Huge bed shortage and poor facilities for psychiatric patients in Gauteng

Treatment of psychiatric patients in Gauteng is hugely compromised by a shortage of about 2700 beds and unsuitable facilities in bad repair.

This is my conclusion following a 22 page comprehensive written reply by Gauteng Health MEC Gwen Ramokgopa to my questions in the Gauteng Legislature (Full reply can be accessed here).

According to norms for severe psychiatric conditions, there should be 28 acute psychiatric beds/100 000 people. There should therefore be 3780 such beds for 13.5 million people in Gauteng, but there are only 1058 beds.

A major problem is that many patients admitted to hospitals for the required 72 hour treatment and observation period are not placed in dedicated psychiatric wards.

Gauteng public hospitals admitted 18387 psychiatric patients in 2016, but 4425 of these (24%) were placed in ordinary wards with other patients.

The worst affected hospital is South Rand Hospital which had 2586 psychiatric patients last year, but 972 of them were placed in ordinary wards because the two psychiatric wards were full. This led to three psychiatric patients dying because they jumped from windows, and one patient raped another because of inadequate security.

The following hospitals have no dedicated psychiatric wards at all but still accept large numbers of psychiatric patients:

Pholosong - admitted 763 psychiatric patients in 2016
Far East Rand - admitted 711 psychiatric patients in 2016
Heidelberg - admitted 285 psychiatric patients in a general medical ward in 2016
Bheki Mlangeni - admitted 95 psychiatric patients in 2016

Other hospitals do have psychiatric wards but these are inadequate so many psychiatric patients are placed in other wards as per the following figures for 2016:

Thelle Mogoerane - admitted 1504 psychiatric patients, 1113 of whom were placed in general wards
Sebokeng - admitted 673 psychiatric patients, but 192 were placed in general wards
Tambo Memorial - admitted 507 psychiatric patients, but placed 214 in general wards
Jubilee - admitted 495 psychiatric patients, and placed 49 in general wards
Leratong - admitted 965 psychiatric patients, and only had to place 24 in other wards

Placement of psychiatric patients in general wards is not ideal as there should be special security measures both for their safety and the safety of others. A number of suicides, injuries and sexual assaults have already been reported at various hospitals for this reason.

Many of the psychiatric wards are in a poor state and need urgent repair.

The psychiatric ward at the Charlotte Maxeke Johannesburg Hospital was meant to be upgraded ten years ago, but has been delayed by incompetent contractors who could not finish the job. The department says there are "plumbing challenges" at this ward - earlier this year patients could not take a bath or shower in the ward because of leaks into other wards. The latest projection is that ward renovations will be completed in May next year, which remains to be seen.

New psychiatric wards at Helen Joseph Hospital have also been delayed for many years by incompetent contractors. Ramokgopa says that the construction work has been suspended and work will commence after a contractor has been reappointed.

Psychiatric Ward 2 at this hospital has basic facilities but doors don't close properly in the bathrooms, and there are no toilet seats. There is no facility to properly house contained patients - they are now put into lockable rooms with a moveable bed instead of an immovable/concrete bed.

Psychiatric Ward 3 at the hospital is " an incomplete shell. No vinyl on the floor, no equipment, no beds or linen."

The only psychiatric wards deemed to be in reasonable condition are at the Steve Biko, Chris Hani Baragwanath, Bertha Gxowa and Kalafong hospitals.

Problems at other hospitals include the following:

Thelle Moegerane (New Natalspruit) Hospital) - the bed capacity of the psychiatric unit is smaller than the previous Natalspruit Hospital and there is no CCTV in the ward.
Sebokeng Hospital - the current ward is not compliant to the provisions of the Mental Health Act.
Pholosong Hospital - the cubicles where the psychiatric oatients are admitted are not conducive for such patients. There is no seclusion facility for violent patients.
George Mukhari Hospital - the sewage system needs revamp. The seclusion rooms need refurbishment. Need an appropriate recreation room.
Tembisa Hospital - no space for Occupational Therapy Services

There are infrastructure problems at all the four specialized mental hospitals, with major renovations needed at the Weskoppies and Tara hospitals.

Cullinan Hospital

Only 8 out of 14 wards are functional at the Cullinan Hospital which has 285 beds for mentally retarded patients.

Sterkfontein Hospital

This hospital has 813 beds in total. Most of the wards are in acceptable standards but minor infrastructure defects arise intermittently.

Ward 11 is habitable but requires significant infrastructural renovations.

Ward 5 was found unsuitable for use and is currently closed.

Weskoppies Hospital

Ramokgopa's reply gives four-and-a-half pages of detail on repair, maintenance and required upgrading at this hospital which has deteriorated alarmingly.

Of greatest concern is that Wards 8, 9, 12 and 13 were "Urgently renovated to accommodate Life Esidimeni patients. Presently not in good condition ... the sewer line, water pipes and locking systems not addressed. Plumbing a great challenge."

It is horrific that Esidimeni patients rescued from unsuitable NGOs are now in substandard wards at Weskoppies.

The High Risk Forensic Ward and the Observation Unit are not in good condition and need to be renovated.

Eight wards have been evacuated and are closed because they are in poor condition.

Other buildings at the hospital are also assessed to be needing repairs.

Unreliable electricity for shock therapy -

the building used for Electroconvulsive Therapy (ECT) does not have an uninterrupted power supply, and power failures have interrupted ECT, which is disastrous. An uninterrupted power supply is needed urgently, but is not budgeted for in this financial year.

A new 300 bed hospital is in the planning phase, with building meant to commence in 2018, but I doubt that this will happen given the past poor record in building hospitals.

Tara Hospital

There are 8 functioning wards with 137 beds but a myriad of faults and structural issues are listed.

Problems include the following:

Ward 1/2 - physical structure not conducive to the treatment of patients, space too small on the first floor. Adolescent patients may be able to jump through the windows. Courtyard and garden not usable as patients can abscond, so patients are kept indoors most of the time.

Ward 4/5 - there is no examination room, same room is used as a computer room. Cracked ceiling causes leakage during rainy season and all the rooms need painting.

Ward 6 - there are no rooms to conduct group sessions. No space to fit a bed for physical examination in the treatment room. No burglar bars in the kitchen and the TV room.

Ward 7 - leaking pipes, blocked toilets. Courtyard needs proper fencing. Security gate and CCTV cameras not working, high risk of patients absconding.

Ward 8 - roof and toilets leaking. The ceiling in the corridor leading to the courtyard is about to collapse.

Ward 9 has a variety of structural issues and becomes extremely cold in winter.

Conclusion

Psychiatric patients are very vulnerable, but present treatment facilities are grossly inadequate.

I am greatly concerned by the shortage of acute psychiatric beds and the poor state of many psychiatric wards in Gauteng.

The Esidimeni tragedy has focused attention on the plight of mental health patients but much more work is needed to provide consistent high-quality care for mental health problems.

Statement issued by Jack Bloom MPL, DA Gauteng Shadow Health MEC, 17 August 2017