MHM Magazine

30 | MENTAL HEALTH MATTERS | Issue 2 | 2022 MHM Clinical Services Management manual: • At a facility level, the patient will be treated and managed by a multi-sectorial team (doctors, nurses, pharmacist, rehabilitative practitioners, audiologist and dieticians) • At the community level, the patient will be assisted by health promoters, community healthcare workers and adherence clubs. • At a population level, the patient will be exposed to mass media coverage addressing healthy living. Prof Robertson notes that while the manual describes mental health support teams (psychiatrist, psychologist and a mental health nurse), it notes that these are not available in most of South Africa. “Where they exist, they function with scheduled appointments, designated waiting areas, and bidirectional referral within the PHC facility.” In addition, mental health is not specifically mentioned regarding other components of a district health system like ward-based PHC outreach teams, school health, NGOs, or social services. A NOTE ON THE UN CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES South Africa ratified the UN Convention on the Rights of Persons with Disabilities (CRPD) in 2007. The Life Esidimeni tragedy, however, showed how non-compliant we are to the Convention. Our mental healthcare system must enable access to equitable services and ensure the rights of people with disabilities to receive quality healthcare. According to the Convention, the therapeutic goal becomes their ‘full and effective participation and inclusion in society’ (Article 3) and ‘equal recognition before the law’ (Article 12) meaning autonomy may not be compromised because legal capacity is distinct from mental capacity. This in particular requires a fundamental shift in the way mental health services are provided. “The MHTAC’s strategy to strengthen district mental health services aims to uphold and deliver on the rights of people with mental illness and correlates with the South African Human Rights Commission recommendations on mental health care in the country,” explains Prof Robertson. It should support deinstitutionalisation and provide housing, food, and informal psychosocial rehabilitation. In Gauteng, however regional hospital psychiatric wards are still poorly resourced. The Department is also dependent upon NGOs to avoid homelessness and re- institutionalisation. The Life Esidimeni tragedy exposed how dangerously inept NGO governance is. NGO governance and compliance teams (NGCTs) were formed in March 2018. “Their immediate role is to manage licensing requirements, ensure users have access to quality mental and general healthcare, and provide ongoing training and support to NGO personnel, who are predominantly lay caregivers.” PREVENTIVE MENTAL HEALTHCARE The aim of preventive mental healthcare is wellness and improving quality of life. One of the concerns of quality of life measures globally is that standard measures are overly focused on physical health. Quality of life measures are also not always appropriate for mental healthcare users and are, often, not culturally diverse. In addition, quality of life measures have been criticised for being created from the perspective of the mental health professional rather than that of the patient. There must be a firmer shift from an emphasis on treatment that is focused on reducing symptoms to a more holistic approach which takes into consideration well-being, recovery, social functioning, and quality of life. Severe mental disorders are chronic and the reality is that patients relapse. This means that hospitalisation, sometimes involuntary, will still be required. Preventive mental healthcare must be supported by hospitalisation when needed but should not be the first- line of treatment. “The district specialist mental health teams (DSMHTs) are key to ensure person-centered continuity of care between hospital and community and to generate evidence regarding effective preventive services for future generations.” South Africa is not a society of care and protection of the vulnerable. South Africa’s high levels of trauma and substance use and abuse could jeopardise all healthcare system efforts at preventive care. In terms of mental health care, we tend to work in silos, focussing on admission to long-term institutionalised care rather than community capacity and care. Our system of public psychiatric care is not working. There is currently no obligation on the Mental Health Review Board to ensure access to care, quality of care, or the right to dignity of care. While the Life Esidimeni Tragedy highlighted severe flaws with the healthcare system and the vulnerability of mental health care specifically, there is a reluctance to change. Reports by the Health Ombud, the South African Human Rights Commission, the Arbitration report, and others have resulted in much lip-service but actual action remains lacking. References available upon request