by Dr Annemarie Paulin-Campbell
As a psychologist I am deeply troubled by recent news that suggests that those who already suffer because of grossly inadequate mental health care resources are likely to be further marginalised.
One in three South Africans suffers some form of mental illness, but an estimated 75 percent will not get access to the professional help they need according to a study published by the Sunday Star eighteen months ago. In the public sector there is one psychiatrist for every 375000 people, and the majority of people cannot afford the cost of private health care. Since then, while levels of mental health problems continue to escalate, access to help will become increasingly difficult due to a withdrawal of critical resources.
This past week South African Depression and Anxiety Group (SADAG) was on the verge of having to close its suicide prevention hotline which manages approximately 400 calls a day due to a lack of funding. They are endorsed by government but receive no government funding. Thankfully Discovery Health has stepped in to provide funding to keep the suicide hotline open for the next year but the overall problem remains.
In six weeks time, the residential mental health care centre Life Esidimeni, is to close its doors leaving 2000 people without likely access to the specialised care they need. For the past 40 years it has cared for people with serious mental health problems needing on-going residential care. The government has cancelled its contact with the private healthcare provider and these facilities will close on 31st March.
The Department of Health says it cannot afford the costs of the patients being treated at these facilities. The rationale given is also that this move to deinstitutionalise these patients will “facilitate community care, human dignity, and community integration.” It’s a nice idea, but in a context such as we are currently in, in which there are no support systems for that kind of process to happen well and safely, it simply cannot but be a disaster. To suddenly send people home who have been in the contained space of a residential care centre – some for over 25 years – without any transitional process or real access to the level of psychological and psychiatric support they will need in that process, is unconscionable. It is also unrealistic to expect families who do not necessarily have the skills or resources to provide the level of care needed. According to government there is a plan but they have not informed the families of those affected of what that plan is.
In this time of Lent and in this Jubilee Year of Mercy, Pope Francis is asking us to be attentive to the needs of those who are most vulnerable. We should not be making decisions that are potentially devastating to people already suffering, on the basis of money. While a policy of closing institutions may possibly be the way to go in the longer-term, that process needs to be managed with great care and access to appropriate levels of support. To do otherwise is risk vulnerable people landing up out on the streets or at home alone without the care they need. That is neither merciful or compassionate.