There is something deeply rotten in South Africa’s mental healthcare system.
The latest tragedy to grab the headlines is the death of 35 year old psychiatric patient Lerato Mohlamme, who died from burn injuries sustained in a fire at George Mukhari Academic Hospital (GMAH) in June 2024. The health ombud’s investigation report into the horror, released last week, reveals neglect and abuse tantamount to torture: she was denied food and medicine as punishment, confined to an unheated seclusion room clad only in underwear and left in the hands of grossly undersupervised staff.
There is no question that the management is ultimately accountable for the failures that happen on its watch. But there is also something deeply worrisome about the apparent ease with which low-ranking staff either meted out abuse or turned a blind eye to their colleagues’ transgressions. GMAH is a teaching hospital, linked to the Sefako Makgatho Health Sciences University. It is responsible for helping to train the next generation of healthcare professionals and should be a beacon of professionalism, care and compassion. The ombud’s report reveals it to be nothing of the sort.
The most disturbing aspect of the human rights abuses exposed by the investigation into Mohlamme’s death is that we’ve seen this picture before. Ten years ago, 144 state psychiatric patients died after the Gauteng health department transferred them from the private Life Esidimeni facilities, where many of them had lived comfortably for years, to unlicensed, ill-equipped non-governmental organisations.
Leadership of that calibre is sorely lacking in the public health sector and there is clearly no political appetite to institute the kind of guardrails required to once and for all end the abuse of mental healthcare patients.
There they died of neglect, deprived of food, warmth and essential medication. In the ensuing years the nation was periodically gripped by the grim details exposed by the health ombud’s investigation into their deaths, an inquest and a report by the South African Human Rights Commission into the state of mental health care in South Africa. Politicians wrung their hands and professed sorrow, but the sea change that health advocates and bereaved families desperately hoped would emerge from the tragedy never materialised.
The malaise that led to the deaths of Mohlamme and the Life Esimidemini patients is not confined to Gauteng. The health ombud’s investigation into psychiatric patient care at Northern Cape Mental Health Hospital, the findings of which were released last year, revealed equally callous indifference to the suffering of some of society’s most vulnerable people. Patients were exposed to dangerously cold conditions in the middle of winter, when temperatures regularly drop below freezing, left in the care of unsupervised junior staff and forced to use bathrooms in which sewage emerged from the showers.
There are clearly problems with resources: provincial health departments allocate on average just 5% of their budgets to mental healthcare, and many facilities are grappling with crumbling infrastructure and understaffing. But as the “tree schools” that achieved high matric pass rates despite their lack of classrooms repeatedly demonstrated, capable and dedicated leadership can overcome infrastructure and staffing constraints.
Leadership of that calibre is sorely lacking in the public health sector and there is clearly no political appetite to institute the kind of guardrails required to once and for all end the abuse of mental healthcare patients.
Former president Nelson Mandela wrote in his autobiography, Long Walk to Freedom, that a nation should not be judged by how it treats its highest citizens but its lowest ones. He was, of course, referring to the apartheid government’s systemic oppression of black citizens. But he could just as well be referring to the government of today and its cold disregard for people with mental health conditions.