High Court of South Africa Ruler It marks a very important milestone in holding public officials accountable for his or her decisions.
As a results of the ruling, Keidani Mahlangu, who was Gauteng's health minister, and Makgabo Manamila, the province's director of mental health, can now be prosecuted for nine of the 144 deaths of mentally sick people. After the transfer. Disability from Life Healthcare Esdimini Hospitals in 2015 and 2016.
October 2015 in Mahlangu announced The Department of Health was terminating its contract with LifeSidemini in accordance with the Mental Health Care Act, “which encourages mental health care practitioners to treat mental health care workers in the least restrictive environment.” Gives”, and to avoid wasting costs.
What followed was one of the embarrassing episodes of the past 30 years.
on this Oral decision On 10 July 2024, Judge Mmonoa Teffo held that Mahlangu, through the choice to terminate the contract, and Mnamila, through the execution of the project, were accountable for the disaster.
Now each of them will be charged criminally.
Like Psychologist With a few years of experience working in academia and in communities, that is, to my knowledge, the primary time in democratic South Africa that public health officials have been held personally accountable for the results of a political decision.
It also highlights the devastating consequences of not caring for the nation's most vulnerable residents and putting perceived value before outcomes.
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Most helpless
It is value remembering how vulnerable the people living in Life Esdimini Hospitals were. They lived with chronic neuropsychiatric conditions akin to schizophrenia, bipolar disorder, mental disability, cerebral palsy, epilepsy and dementia, often greater than certainly one of them.
Their influence was such that it became difficult to live of their communities. A person affected by chronic schizophrenia had reportedly resided at Esdimini Hospital for 40 years.
Most people living in life-saving facilities were admitted under this. Mental Health Care Act As “Assists consumers in mental health care.“By trained medical professionals, meaning that decisions about their care were supported by a member of the family or carer and two mental health practitioners.
Essentially, contract termination overrides decisions made by families and trained professionals, ostensibly to get monetary savings.
How did the tragedy unfold?
Mahlangu in October 2015 announced The Gauteng Health Department will end its decades-long contract with Life Esdimini, a cluster of privately run mental health facilities.
The agreement ensured the availability of medium to long-term hospital look after individuals with severe mental disabilities.
Mahlangu justified the choice as a “project”. Deinstitutionalization of patients According to national policy, but said the explanation for the choice was that the contract was unaffordable.
The contract was meant to be terminated. 1,700 Mental health patients needed to be transferred from life-saving hospitals to alternative care.
As of the top of June 2016, some users had been sent to their families, just over 200 had been transferred to provincial tertiary teaching psychiatric hospitals, and over 1,200 had been transferred to either government-run care centers or Moved to certainly one of 27 residential homes run by foreigners. -Governmental Organizations (NGOs).
The process was chaotic. A scarcity of planning meant that many informal homes were inadequate, understaffed, and lacked experience in providing the care needed.
It was later revealed that there have been many NGOs. Fraudulently licensed and is inadequately subsidized by the health department.
Former Gauteng health chief, Tiego Selebano, later Admitted Under oath to sign and backdate the NGO license – even after the patient's death.
Some mental health clients with different diagnoses and medical needs were transported to different NGOs in open pick-up trucks.
Some had hands and feet. tied up.
Families weren't informed of their family members' whereabouts, confidential patient records were lost or damaged, and folks were sometimes bounced between multiple NGOs.
By early September 2016 it was clear that things had gone tragically fallacious. Mahalingo announced In the Gauteng legislature, 36 people died consequently of the policy.
By the time the inquiry chaired by Tafo began its work in July 2021, the death toll had risen to 144.
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Last in line
I used to be a member of the Sedebeng District Mental Health Team throughout the Life Esdimini tragedy. We received 63 mental health care consumers, who were placed in five different non-governmental organisations.
In Life Esidimeni, users were allocated. R320 Or just below $18 per day. Now other than NGO subsidy R112 Or just $6 per user per day, with no additional resources allocated to our (or every other) district.
However, the care we provided required close collaboration between the mental health team, family medicine and first health care practitioners, and non-governmental organizations.
Already understaffed, routine medical services met the urgent needs of probably the most distressed, fragile people coming from Life Esdimini.
The process was such that it seemed that decision-makers and government officials didn't need to take care of all eight. People first – or “people first” – principles of public service: consultation, quality of service, accessibility, courtesy, information, openness and transparency, redress, and value for money. Or perhaps Batho Pele's principles didn't apply to individuals with mental disabilities.
Will it matter?
gave Mental Health Care Act Promotes care in a minimally restrictive environment. Wherever possible, individuals with mental illness requiring long-term care ought to be discharged for follow-up in primary care or community mental health services.
However, 20 years after the Act's enactment, government funding continues to prioritize stand-alone psychiatric hospitals. Primary care and community mental health services remain under-resourced despite the cruel lessons learned throughout the Zindagi Esdimini tragedy.
South African society shouldn't be protected, secure or supportive of individuals with mental disabilities. It is riddled with violence, poverty and psychological stress, aspects from which individuals with mental disabilities are most in danger. If they'll't access long-term hospital care, they often should fend for themselves.
Holding government officials accountable for his or her indifference and incompetence is a very important step.
But, while the Life Esdemini decision brings some dignity to individuals with mental disabilities, it shows the devastating consequences of policies that should not supported by adequate funding.