Cassey Chambers, operations director of the South African Depression and Anxiety Group, says many people’s mental health is in need of serious attention and support. But the mental healthcare system in the country is deeply flawed and the public needs to start seeing that policy gets put into practice.
Chambers says the need for mental health services had skyrocketed since the Covid-19 pandemic started, resulting in a drastic demand for the organisation’s services.
“Our call volumes literally doubled overnight from 600 calls to well over 1 200. Now, looking at it years down the line, we’re receiving well over 2 500 calls every single day, excluding WhatsApps, emails and SMSs.”
Chambers has previously given testimony at the inquest held virtually at the High Court in Pretoria. Her testimony followed the 2015-2016 scandal when hundreds of patients who were moved to unlicensed non-governmental organisations (NGOs ) suffered abuse, starvation, torture, neglect and relapse, and 144 died. Many remain missing as their families were not aware that their loved ones had been transferred or died.
“Do we have a good mental health policy in South Africa?” she says. “Yes, on paper. The policy expired in 2020. We should be having a new mental health framework and policy for a strategic plan. We don’t have an updated one,” she says. “We have to see it being practised on the ground in communities, helping people who are affected the most.”
Chambers says serious issues have been raised about the silent crisis in mental health, but they need to be acted on to show that there are some changes taking place since the Life Esidimeni tragedy.
The Gauteng Department of Health had terminated its contract with medical services provider Life Esidimeni towards the end of 2015. The many patients who were being treated in its facilities were hurriedly transferred to ill-equipped and often unlicensed NGOs in what was known as the Gauteng Mental Health Marathon Project.
Witnesses have testified that due process was not followed, and the move was rushed owing to political pressure. In some instances, officials knew that the NGOs were not ready for patients. Plans went ahead despite warnings from various sectors of society, concerned family members and health officials.
Former Gauteng deputy director for mental health services Hannah Jacobus testified that the preparation and licensing of an NGO for mental healthcare users is a three-year process. Many licences for the marathon project were unlawfully revised and backdated, and inspections were not conducted. A number of NGOs did not even have good security or enough medication, food and beds. The Tshepong Centre in Atteridgeville in Pretoria, for instance, was not paid for the first three months and could not afford to take care of its patients, let alone offer sufficient medical care.
Musa Makhoba, a pathologist who performed postmortems on patients who died in the scandal, testified on 24 February that overall clinic management was inadequate, and this compromised patients at different facilities.
Makhoba said the causes of some patients’ deaths were negligence, bedsores, severe septic burns, coronary artery disease complications and sepsis from foreign matter in the lungs during seizures.
Some family members testified that their loved ones had to eat cardboard and plastic because they were not fed. On 28 February, the high court in Pretoria heard testimony from Sandra de Villiers, the sister of Jaco Stols, 51. She testified that her brother had marks on his body and there was a possibility that he was sexually abused.
Stols was at the Cullinan Care and Rehabilitation Centre before being transferred to Siyabadinga in the same town in 2016. Siyabadinga closed its doors after just two months and Stols was readmitted to the centre. When De Villiers reported her brother’s deteriorating condition and potential abuse, nothing was done.
“He was crying so much and said that ‘they’ were hurting him. He looked ill and I decided to take him to a private doctor,” she said.
Stols, like many others at other NGOs, suffered from dehydration and malnutrition and weighed 39kg a month before his death on 14 October 2016.
No justice yet
As the bereaved families continue to hope for closure and justice, Gauteng health officials continue to shy away from accepting any accountability. Jacobus is now a pensioner and, like many other high and low-ranking officials, she has not suffered any consequences. Some have resigned, however.
But the families of the victims remain adamant that a resignation does not amount to an apology or justice. A number of health department officials are represented by three top law firms and the bill is being footed by the Gauteng government. In November, Gauteng Premier David Makhura said “senior counsel advised the government that it has an obligation to provide legal representation as a basic principle”.
Judge Mmonoa Teffo will, at the end of the inquest, deliver a set of findings on the legal cause of death for each of the former Life Esidimeni patients so that the National Prosecuting Authority can decide whether there are sufficient grounds for criminal liability and prosecution.
The inquest continues and testimony is likely to be heard for months.