Lessons from Life Esidimeni tragedy: 144 mentally disabled South Africans died.

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Most Helpless

As a psychiatrist with many years of experience in academia and working in communities, this is the first time in democratic South Africa that government health officials have been held personally responsible for the consequences of a political decision.

How the Tragedy Unfolded

In October 2015, Mahlangu announced the Gauteng health department would end its decades-long contract with Life Esidimeni, a cluster of privately run mental healthcare facilities. The contract had ensured the provision of medium- to long-stay hospital care for people with severe mental disabilities. Mahlangu justified the decision as a "project" to deinstitutionalise patients in line with national policy, but said the reason for the decision was that the contract was unaffordable.

The Devastating Consequences

Ending the contract meant about 1,700 mental health patients had to be relocated out of the Life Esidimeni hospitals to alternative care. By the end of June 2016, some users were sent home to their families, just over 200 were transferred to provincial tertiary academic psychiatric hospitals, and over 1,200 were moved to either a state-run care centre or one of 27 residential homes run by non-governmental organizations (NGOs).

Lessons from the Inquest Judgment

The inquest presided over by Judge Mmonoa Teffo has brought to light the catastrophic consequences of the Gauteng health department’s decision to terminate the Life Esidimeni contract. Judge Teffo’s oral judgment on July 10, 2024, found Mahlangu, through the decision to terminate the contract, and Manamela, through implementation of the project, responsible for the deaths of 144 people.

Holding Officials Accountable

The judgment marks an important milestone in holding public officials to account for their decisions. As a result of the ruling, Qedani Mahlangu, who was the health minister for Gauteng province, and Makgabo Manamela, who was the province’s mental health director, can now be prosecuted for nine of the 144 deaths that occurred following the transfer of people with mental disability out of Life Healthcare Esidimeni hospitals in 2015 and 2016.

Will It Make a Difference?

The Mental Health Care Act promotes care in the least restrictive environment possible. Wherever possible, people with mental illness who require long-term care should be discharged for follow-up at primary care or community mental health services. However, 20 years since promulgation of the act, government funding continues to prioritize stand-alone psychiatric hospitals. Primary care and community mental health services remain underresourced, despite the hard lessons learnt during the Life Esidimeni tragedy.

Conclusion

Holding public officials accountable for their callousness and incompetence is a significant step forward. However, while the Life Esidimeni judgment brings some dignity to people with mental disability, it lays bare the catastrophic consequences of policies which aren’t backed up by appropriate funding.

FAQs

Q: What happened during the Life Esidimeni tragedy?
A: The Gauteng health department terminated its contract with Life Esidimeni, a cluster of privately run mental healthcare facilities, resulting in the deaths of 144 people with mental disability.

Q: Who was responsible for the tragedy?
A: Qedani Mahlangu, the former health minister for Gauteng province, and Makgabo Manamela, the former mental health director, were found responsible for the deaths of 144 people through their decisions to terminate the contract and implement the project.

Q: What is the Mental Health Care Act?
A: The Mental Health Care Act promotes care in the least restrictive environment possible and ensures that people with mental illness who require long-term care are discharged for follow-up at primary care or community mental health services.

Q: Why is it important to hold public officials accountable?
A: Holding public officials accountable for their decisions and actions is crucial in ensuring that they are held responsible for their actions and that they do not get away with neglecting their duties.

Q: What can be done to prevent such tragedies from happening in the future?
A: Appropriate funding for primary care and community mental health services is crucial in ensuring that people with mental disability receive the care they need. Additionally, holding public officials accountable for their decisions and actions is essential in preventing similar tragedies from occurring in the future.