MHM Magazine

28 | MENTAL HEALTH MATTERS | Issue 2 | 2022 MHM Organisationofmentalhealthcareservices.Source:GautengProvinceMentalHealthStrategyandActionPlan2019-2023 (https: /www.spotlightnsp.co.za/wp-content/uploads/2021/11/Robertson-et-al.-2021-Strengthening-district-mental-health- services-in-Gauteng1.pdf) IntegratedClinicalServicesManagementmanual(https: /www.knowledgehub.org.za/system/files/elibdownloads/2019-07/ Integrated%2520Clinical%2520Services%2520Management%2520%2520Manual%25205th%2520June%2520FINAL.pdf) and Persistently Mentally Ill patients. Until 1968, they were held in state prisons. In 1968, the Smith Mitchell Organisation moved SPMI to chronic care facilities in abandoned mines. In 1999, each province was responsible for their own SPMI citizens and had no duty of care to anyone not from the province. Between 1998 and 2000, SPMI were cut in half at Life Esidimeni facilities. Where did those 6 000 SPMI go? Life Esidimeni specialises in the care of people with schizophrenia, intellectual disability, dementia, head injury, and epilepsy. The primary responsibility is to the safety of every patient – their physical and emotional safety. “People are there to be rehabilitated, not stored,” says Dr Lennart Erikson. The SPMI are especially vulnerable to abuse because they are an ‘unviable’ group that policy makers don’t want to spend money on. CLINICAL RESPONSIBILITY AND DUTY OF CARE “Psychiatrsists have a responsibility to protect and care for our patients,” says Dr Erikson. “Life Esidimeni patients died because of policy makers and money. It’s a psychiatrist’s duty to be the voice of their patients, and to give these people a human face.” The Department of Health controls policy and controls money. “Policy is there to protect admistrators, not to improve care.” Psychiatrists need to inform care. WHAT IS THE BEST MODEL FOR SPMI MANAGEMENT? Deinstitutionalisation is often hailed as the ‘perfect solution’ but seldom is the full story shared. Deinstitutionalisation with no psychosocial or community psychiatric services in place is disastrous. The