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Savings in mental health care costs lives

24 February 2017

With 94+ patients dead and more displaced, the Health Ombudsman calls for justice. The release of the Health Ombudsman, Professor Makgoba’s report into the circumstances surrounding the deaths of mentally ill patients in the Gauteng province has triggered an outcry. Attention has been focused on the horrific treatment of mentally ill patients after the closure of Lifecare Esidimeni due to the withdrawal of Gauteng Department of Health funding.

In his report, Makgoba established that more than 94 deaths occurred between 23 March and 19 December last year as a direct result of patients being transferred to unlicensed NGOs from Life Esidimeni. The report states that the NGOs where the majority of the patients died had neither the basic competence and experience, the leadership/managerial capacity nor “fitness for purpose” and were often poorly resourced. The NGOs who were entrusted with providing care for the high specialized needs of ‘assisted’ Mental Health Care Users were not only unsuitable, but inadequately prepared.

Treated like cattle

The report points out the evidence that these patients’ human rights were grossly violated. “Some NGOs rocked up at LE in open ‘bakkies’ to fetch mental health care users while others chose patients like they were at a cattle auction ”the report states.“ Frail, disabled and incapacitated patients were transported in inappropriate and inhumane modes of transport, some ‘without wheelchairs but tied with bedsheets’ to support them.” The conduct of these unlicensed NGOs was most negligent and reckless and showed a total lack of respect for human dignity, care and human life.

Lack of funding

“Mental health care has been chronically under-funded for many years in South Africa,” says Professor Crick Lund, the University of Cape Town’s head of Public Mental Health. “We see this in the inadequacy of mental healthcare in primary care clinics, the lack of community residential care facilities, and the lack of beds in acute mental health units in district and regional hospitals. Although we now have an excellent National Mental Health Policy Framework and Strategic Plan (2013-2020), most provincial Departments of Health have so far failed to adequately implement the policy and plan.”

The Gauteng Department of Health undertook deinstitutionalization of the Life Esidimeni patients as a cost-saving strategy, but this has led to disastrous consequences.

“Deinstitutionalisation should never be seen as a cost-saving strategy,” says Lund. “Deinstitutionalisation can work, and most health care systems are moving (correctly) to emphasizing community-based care. But the money must follow the patients into the community. Several studies have shown that community-based care is generally more acceptable to patients and their families and leads to better clinical and functioning outcomes. But it must be backed by substantial investment in community-based care, including adequate staffing, residential care facilities, and support systems for activities of daily living.”

In 2003, the National Department of Health commissioned a study to develop norms for community-based care, including staff/population ratios, bed population ratios, facility requirements, and so forth, from the CPMH, but this has never been implemented by the provincial Departments of Health. “Our studies show that the indirect costs of mental illness through lost income far outweigh the direct costs of mental healthcare,” explains Lund. “So it is not a question of South Africa not having enough resources to treat mental illness. It is costing South African society more to not treat mental illness than to treat it.”

About the Alan J. Flisher Centre for Public Mental Health

The CPMH is a collaborative inter-institutional multi-disciplinary centre that conducts high quality research on public mental health, and uses evidence for teaching, consultancy and advocacy to promote mental health in Africa.

Learn more at http://www.cpmh.org.za/

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