Despite a desperate need for facilities for psychiatric patients, Fort Napier Hospital in Pietermaritzburg is operating way below capacity because it simply lacks the staff to admit more patients. Although the facility has 370 beds, serious staff shortages have forced management to reduce patient numbers to about 280, says the superintendent, Dr Sharma Jogessar.

A narrow security gate and a sign proclaiming rules for visitors are the only indication that the steel gate is the entrance to Valkenberg Hospital’s infamous ward 20. While hospital staff and provincial government officials are at pains to point out that it is a hospital, it resembles a prison, with its bleak buildings, visitor body searches, the sounds of clanging steel gates and burly security guards.

Psychiatric patients have long been neglected by the health system and hidden from the public eye. Recently, a commission of enquiry heard evidence of gross abuse — including sexual and physical — of psychiatric patients by staff at Townhill Hospital in Pieter­maritzburg. The government has made significant efforts to improve the psychiatric wards over the past decade, but the main refrain remains acute staff shortages.