South Africa’s mental health system is deeply rotten.
The latest tragedy to hit the headlines is the death of 35-year-old psychiatric patient Lerat Mawlam, who died from burns sustained in a fire at the George Muhari Academic Hospital (GMAH) in June 2024. A Health Ombud investigation into the horrors, released last week, revealed neglect and abuse that amounted to torture. As punishment, she was deprived of food and medicine, confined in an unheated isolation room wearing only her underwear, and then left. In the hands of grossly poorly supervised staff.
There is no question that management bears ultimate responsibility for failures that occur under its watch. But the ease with which lower-level staff deal with abuse and turn a blind eye to transgressions by colleagues is deeply worrying. GMAH is a teaching hospital affiliated with Sefako Magath University of Health Sciences. We have a responsibility to help develop the next generation of healthcare professionals and should be a beacon of professionalism, care and compassion. The Ombud report makes clear that is not the case.
The most disturbing aspect of the human rights violations uncovered by the investigation into Mowlam’s death is that we have seen this photo before. Ten years ago, 144 provincial mental health patients died after the Gauteng Department of Health transferred many of them from the private Life Esidimeni facility, where they had lived comfortably for years, to unlicensed and ill-equipped nongovernmental organizations.
Such leadership is severely lacking in the public health sector, and there is clearly no political will to put in place the guardrails necessary to end abuse of mental health patients once and for all.
There they were neglected and died without food, warmth or necessary medicine. In the years that followed, the public was regularly haunted by the gory details revealed by the Health Ombud’s investigations into their deaths, the inquests, and the South African Human Rights Commission’s report on the state of mental health care in South Africa. Politicians clasped hands and professed their grief, but health advocates and bereaved families had hoped that major changes would emerge from the tragedy, which never materialized.
The fatigue that led to the deaths of Molam and Life Esimidemini patients is not limited to Gauteng. A Health Ombud investigation into the care of psychiatric patients in Northern Cape mental health hospitals, the results of which were published last year, revealed a similarly callous indifference to the suffering of some of society’s most vulnerable people. Patients were exposed to dangerously cold mid-winter conditions, with temperatures regularly below freezing, left in the care of junior staff with no supervision, and forced to use bathrooms with sewage running from the showers.
Obviously there is a problem with resources. On average, state health departments allocate just 5% of their budgets to mental health care, and many facilities grapple with crumbling infrastructure and staffing shortages. However, with competent and committed leadership, infrastructure and staffing constraints can be overcome, as the Tree Schools, which achieved high math pass rates despite classroom shortages, have repeatedly demonstrated.
Such leadership is severely lacking in the public health sector, and there is clearly no political will to put in place the guardrails necessary to end abuse of mental health patients once and for all.
Former President Nelson Mandela wrote in his autobiography: long road to freedomthat a nation should not be judged by how it treats its lowest rather than its highest citizens. He was, of course, referring to the apartheid government’s systematic oppression of the black population. But he could also be referring to today’s governments and their callous disregard for people with mental health conditions.
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