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Better protection of mental health patients’ human rights needed

One in three[i] South Africans will experience mental illness in their lifetimes. Although evidence-based interventions have been developed, close to 91%[ii] of people with mental illness in South Africa do not receive treatment. Poor access to quality mental health care may be related to reduced attention on mental health care, ignorance, stigma, shortages of psychiatric medicines, scarcity of practitioners and facilities. This creates a real potential if not reality of multiple violations of people with metal disability’s psychiatric patients’ human rights.
In Human Rights Month 2022, with the deaths and human rights abuses of public sector mental health patients in the Life Esidimeni tragedy five years ago still fresh in the national memory, the South African Society of Psychiatrists (SASOP) has called on the government to act decisively to prevent further violations of the human rights of mental health patients. Human rights not only include the right to life, but also to equality (meaning easy access to quality health care) and human dignity to name but a few.
Dr Kagisho Maaroganye, SASOP board member and public sector psychiatry national convenor, said that with over 70% of South Africans reliant on the public healthcare system, government should step up “as the ultimate protector of its citizens’ human rights and thus the foremost defender of our patients’ rights”.
“Good mental health is also a universal human right, and South Africa signed and ratified the United Nations Convention on the Rights of People with Disabilities (CRPD), but we are failing to implement the provisions of the convention, to use its reporting function for critical analysis of our situation, and to effectively use the mechanisms that we do have to protect the rights of people with mental disabilities.
“We call on government to dissect all the points where the human rights of our patients are likely to be violated – in their homes, within the wider community and while admitted to hospital – and take active steps to prevent these violations,” he said.
In addition to improving the national budget allocation for mental illness management and prevention, practical steps recommended by SASOP as a start to remedying the situation would involve government making more use of psychiatrists and technical experts on bodies tasked with assisting and advising on the rights of mental health patients, Dr Maaroganye said.
Mental Health Review boards, intended to be an independent local ombud ensuring that mental health patients’ rights are not violated in the first place, should have greater professional capacity, SASOP argues.
“If the board is just made up of community representatives and advocates, that may not be enough to address violations of patients’ rights. As SASOP we are calling for the inclusion of independent psychiatrists, retired or in private practice, into all district and provincial review boards. When a violation is identified, such a professional would be able to expertly and objectively review the processes that led to the violation and proposed solutions. They can then make informed recommendations on the most appropriate remedy to protect other patients,” Dr Maaroganye said.
In addition, he said, government should make greater use of the technical expertise available in the mental health professions rather than relying on non-specialist administrators, managers and general medical practitioners.
“For example, in Gauteng and KwaZulu-Natal, the mental health technical advisory team consists of psychiatrists, psychologists, occupational therapists who advise the government on how to improve mental health services in the province. We are calling for other provinces to have a similar, well-functioning specialist and technical team. 
“It is the technical experts, not the managers and administrators alone, that we need to figure out how to get us out of the current mental healthcare quagmire,” he said.
Mental illness comes with social and economic costs, as a leading cause of disability, reduced life expectancy and greater risk of suicide. Psychiatric disorders have overtaken musculo-skeletal conditions (i.e. physical disabilities) as the leading cause of medical disability claims in South Africa.[iii]
Dr Maaroganye said that the human rights of people with mental health disorders were violated by lack of access to appropriate care and treatment, with which “is under-resourced in general and even more so in mental health care”.
He said that inadequate budget allocations on public sector mental health care, as well as significantly increased spending at tertiary rather than community level, were felt in shortages of medicine, especially at the community level where the majority of patients receive treatment.
“The cost of chronic underspending is felt in rising suicide rates, the inability of mental illness sufferers to work and earn an income due to lack of treatment, and the burnout experienced by mental health practitioners.
“Psychiatrists are being forced to discharge patients earlier than advisable, because there are not enough beds to accommodate patients long enough for their condition to improve optimally. The serious, countrywide lack of child and adolescent clinics and wards is a contributing factor to teenagers and young people turning to substance abuse to alleviate their mental distress,” he said.
Dr Maaroganye said lack of treatment for mental health conditions contribute to the epidemic of violence against women and children.
“With the low rate of access to treatment, the vast majority of people with common mental health disorders such as anxiety or depression suffer in silence. Tragically, the end of the suffering is often violent, either through suicide, violence against the sufferer or violence by the sufferer against others, including homicide and gender-based violence.
“In the meantime, people with mental illness face discrimination in the workplace and in job and business opportunities; and their displays of disorganised or unusual behaviours and speech patterns damage their reputation and standing in society,” Dr Maaroganye said.
In addition, he said, the speech and social interaction impairments of mental health patients meant they were often unable to speak for themselves and enforce their human rights, “Facing barriers of stigma, prejudice and ignorance that hamper them from seeking professional care, they are at risk of their families losing hope and turning to unconventional treatment methods such as prolonged restraint”, he said.
“A society without human rights is a society without dignity, no matter how rich it may be. A society where large parts of its citizens are mentally unwell is still poorer and unjust even if everyone else is physically fit.”
[i] Herman AA, et al. The South African Stress and Health (SASH) Study: 12-month and lifetime prevalence of common mental disorders. SA Medical Journal, Vol 99, No. 5. 2009.
[ii] Docrat S, Besada D, Cleary S, Daviaud E, Lund C. Mental health system costs, resources and constraints in South Africa: a national survey. Health Policy Plan. 2019;34(9):706-719. doi:10.1093/heapol/czz085
[iii] Mokoka, M., Rataemane, S., & dos Santos, M. (2012). Disability claims on psychiatric grounds in the South African context: A review. South African Journal of Psychiatry, 18(2), 6.

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