According to the WHO, nearly 14% of the global burden of disease can be attributed to mental disorder
The events surrounding the Life Esidimeni tragedy, where 91 mental health patients died in the Gauteng province of South Africa while under government care, is a shocking reminder of the gap between the lawful rights and harsh realities of mental disorder sufferers in South Africa.
According to the WHO, nearly 14% [1] of the global burden of disease can be attributed to mental disorders. It is estimated that about 300 million people suffer from depression and 60 million from bipolar mood disorder alone [2]. Suicide accounts for 800,000 deaths annually and has become the second leading cause of death in 15 to 20-year olds [3].
Within South Africa, one in six people suffer from anxiety, depression or problems associated with substance abuse and over 40% of those living with HIV suffer from a mental disorder [4]. With increasing research focused on the social determinants of mental health, including social and economic factors such as income, inequality and gender; this means that more vulnerable and marginalised communities are at higher risk of mental illness.
Professor Sylvester Chima, Associate Professor and Head of the Programme of Bio and Research Ethics and Medical Law at University of KwaZulu-Natal, and expert speaker at the upcoming Africa Health Conferences, says that while progress has been made in recent years with policies and laws that aim to increase accessibility to mental disorder treatment, many health systems are still not able to respond to the growing number of cases. It is crucial that the gap between the need for treatment and its provision is addressed.
“In many countries, legal frameworks that permit detaining and treating the mentally ill without their consent are not accompanied by any corresponding duty to ensure adequate, appropriate treatment for the patient in question. This leaves people with mental disorders vulnerable to a myriad of human rights abuses,” says Chima.
For example, every patient has a right to informed consent. This means that patients should be given the information they need and should understand well enough to be able to make an informed decision about their care, that will be respected by their healthcare worker.
Chima says that while patients with mental disorders can be detained for treatment without their consent if they are at risk of harming themselves or others, this represents a small percentage. “Legally a vast majority of patients with mental health disorders still retain their right to informed consent.” However, many patients are confined to mental health facilities against their will, some for months or even years. The WHO lists reported consent violations as one of the most common human rights abuses for people with mental disorders [5].
Involuntary detention can take extreme forms such as in Ghana, where people with mental disorders are often restrained with shackles [6]. Shackling is commonly the result of stigma and misinformation about mental illness, which is most often due to the families of the mentally ill lacking the resources or access to more appropriate forms of treatment.
The lack of support for families of the mentally ill is also aggravated by the allocation ofavailable funds, which are spent on mental health facilities that only serve a small proportion of those who need care, leaving community-based treatment programs severely under-resourced.
