Esidimeni: Global lessons from a local tragedy

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cemetery at nightThe former SA head of mental health services Melvyn Freeman has broken years of silence over the Life Esidimeni tragedy, writing  in The Lancet Psychiatry that NGOs chose patients like ‘slave owners choosing their new ‘possessions’.

According to a Bhekisisa report, Freeman was the national Health Department’s chief director of non-communicable diseases when the Gauteng Health Department decided to remove about 1,700 long-term state-funded patients out of private Life Esidimeni facilities. Patients were then placed mainly in ill-equipped and unlicensed NGOs, and at least 144 people died.

The Gauteng Health Department never informed Freeman, nor the national health department of its plans, the report says the 2017 Health Ombudsman report revealed.

Freeman writes: “The owners of the NGOs were provided with ‘line-ups’ of mental healthcare users and were allowed to decide whom they wanted to take. This draws parallels with slave owners choosing their new ‘possessions’.

“The way people were moved…, where they were moved to, how they were treated and even the handling of bodies after death, suggests that the co-ordinators and enforcers of the project perceived mental health users as lesser human beings.”

After the national Health Department became aware of the Gauteng government’s plans, its director-general Precious Matsoso also repeatedly requested that Gauteng mental health directorate and nurse Makgabo Manamela brief Freeman on the project. But Manamela never did, the ombuds’s report found.

“It is especially worrying that healthcare leadership and professionally-trained health workers could permit such things to happen. A few healthcare workers refused to participate,” Freeman writes. “No professional is obliged to carry out an instruction if it is unlawful in their judgement or is likely to lead to the death and injury of a person.”

South Africa witnessed a national tragedy between October, 2015, and June, 2016, when the Department of Health in Gauteng province moved 1711 mental health-care users with severe mental illness or severe and profound intellectual disability out of facilities managed by a private company, Life Esidimeni, mainly into the care of non-governmental organisations. The plan was called the Gauteng Mental Health Marathon Project. In a rushed and flawed process, 144 people died, and the whereabouts of another 44 remain unknown. The report of an extensive arbitration process, released in March, 2018, raises important ethical, moral, political, legal, governance, accountability, and clinical issues. The events from the tragedy and findings that were made also serve as lessons for future deinstitutionalisation globally.

Melvyn Colin Freeman

Bhekisisa report
The Lancet Psychiatry report summary

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