Gauteng health department accused of shirking mental healthcare rights

In an urgent application to the Johannesburg High Court, the South African Depression and Anxiety Group (Sadag), the South African Federation for Mental Health, the South African Society of Psychiatrists and the Association of Concerned Families of Residents of Life Esidimeni will today argue that the provincial health department should be prevented from discharging or relocating mental healthcare patients at Life Esidimeni facilities until it meaningfully engages stakeholders and develops a plan to ensure patients receive adequate care.

The Gauteng Health MEC last year announced the province was ending its contract with Life Esidimeni, which provides chronic mental healthcare to almost 2,000 patients on contract from the government, to save costs. After civil society groups and relatives raised concern about potentially having to look after the patients at home or having the patients moved to other facilities, which appeared inadequate, the government extended its contract with Life Esidimeni to the end of June. A December settlement agreement saw the government commit to maintaining the status quo at the institutions, and not relocating patients until discussions are completed.

This week, however, 54 patients are to be moved to an alternative facility, Takalani Home.

“We considered this to be in direct breach of the settlement agreement, in which the respondents undertook not to discharge users until a reasonable plan was developed following a meaningful consultation process,” said Sadag operations director Cassandra Chambers in an affidavit. The relatives and civil society groups say that while discussions with government have taken place, the department of health is not providing adequate information on the number of patients at Life Esidimeni.

They also say a viable plan as to where the patients will go is yet to be finalised. Moving the patients to Takalani could hamper their healthcare and negatively affect the patients already at the facility.

Takalani Home is listed as a residential facility for children with severe or profound mental illness. Psychiatrist Joanna Taylor, who has treated patients from Life Esidimeni and Takalani, assessed the basic details of the 54 people set to be moved to Takalani and said there are a number of questions and concerns.

While the Takalani facility is primarily for children, the patients being sent there range from 24 to 101 years old. Some patients are adult males on medication to treat symptoms of hypersexual behaviour and could be in contact with vulnerable children at Takalani. Others are on antipsychotics, often used to treat aggression, irritability, impulsivity and hypersexuality.

“The current residents of Takalani Home, mostly intellectually disabled children, are likely to be distressed, confused and unsettled by the influx of new users, who will most likely also themselves be distressed by the move. The situation would increase the levels of care required for all concerned and is arguably an infringement on the rights of the existing users even before any potential physical harm takes place,” said Taylor in her affidavit.

In replying papers, the Gauteng Department of Health and the MEC say Takalani is suitable for the patients.

“Takalani Home has been approved as a suitable alternative facility, which is able to accommodate the selected users and provide the necessary mental health care. The fact that the applicants are not happy with the respondents’ election of facility for discharges does not create any reasonable apprehension of irreparable harm, let alone harm itself,” they say.

The department of health and MEC also say there is a difference between patients being discharged and those being placed in a different facility. They say the settlement agreement isn’t applicable in this case, and even if it was, a new agreement should have been reached regarding placement by 31 January.

Earlier this year, relatives of patients at Life Esidimeni marched to the Gauteng Department of Health, concerned that their loved ones would not receive adequate care after the facilities closed. The department has said no patients will be stranded, but plans to refurbish other facilities and work with NGOs to house patients from Life Esidimeni appeared far from complete.

While the contract with Life Esidimeni has been extended to the end of June to give the department more time to prepare, the decision to move 54 patients to Takalani remains worrying.

As Sadag’s Chambers said in her affidavit: “They continue to undermine the rights of the Life Esidimeni users to mental healthcare services and shirk their obligations to consult meaningfully with stakeholders.” DM

Read more:

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

Photo: Photo by Rod Waddington via Flickr.