MHM Magazine

Issue 2 | 2022 | MENTAL HEALTH MATTERS | 27 MHM “This is a harrowing account of the death, torture and disappearance of utterly vulnerable mental health care users in the care of an admittedly delinquent provincial government. It’s also a story of the searing and public anguish of the families of the affected mental health care users and of the collective shock and pain of many other caring people in our land and elsewhere in the world.” (Justice Dikgang Moseneke, 19 March 2018) Between March and August 2016 long-term mental health care users with varying diagnoses and needs were inhumanely discharged from Life Esidimeni and transferred to unregistered NGOs and hospitals across Gauteng. Over 1 400 survived severe trauma and severe violations of their human rights; 144 people died, and 44 remain missing. (https:// section27.org.za/life-esidimeni/) DEINSTITUTIONALISATION AND COMMUNITY MENTAL HEALTHCARE The aim of community mental healthcare is the reduction of custodial care and institutionalisation. In order to facilitate social inclusion, support, and mental and physical healthcare for people with mental illness, the goal is a person-centred, recovery- orientated therapeutic approach. Adopted by South Africa in the 1997 White Paper for the Transformation of the Health System, community mental health services incorporate the community, the non-health government sector, non- governmental organisations (NGOs), traditional and faith healers, families and lay society. Community mental health services operate back-to-back with psychiatric services in general hospitals, and include residential and day-care and outpatient mental healthcare. The process of deinstitutionalisation started in the 1990s with funding from the closure of institutions intended to ‘follow the patient’ to the district and community. This didn’t happen. Despite not sustaining human resource allocation, deinstitutionalisation continued. The Life Esidimeni tragedy was a culmination of this process. THE HISTORY OF CARE OF THE SERIOUSLY AND PERSISTENTLY MENTALLY ILL (SPMI) South Africa has never ‘known’ how to care with its Seriously THE LIFE ESIDIMENI TRAGEDY ARE WE LEARNING THE LESSONS? Contributions by Dr Mvuyiso Talatala, Psychiatrist, Gauteng Dr Lennart Erikson, Psychiatrist, Durban Prof Lesley Robertson, Psychiatrist, Gauteng Clinical Responsibility (Dr Lennart Erikson)