Gauteng: Contract cancellation may force 2,000 mentally-ill patients out of care homes

Nompilo Nkosi loves her 29-year-old brother Sizwe. She wants him home. “But there's no way. It's impossible,” she says.

For 13 years, Sizwe has been a patient at Life Esidimeni's Waverley facility. “My brother is autistic and it's very serious. He gets so aggressive, he breaks things, he hurts himself,” says Nkosi. When he came home for a week in Christmas, Sizwe was restless, wanting to return to his routine at Waverley.

Now, Nkosi has no idea where her brother will go. In six weeks, almost 2,000 Life Esidimeni patients are to be relocated after the Gauteng government cancelled its contact with the private healthcare provider. Sizwe is one of them. “It has been a horrible time,” she says, unsure of where her brother could be sent, and unable to provide for him at home.

For almost 40 years, Life Esidimeni has provided chronic mental healthcare to patients in Gauteng under contract from the government. It accommodates long-term patients needing specialised care.

In October, Gauteng Health MEC Qedani Mahlangu announced the province would terminate its contract with Life Esidimeni and as a result the private facilities are to close on 31 March.

In 2014/15 the province spent R323 million to treat 2,378 patients at the facilities, and Mahlangu said “the department cannot afford this”. She said the move would facilitate community care, human dignity and community integration. Patients would be discharged to the care of their families, and if they still require attention will either be sent to the psychiatric ward in a public hospital or to NGOs.

Relatives and experts have criticised the decision, saying it came without consultation, could harm patients and would endanger their right to healthcare. The move is in line with the province's long-term policy, but it has come years early, without the planned support structures yet in place.

On Tuesday morning, relatives of the patients will march in Johannesburg to the provincial department of health. “The department’s actions are callous, immoral and unlawful. Unless we take action, the department will trample the rights of the most vulnerable amongst us,” said a statement from the march organisers. “As the 31 March deadline looms, there is no evidence the department has or can soon have a proper plan. We are now forced to ask, what does this mean for our loved ones and their futures?”

When relatives and civil society groups threatened to take the matter to court in December 2015, the department of health signed a settlement agreement to engage the parties in finding a plan and “at the very least endeavour that users receive health and other services [of] no lesser quality than the services they currently receive at Life Esidimeni”.

Christine Nxumalo, whose sister is being treated at Esidimeni's Randfontein facility, said on Monday that this was not good enough. “Everybody is aggrieved by the way the department is handling this.” The first she heard of the closure was when she went to visit her sister, and in subsequent discussions with the department they haven't taken responsibility for the failure to consult patients' loved ones.

“It just doesn't sound right. It just doesn't sound fair,” said Nxumalo.

Despite the settlement's requirements, the department of health hasn't yet explained how it will close the Esidimeni facilities while ensuring the needs of patients are met. While other hospitals have psychiatric wards, not all have the space or expertise to take the patients. The department has said the gap will be filled by NGOs and by re-opening old facilities. None of those NGOs have been named, however, and renovations are reportedly yet to begin at old, dilapidated facilities.

Lebo Mashifawe's uncle has been at Life Esidimeni in Waverley for 25 years and she's scared that if he and other patients are sent home they will be a danger to themselves and others. Mashifawe worries that it's not safe for her uncle in the township they live in and her family does not have the space or skills to look after him.

“We don't know what's going to happen with our uncle,” she says. The department hasn't given them any indication of where he will go and, even after a meeting with the MEC, Mashifawe is not convinced that any other facilities or NGOs are ready to help.

“I don't know why they're being so pig-headed about the whole thing,” said Jack Bloom, Democratic Alliance spokesperson for health in Gauteng. Bloom was adamant that despite the MECs assurances that no one will be kicked out on the streets, the department will not be ready by April to provide care for the Life Esidimeni patients.

Bloom said the department should at least extend the contract while it puts a proper plan in place. Rather than trying to build and equip new facilities, he believes the department could try to negotiate a more affordable deal with Life Esidimeni, to continue a public-private partnership that has been relatively successful.

Mahlangu and her department have been adamant the contract will be over by the end of March and the patients taken care of. No plan however has been produced to show the details of how that might happen.

On Tuesday, marchers will be demanding one. DM

Photo by Rod Waddington via Flickr.