or the skills. These people are our saviours." Life Esidimeni is not a walk-in facility. Patients here have been through the system and cannot live without care. "These patients are often treatment resistant, are generally fairly low functioning, and their mood swings can be hard to deal with for people who aren't trained," said a Life representative. Families are understandably apprehensive about the future.
In accordance with the Mental Health Care Act, the State has a duty to ensure the provision of mental health care services and promote the provision of community-based care, treatment and rehabilitation.
MEC Mahlangu stated, "As a Department, we want to reduce psychiatric patients at facilities by discharging all those who are responding well to treatment and re-integrate them into their communities."
However, the termination of the contract between the Gauteng provincial Department of Health and Life Esidimeni in actuality means that over 2 000 patients in need of care, will not have access to it. Life Esidimeni provides inpatient care, treatment and rehabilitation for people with chronic psychiatric disorders, and severe intellectual disability, who do not have access to resources. "These are patients who are in full-time care because they do not respond well to treatment and because they cannot be looked after in a home or community setting," says Marion, daughter of a schizophrenic patient at Life Esidimeni.
According to MEC Mahlangu, the way forward is simple and structured. She said that patients that require further management would be referred to government hospitals, which have psychiatric wards. "This will help as patients will be treated closer to home," she said.
The reality is that government hospitals are severely overcrowded, many lack enough psychiatric beds, and hospitals are used for emergencies and not as long-term care facilities. "I don't have any government hospitals with psychiatric wards within 30 kilometres of where I live," says one mother whose son is a low-functioning paranoid schizophrenic. "When there is an emergency, I have to take two or three taxis to the hospital and there is no guarantee anyone will even see us when we get there. Life Esidimeni has saved all our lives."
MEC Mahlangu also stated in the Department's media release that the Department would continue to work with NGOs in the mental health environment to manage these patients accordingly. By definition, NGOs are non-governmental and not supported by government. In addition, when there are funds available to assist NGOs, they are very limited and slow to pay out. The Minister is talking about re-opening three facilities that are defunct and would have to be rebuilt, that would be run by NGOs. Mental health NGOs are already taking much of the burden in dealing with discharged patients and the NGO and the volunteer sector is already overstretched.
If adequate alternate arrangements are not made‚ there will be many vulnerable people left to fend for themselves and at risk of relapse. The State's duty, in accordance with the Act, is to protect the rights and interests of patients and promote the mental health status of the population in general. This decision, and lack of real strategies to assist patients and their families, is in direct contravention to the Act.
Whether this decision is the result of 're-integration' or 'budget cuts' - both of which are referred to by MEC Mahlangu in the Department's media release - the reality remains that for these patients, Life Esidimeni is the one place they can call home and be cared for in accordance with their needs. This is a looming crisis and one that threatens more than 'merely' 2,000 patients but their families, communities and caregivers as well. "A patient's health and wellness affects more than just their own life," says SADAG's Cassey Chambers. "When an institutionalised patient is released without care or support from professionals, how many lives are impacted?"
