When South Africa’s Gauteng province wanted to save money, its government decided to cut costs on mental health care. It moved more than 1,000 patients out of private hospitals into unregistered facilities without trained doctors or nurses. Patients were selected like an “auction cattle market” and transferred on the back of pickup trucks. Then, without their relatives knowing, 94 of them died in unlawful circumstances. 


These are the findings of an explosive investigation into one of the biggest health scandals to rock South Africa in decades. A newly released report from the Office of the Health Ombud found only one of the patients died from mental health-related causes. The rest died from dehydration, diarrhoea, epilepsy, heart attacks and other causes between March and December last year. Some of the bodies had unexplained bruises. 


Gauteng’s health minister has resigned, but victims’ relatives are pushing for greater accountability and financial reparations from the ruling African National Congress. After public outrage flooded social media, President Jacob Zuma issued a statement last week welcoming the investigation and expressing his condolences to the victims’ families. He said he would be apprised on steps needed to ensure patients requiring mental health care receive the utmost support, empathy and expertise. 


That would take a cultural shift from a system that now treats patients as a business opportunity, according to the health ombudsman, who found profit-seeking led to fatal neglect. As officials warn the death toll could rise, South Africa is grappling with the value it places on human life. 


Families of people with mental health disorders like schizophrenia, bipolar disorder and even Alzheimer's are often unable to provide the needed care. But placing them in psychiatric hospitals, even when they are well run, can widen the gulf between “healthy” and “unhealthy” people, worsening the stigma around mental illness. On a small scale, South Africa is experimenting with integrated care, bringing trained specialists into communities where the patients live. More often, however, mental health patients are being moved out of hospitals without a community-based program to support them.


We discuss South Africa’s response to the mental health scandal, and how it may help or hurt the country’s handling of deinstitutionalisation and move towards community-based care.


On this episode of The Stream, we speak with:


Dr. Bharti Patel @safmh
National Director, South African Federation of Mental Health


Christine Nxumalo 
Sister of patient who died


Laura Lopez Gonzalez @LLopezGonzalez
Health News Editor, Bhekisisa Centre for Health Journalism


Crick Lund @CPMentalHealth
Director, Alan J. Flisher Centre for Public Mental Health


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