Is it tragedy or is it hope? Death of 94 patients has elevated mental health issues

Although there is a dichotomy in the meaning of this expression, ‘one becomes alive as another one dies’, it perfectly highlights how the tragic and unjustified deaths of 94 extremely vulnerable mental health patients has brightly shone the spotlight directly onto the state and civil society’s responsibility for medical care.

The consequences of implementing a course of action, rapidly and hurriedly, without clarifying reasons behind it, has ironically shown how powerful silent voices can be when strategic leadership makes a technical decision without truly considering the consequences of it, or taking responsibility for it.

We are all up in arms to ensure that the Gauteng health officials are made to account for the death of these 94 people from Life Esidimeni.

The decision to literally farm these patients out to NGOs, was based on a poorly planned and executed deinstitutionalisation process.

It is tempting to lay the blame at these officials, but there must be other drivers that forced the Gauteng Department of Health to take such drastic measure to deal with this issue.

Perhaps rising concerns around drug abuse contributed to a knee jerk reaction, where government was under severe pressure to prioritise one matter over the other.

In short, making an economic decision when people’s lives are at stake.

In light of this, one wonders if the disastrous consequences could have been foreseen by the MEC for Health, Qedani Mahlangu, Head of Department, Dr Tiego Selebano and Director, Dr Makgabo Manamela?

Even when forced to embrace the economic imperative, leadership must unconditionally consider the ethical consequences without compromising responsibility to people. In short, a minimum expectation of responsible leadership and governance means embracing meaningful stakeholder engagement. It seems the latter was not sufficiently done.

So this begs the question, when is it sufficiently exhausted? The implementation of the decision to  remove persons with mental disabilities from government health institutions thereby reducing  healthcare expenditure is one that some might justify for the survival of the business. In short, outsource.

However the context and manner in which such a decision is taken cannot be done lightly.

Implementing change strategies requires an investment in communication, transparency, honesty and acknowledging fears and dealing with anxieties of the unknown. Conditions and resources of where the patients were to go, should be diligently investigated and monitored. Transferring patients out, does not mean abdication.

We should not be diverted with the noise and concerns that are used through this tragedy to settle political scores.

At the same time we should lose focus or be distracted by the noise.

Are these noises for the benefit of the 94 patients, will this bring justice and closure to the grieving families of the 94 patients or will this ensure that strategic decisions are never, ever again implemented in a haphazard or ad-hoc knee jerk reaction?

The MEC has now resigned, charges have been laid and some are calling for the head of the Gauteng Premier, David Makhura.

Will these actions alone help in changing the narrative? Is this an opportunity for mental health and in fact all vulnerable patient issues to be raised and  be dealt with due humility, respect , dignity  and humaneness as indicated in both the Mental Health Care Act and the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).

It is through the UNCRPD where the rights of persons with disabilities are ensured that they have a right;

  • to high standard of health without discrimination (article 25),
  • not to be subjected to torture or cruel, inhuman or degrading treatment (article 15),
  • to life (article 10), the right to an adequate standard of living for themselves and their families, including adequate food, clothing and housing (article 28) and
  • to live independently and to be included in the community (article 19).

Through the death of the 94 patients, they have been heard, their voices have been raised higher, dialogues and narratives are enacted.

Lefu la hae la mphidisa’.  Hopefully others who are suffering silently from mental illness will get heard.

Some leaders resign (either forced or voluntary) when the public backlash becomes acute, yet on the other extreme there are leaders who do not show any remorse, even in the midst of a court finding.

Taking responsibility instead of denial, generally gains some measure of respect.

Stepping down certainly is not grounds for forgiveness, but it gives way for justice, honesty and respect of processes to occur, which in time will help with the healing process.

However, failure to put the interests of others ahead of your own is usually the downfall for most leaders.

Former MEC, Mme Qedani Mahlangu, now has the time and the space to restore dignity to the families of the bereaved.

The state and civil society must now reflect not only on this moment’s tragedy but the processes that led to it.

Trying to get to consensus on how to repair the harm done is a difficult step during the restoration process.

The tragedy is everlasting, but by ensuring that we become alive through their deaths, we respect their passing and ensure that the benefits of doing the right thing are too.