The government plans to release
psychiatric patients from state hospitals into the community, writes Stuart Hess
THE government is planning to shunt thousands of mental patients out of state- run institutions and into the care of their families and friends.
The Health Department said this week its fledgling, community-care programme involved closing hospitals and wards, and moving out many of the 10 000 to 15 000 mental patients currently under the state’s care.
A two-year pilot project in the Eastern Cape and Kwa-Zulu Natal is already under way, with patients treated at the new clinics that form the central plank of the government’s primary health-care drive. The scheme will be rolled out across South Africa should the pilot prove successful.
The initiative follows a similar drive in the United Kingdom and the United States, where savage cutbacks in state-provided mental care left tens of thousands of former patients on the streets or in prison.
The department’s director for mental health and substance abuse, Mervyn Freeman, said this week that the British and American programmes “weren’t run properly”. However, the South African pilot programme would be overseen by experts from both countries.
The pilot programme would also throw up potential cost savings – the current budget for state-funded mental institutions stands at more than R756-million – although Freeman said cost-cutting was not the priority.
“Until we are sure of exactly how many can be moved it is difficult to determine how many beds are needed,” he said.
“The department is in favour of moving people into community-care facilities wherever possible. Many people prefer the option of returning patients to the community.”
The new clinic network would be called on to offer psychiatric care, and the government was also looking at establishing “halfway houses” and daycare centres for newly released patients.
Chronic patients would remain in state care, in institutions controlled for the past 20 years by the Life Care Company – now part-owned by the listed black empowerment group, Real Africa Investments.
Freeman said the programme formed part of a national plan to improve conditions at mental institutions.
Gauteng’s Sterkfontein and Weskoppies have both been restructured, he said, while Westfort – roundly condemned in an official investigation last year – is to be closed. Other institutions remain below standard.
But serious concerns remain about the new clinics’ ability to provide normal healthcare to their communities – many don’t even have staff – let alone specialised treatment for mental health.
Overseas experience, where care-in-the- community policies have been associated with the worst excesses of Reaganism and Thatcherism, have also left independent experts anxious.
“We must learn from the US and UK experience and not rush into this programme,” said Lage Vitus, national director of the South African Federation for Mental Health. It co-ordinates various mental health NGOs in South Africa.
The programme had several pitfalls, he said, not least the need for adequate training of clinic staff and education for families and communities.”The bulk of the work falls to members of the community, people who act as friends to support mentally disabled members of the community,” said Vitus.
Freeman said much of this education would involve teaching families how to “deal with patients and to make sure they take their medication”.
He added that a major obstacle was actually tracking down the families. “In some cases they are simply dumped at the institution and their families totally disown them.”
Rhona Chetty, a social worker at the Aryan Benevolent Home in Durban, said more emphasis was needed on care in the community, particularly as institutional care was so expensive.
But the state should also look at patients’ functional ability before admitting them to mental homes.
“We don’t need high-tech electronic security at the homes,” she said. “It could be a place where people care for themselves.”