Eastern Cape mental health unit needs facelift, says Public Service Commission

The Public Service Commission (PSC) released its findings and recommendations on Tuesday following an unannounced visit to an Eastern Cape mental health unit in August.

The PSC’s visit followed 10 days after Spotlight published its investigation into the Cecilia Makiwane mental health unit in Mdantsane, East London.

Spotlight reported that the unit was left in the shadows of condemned old hospital buildings, posed grave safety and security risks to patients and staff, and had no full-time psychiatrist. The PSC’s findings confirm the issues and concerns highlighted in Spotlight’s investigation. The entity presented its findings to the Eastern Cape Department of Health and media earlier on 3 December at the provincial legislature.

State of disrepair

In August, PSC Commissioner Lulu Sizani called the unit a “disaster” and urged that immediate action be taken to improve conditions. Some of Sizani’s key grievances included the decaying infrastructure and unsafe seclusion rooms.

Sizani said: “It’s like a place that is deserted or has been deserted for many years,” she said. “I’m deeply hurt. It’s not something that happened last month or last year; it’s in a state of disrepair. You’ve seen the wires outside, uncovered in the passages, the walls are falling apart.”

Sizani said at the time that the PSC would present its findings to the Eastern Cape legislature two weeks after the visit to the unit on 5 September. Almost three months later, Spotlight can now confirm that the report has been handed over to the Eastern Cape Department of Health.

Key findings

The report described the dire state of infrastructure at the unit, claiming that it had not been maintained for years.

“The windows were broken, the walls peeling off and electrical wires in the passages were exposed, which posed a serious threat to staff, patients and the citizens,” read the report.

In its recommendations the PSC stated that “the existing building requires a major facelift as the conditions outside the old building reflects the high degree or standard of uncleanliness and lack of years of maintenance”.

The PSC also found patient recreation areas lacking. These consisted of cement courtyards for each ward, male and female, with a few mattresses and chairs. During the PSC’s visit, patients were mostly lying on the cement floor in the sun with little else to do. The PSC writes that this is an “unacceptable way of treating patients”.

“The resting areas (courtyards) for both male and female patients must be provided with the necessary equipment to avoid patients resting and lying on the cement floor,” the PSC recommended.

Seclusion rooms

Along with infrastructure and recreation areas, arguably the biggest concern in the PSC’s report is the seclusion rooms. Spotlight had reported that the small concrete rooms consisted of a sink, toilet and sometimes a mattress. The rooms were equipped with cameras but none was functional, making it nearly impossible for staff to monitor patients.

In the report, the PSC states that the seclusion rooms are akin to “apartheid secluded prison cells”, and deemed them unfit for rehabilitation and healing.

The PSC further recommended that these seclusion rooms be demolished and more suitable facilities be built.

“The Cecilia Makiwane Hospital should set funds aside to fix the dysfunctional camera in the seclusion [rooms] in order for the psychiatric staff to be able to monitor the movement of patients detained in that room. While waiting for the long-term fixing of the seclusion rooms, mattresses and other safety equipment should be installed in these rooms,” read the report.

Last, while the PSC found the unit’s lack of a full-time psychiatrist to be a concern, no recommendation was made in this regard.

Some improvement

Since Spotlight’s investigation, some steps have been taken by the Eastern Cape Department of Health to improve conditions at the unit, including upgrades to security and safety. However, plans for a new unit remain uncertain as finances run low.

In October, Spotlight reported that the Eastern Cape Department of Health had budgeted R30-million in both the 2021/22 and 2022/23 financial years towards building the new unit. However, the estimated cost of the project was R100-million. Should the department continue to budget R30-million a year, the new unit would likely only be completed in 2025.

Comparison to Tower Hospital

Watchdog group, the Public Service Accountability Monitor (PSAM), responded to the PSC’s findings and recommendations with concern.

“The PSC’s findings and recommendations largely vindicate the media article that brought to light the unacceptable state of health care being provided to patients of the [unit],” said Public Service Accountability Monitor Director Jay Kruuse.

However, the Public Service Accountability Monitor notes the similarities between the state of care and infrastructure at the unit, and the state of Tower Hospital in 2018. Widespread media investigation into Tower resulted in intervention by the Health Ombudsman, the OHSC and the National Department of Health.

“This provides further evidence of a health system that is at odds with the basic needs of patients, especially mental health patients,” said Kruuse.

“While some may argue that the NHI will better respond to the funding needs of health facilities, many facilities require improved decision-making and accountability processes that are not always dependent upon improved funding.”

Spotlight has approached the Eastern Cape Department of Health for comment and will update this story when comment is provided. The full PSC report has not been made public yet. MC

This article was produced by Spotlight – health journalism in the public interest.