Letter regarding the closing of Waverley Care Centre in Germiston

18 January 2016

Dear

Mr David Makhura (Gauteng Premier)

Ms Qedani Mahlangu (Gauteng MEC for health)

Ms MP Matsoso (Director General of the NDoH)

Dr Terence Carter (Deputy Director General: National Department of Health & Advisory board member of the University of the Witwatersrand Steve Biko Centre for Bioethics)

We as the occupational therapy class of 2016 at the University of the Witwatersrand have been deeply aggrieved by news of the closure of Waverley Care Centre in Germiston, and are writing with the hope that the closing of this crucial facility may be prevented.

As a student body, we have spent many hours at this institution over our first, second and third years of study and have thus developed a great appreciation for its cause.

While we are not oblivious to the problems that exist at placements like Waverley Care Centre, we consider it an important and beneficial facility with regard to the following:

Waverley is an essential mental health care facility for individuals who would be unable to function on their own in society and in many cases have been abandoned by their families. Mental health care users who have family support or capability to be reintegrated into society\their communities are discharged to allow space for new admissions.

In many cases families are not sufficiently equipped to take care of these chronic mental health care users (e.g. ensuring medication compliance and prevention of substance abuse) – this results in the stabilised mental health care users relapsing and becoming acutely psychotic. During a psychotic episode the mental health care user may be violent and harmful to themselves and others, requiring police intervention and hospitalisation at an acute mental health facility. This is problematic because

- Each subsequent relapse causes a further decline in mental function and poorer prognosis

- It worsens the “revolving door” phenomenon whereby mental health care users are admitted to hospital to have their acute symptoms stabilised, they are discharged, relapse and then are readmitted again. This is more wasteful of hospital resources as very little is ultimately accomplished (the client continues to return in a worse state than prior to discharge).

There are clients at Waverley at a very low level of functioning at which only immense external structure (i.e. constant assistance and support from caregivers) and routine managed by caregivers would allow them function. Waverley provides this structure and routine efficiently it’s structured routine and programs. This could not be replicated by individual households, because the patients as a group are treated similarly at the placement, but at home the patients could easily feel demeaned if family members or caregivers attempt to structure their routines.

Waverley has a high number of patients who have treatment resistant forms of their conditions, mostly schizophrenia. Because of the experienced and qualified staff at Waverley Care Centre and similar placements, patients have easy access to the level of care they need, which is likely not to be the case in the community, or even at community based non-governmental organisations and non-profit organisations. These organisations are unlikely to have the same cadres of staff that placements like Waverley Care Centre do.

Waverley’s structured programme allows the mental health care users a more balanced life – it incorporates opportunity for personal management, physical exercise and engagement in meaningful and productive activity (e.g. industrial therapy – such as a vocational workshop where patients can engage in assembly tasks) as run by the occupational therapy technicians and nursing staff.

Waverley Care Centre’s relationship with training institutions such as the University of the Witwatersrand (Wits):

Nursing students are placed at Waverley Care Centre as part of their psychiatric nursing rotations. This provides invaluable learning opportunities to students to learn to manage large numbers of chronically ill patients.

Patients at Waverley receive additional, individual occupational therapy treatment from Wits second, third, and fourth year occupational therapy students, supervised by qualified occupational therapy clinicians from the University. This is beneficial for the patients as their placement at this facility allows them individualised treatment.

o This treatment is of little cost to the institution as most of the cost is carried by the students. As a result the students often attempt to find low cost but meaningful activities for the patients to engage in, using recycled products wherever possible.

o This treatment does not place additional demand on the currently employed health care professionals at Waverley.

Waverley in turn provides a wonderful learning ground for Wits occupational therapy students to practice their skills in handling mental health care users, assessing their function, designing a person-specific treatment plan and then executing the treatment. It allows the occupational therapy students to observe clients of greatly varying degrees of function and provides a substantial contribution to allow them to develop their clinical skills.

As occupational therapy students, our aim is for all people to live lives at the highest level of independence possible and to attain the highest possible quality of life. This means that we do not believe that a person is well simply because they are not psychotic, and are not unwell simply because they have a mental illness. At Waverley Care Centre, residents are afforded the highest level of independence, quality of life and safety that we believe is currently available for them in South Africa.

Many people are residents at Waverley because they are not able to cope with the demands of the environments from which they came, therefore requiring the need for chronic psychiatric care. Outside of Waverley, we believe that it is unlikely that these individuals will lead meaningful, fulfilling lives. Moreover, it may not even be possible for some of them to survive in their homes as many do not have families to care for them full time, as would be required.

As we are not yet at the stage where we can provide sufficient care within the communities to the scale at which it is needed, it is imperative that we properly provide for persons with mental illness as best we can, which for now means institutions such as Waverley Care Centre. As with your remarkable helping hand in many other avenues we would implore you to also consider that this particular institution is also deserving of your assistance.

We are well aware of financial matters being at the heart of the decision to the closure of Waverley Care Centre, however mental health patients have a right to adequate treatment, but historically have been subjected to inhumane and inadequate treatment. We are concerned that these patients, who are already vulnerable, will be at risk of abuse and injury should they be discharged from Waverley. Recently, the media has published examples of under-expenditure of the allocated budget in multiple government programmes and we were wondering whether a reallocation of that budget to mental health care services could be requested.

We therefore beseech the government of our proud “new South Africa” to consider allocating some of the available funds towards this important cause to fund Waverley Care Centre so that it can provide its vital service towards caring for mental health care users in South Africa.

With kind regards and best wishes

The class of 2016 occupational therapy students of the University of the Witwatersrand