The public sector averages just 0.31 psychiatrists per 100 000 people, with far fewer in remote areas, with lack of specialised facilities, collapsing infrastructure and unequal access to psychiatric specialists exacerbating the problem, reports TimesLIVE.
Recently, staff at Zithulele Hospital in Mqanduli, Eastern Cape, watched in horror as a mentally ill patient scaled the hospital roof.
Nurses, speaking on condition of anonymity sai: “He was not only endangering his own life but was also a danger to other patients and staff.” Security coaxed him down, but it was not an isolated incident.
Zithulele serves a population of 130 000 but has no psychiatric unit.
“Sometimes mentally ill patients jump out of windows trying to escape,” said a nurse. “They are mixed with other patients because we have no dedicated psychiatric ward. None of us is a trained psychiatric nurse. We have to call security to administer injections to some patients.”
About 200km away, nurses at Komani Psychiatric Hospital said for two years, patients had no toiletries and bathed in cold water due to budget constraints.
“All of the hospital beds are full. Some patients are sent to Frontier Provincial Hospital. Doctors have to travel between the two facilities. We work under immense pressure because of a chronic shortage of nurses.”
Eastern Cape Health spokesperson Siyanda Manana said to improve safety in hospitals without dedicated mental health units, staff are undergoing training.
“This took place last year and is happening again this year, with assistance from the Foundation for Professional Development.”
He said safety concerns at Zithulele Hospital will be mitigated by upgrades, including two secure seclusion rooms to contain unmanageable patients.
Manana said 56 listed district hospitals were meant to admit acute mental health patients, but did not meet standards to safely accommodate all mental health conditions.
“However, over the past months, the department has contracted the Coega Development Corporation (CDC) with plans to roll out acute mental health observation units across all district and regional hospitals. CDC has conducted detailed assessments at more than 25 hospitals … for proper acute … units.”
Frontier, Bhisho, Nompumelelo, Butterworth, Glen Grey and Malizo Mpehle hospitals are already at advanced planning stages with proposals tailored to their unique needs and capacities, he said.
Dr Kathleen Mawson, a specialist psychiatrist and senior lecturer at Tygerberg Hospital and Stellenbosch University, said without access to medication, patients’ recovery prospects were limited.
Manana said the department was drafting a new organogram to focus on strengthening district services and community-based services. In collaboration with Walter Sisulu University, Rhodes University, Nelson Mandela University and Lilitha Nursing College, psychiatrists, psychologists, social workers and psychiatrists nurses were being trained.
He added that doctors, psychologists and social workers from Fort England Hospital conduct outreach services to district hospitals.
“Every clinic has basic mental health medication for dispensing purposes and refers to the upper level of care when need arises,” he said.
But in March, Health Ombudsman Professor Taole Mokoena released findings from an investigation into psychiatric patient neglect in Northern Cape hospitals, citing leadership failures, staff shortages and collapsing infrastructure. Two psychiatric patients died, one was left bedridden.
The country’s mental health system is governed by the Mental Healthcare Act and the National Mental Health Policy Framework and Strategic Plan 2023-2030, which calls for better funding, integration of mental health into general health care, and expanded community-based care.
Yet the country spends only 5% of its health budget on mental health, the lion’s share going to inpatient psychiatric hospitals, not preventive or community services.
Cassey Chambers, operations director at the SA Depression and Anxiety Group, said access remains “shockingly” limited: “Only one in 10 South Africans with a mental illness receives treatment. In rural and underserved areas, services are severely limited or non-existent.”
Mawson said the Mental Healthcare Act required district hospitals to have psychiatric wards, but only about 13% did.
TimesLIVE article – The shocking truth about SA’s mental healthcare crisis (Restricted access)
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