In general, people with mental disorders have limited accessibility to appropriate healthcare services. The life expectancy of people with mental health disorders is lower, and they are at a higher risk for co-morbid illnesses. They need a stable, medically qualified environment.

The report of the health ombudsman was damning. The report found that 94, not 36 patients as reported previously, died after being transferred from a hospital to NGOs.

Total 1,039 patients have been transferred to 27 NGOs. In 16 out of 27 NGOs, deaths were reported. The patients were not cared for by anyone who had the proper license.

The most damaging findings of the report are:

Transferring patients without informing their families: Patients are moved without notifying their families. Some patients who were unable to use wheelchairs had bed sheets tied around them as support. Other patients were transported in open trucks.

Patients were placed in organizations that weren’t originally chosen for them, or they were transferred far from their families. Patients with co-morbid conditions that require specialized medical care were moved to facilities without such care.

Conditions for NGOs: These organisations are not sustainable. The organizations did not receive financial support to cover the costs of winter clothing, bedding, and food. Some patients were left without blankets or bedding, while others went hungry. Many patients were malnourished and had suffered a severe weight loss.

Staff were also not properly trained or prepared to take care of patients. There was a lot of overcrowding, and many patients were dirty, uncared for, and left without treatment. Some patients were not given the right medication, which put them at risk of relapsing.

Fourteen out of 25 inspected NGOs were found to be unfit for purpose. It was recommended that the NGOs be closed.

Causes for death: We selected 38 patients to determine the cause of their death. The immediate cause of death was identified in 21 out of 38 patients. Most of those who died were victims of pneumonia, uncontrolled seizures, stroke, sepsis, or dehydration.

The families were not notified immediately of the death. Some families learned about the death three weeks after it occurred.

What can we learn from the report about mental health care in South Africa as a whole?

The report shows mental health care is in disarray in South Africa.

South Africa has good mental health policies. The implementation of these policies remains a challenge. Mental health services are not integrated into routine chronic disease care and the primary healthcare system. Mental health is marginalized and underfunded.

Several factors can create barriers to effective mental health services. They include:

Lack of financial investment. Without the resources to invest in mental health programs, they will not be sustained. It is important to note that studies have shown that not treating mental disorders costs more than treating them.

Stock-outs of medication: According to the Stop Stock-Outs Project, psychiatric medications accounted for 10% of all reported stock-outs between January and July 2015 in the United States.

Social stigma and mental illness

Is mental health care second to primary care in this country?

Mental health has always been “the stepchild” of healthcare. In South Africa, 75% of those with mental disorders don’t get mental health services. The “mental treatment gap” is what’s called.

Including mental health services in the current health system structure could help reduce stigma and improve the effectiveness of healthcare interventions.

Mental health is being better integrated. The National Department of Health has recently released policies that show their commitment to integrating mental health services into primary healthcare.

The Department’s mental health policy framework 2013-2020 and strategic plan envisage the scaling up and decentralization of integrated primary mental healthcare services. The care provided includes primary care, community-based services, and district hospital care. The key is to implement and sustain these policies.

Mental health care is marginalized in the National Health Insurance long-term health plan. Mental health is mentioned only in a general way in the NHI white paper. The NHI includes mental health services but does not provide any details about the programs or how to address the shortage of mental healthcare professionals.

What’s next? What should we do next?

Five NGOs were already closed. The Ombudsman recommended remedial actions be taken within 45 days after the release of his report.

It is important to study the report in detail and determine what actions to take to avoid this happening again.