The financial woes of mental health NGOs

The Life Esidimeni outrage triggered changes to operating licence requirements for mental health NGOs. But many, like Gordonia, lack the funding to comply.

It’s little things, such as the sight of a shirtless man, that set off Debra Moore*, who was molested by her stepfather from the age of seven.

The abuse continued until she was 15. “He is in jail now,” she says.

Now 50 years old, Moore was diagnosed with post-traumatic stress disorder and critical depression at the age of 22. She has found refuge at the Gordonia Rehabilitation Centre for the past 19 years.

While the Department of Health scrambles to redress the mammoth problems the mental health sector faces, such as a shortage of psychiatrists and ill-treatment of those living with disabilities, the centre Moore calls home is likely to shut its doors if it fails to raise enough funding to renew its 12-month operating licence.

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The centre in Bertrams, in the east of Johannesburg, houses 69 mentally ill residents living with bipolar disorder, trauma and schizophrenia, according to manager Bhengu Shongwe.

The centre admits people between the ages 18 and 45, said Shongwe.

New requirements

She said the majority of Gordonia’s residents do not have families and either receive a government disability grant or are in the process of accessing a grant.

Shongwe told New Frame that the lack of funds has affected the facility in many ways.

“What is worrying is that if we don’t have those licences, it means we will not be licensed to operate,” Shongwe explains softly.

Licence requirements for non-governmental organisations changed in the aftermath of the Life Esidimeni disaster, she says. “Now they need things that we find difficult to obtain. Like an occupancy certificate.”

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The building plans for the facility are old. It has been in existence since 1919 and the Gordonia centre needs an architect to draw up new plans.

“Now we need to have that certificate and to get it, it needs money that we don’t have. And unfortunately, the department of health doesn’t have a budget allocated for that.”

Shongwe said the centre is also plagued by maintenance problems, almost on a daily basis. “In the building, you find a leak somewhere. There are cracks. The infrastructure does need revamping.”

Lapsed licences

In April 2012, DA Gauteng health spokesperson Jack Bloom told the Human Rights Commission about the Gauteng health department’s failure to pay the Gordonia residents their grants for going on five months. He said the residents owed the centre R400 000 as a result and it had been running on donations.

“I am disappointed that I never got a reply from the Human Rights Commission,” said Bloom.

In April 2018, Bloom said there were mental health NGOs in Gauteng – taking care of more than 3 000 patients – that were operating without licences after theirs had expired at the end of March 2018.

He told New Frame earlier this year that “there are still major problems with late and missing payments to NGOs. Many NGOs have struggled to comply. They should have received extra assistance from the department in this regard.”

Shongwe said the department has been helpful and that they understand the challenges the facility encounters.

The centre is planning a family day to inform the families of those residents who have relatives about the licence and other challenges, said Shongwe. “Now it’s like we are adding another burden on them. They might help, they might find someone who can help us.”

22 January 2019: Bhengu Shongwe, the service manager at Gordonia Rehabilitation Centre, talks to a resident.

Donations are a drop in the ocean

The facility receives donations from various companies, NGOs and the health department. Shongwe said the funds they receive from the department are determined by the number of residents they house.

“What we get from the department is like a drop in the ocean, because it doesn’t really cover the needs of our residents. Their needs are ongoing. For example, when it comes to meals, we must make sure that at least we provide five meals a day, because they are on heavy medication and consume a lot of food. And also, on a daily basis, we have clinic and hospital visits. Fuel is also expensive.”

Shongwe explained that the facility has no psychiatrist because they cannot afford one. They have one social worker and a nurse.

“We have professionals that need to be paid a decent salary. But what we give is per what the department gives. It’s nothing really, we always lose our professionals because we can’t match what the department is giving.”

Security and maintenance problems

In addition to the burdens the centre faces daily, they have experienced break-ins in the past.

“Our security system has been challenged over the holiday. The area in itself where we are, the crime rate is so high. Now we have to strengthen that so that at night we have two guards.”

“The assets that we have, like boilers, they are very old – and so difficult to replace the old ones with the new ones. Or to repair what we have because you find that the material that was used then is no longer available. We also need generators, and a water tank.”

In 2016, when patients were transferred from Life Esidimeni to NGOs, Shongwe said they were contacted to accommodate some of the patients. “We said we can only take those who meet our admission criteria, so unfortunately most of them didn’t. We couldn’t take them.”

22 January 2019: A resident walks through the courtyard at the Gordonia Rehabilitation Centre, which houses people with mental health issues.

Missing guidelines

Health department spokesperson Popo Maja says licensing and support of NGOs is a provincial mandate, and the provincial department may withdraw the licence if an NGO does not comply with a condition of said licence. “Expired licences for NGOs and consequent actions to be taken are handled by the provincial departments of health.”

In 2017, when psychiatrist Dr Lesley Robertson testified at the National Hearing on the Status of Mental Health Care in South Africa convened by the Human Rights Commission, she said that there is no programme guideline for mental healthcare.

“There is no national programme guideline in a way that we have guidelines for TB, HIV, sexually transmitted infections, maternal and child health, and integrated health school programmes,” Robertson said.

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“There is nothing to tell us in detail what to do with a mentally ill patient. This results in more confusion from a district direct perspective,” she continued.

Shongwe told New Frame that for someone to work with people with disabilities, they have to have compassion. “If you think you are here to make an income, this is not the best place for you. You need to make sure that you are here to make an impact. Because it is about making a difference in people’s lives. You need to create a home away from home.

“We need financial support. If we can get that right, we will be proud to say we are making a difference in the country,” she concluded.

Dignity and support

For Moore, people like Shongwe create a safe space in which those living with mental illness are treated with dignity. Gordonia holds a special place in her heart, so much so that she would recommend it to others.

Moore, who had to give up her job as a teacher at a crèche because of her illness, said the staff working at Gordonia are very supportive. “For the staff, it is also quite a difficult thing to come from their home and come and take care of us.”

She said the facility has set out rules that help residents deal with their specific illness.

After the interview, Moore showed New Frame her pink-painted bedroom. Bird stickers fill the walls and she has a pet bird in a cage. She said it was her dream to work with animals.

* Not her real name

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