by Federica Miccoli, Tshwane WASP
Life Esidimeni. A name which has become identical with the horrific abuse of the most vulnerable, identical with exploitation, neglect, indifference and inhumanity.
A name that should remain carved in our memories like Marikana, where human beings were sacrificed on the altar of capitalism.
A story whose every detail underlines the ways a neo-liberal society oppresses the needy and steals from them.
The facts are well known: at least 141 mental patients died in unspeakable circumstances in the first months of 2017, after 800 of them had been transferred from a health care facility to a number of NGO’s absolutely unequipped to take care of them. Allegedly the move was made in order to save financial resources. It is a direct consequence of the ANC’s post-2008 austerity programme, strengthened and deepened every year, especially under Pravin Gordhan’s time as finance minister.
Transported like cattle, sometimes tied in bakkies on the route from the health care facility to the NGO’s quarters, mentally disabled persons were deprived of decent accommodation and proper nutrition and left without adequate medical assistance and medication.
Their relatives were not informed of their whereabouts and after at least 141 of them died, often their identity kept and unlawfully used by the same NGOs to receive social grants.
Allegations of devilish collusions between the NGOs and the mortuaries simply add misery to the picture.
Proceedings are still ongoing at the Esidimeni arbitration hearing to acknowledge responsibilities and grant the families of the deceased an opportunity to know the truth about the circumstances of the death of their loved ones and, if available, receive financial compensation.
While we hope that the arbitration will help the relatives of the departed to get closure and possibly also lead to an increased accountability of the government, when loved-ones lives are involved, and our fellow citizens, we cannot get closure just by the unveiling of the individuals responsible.
Can we really believe that the naming and shaming of the few immediately responsible will avert the repetition of similar tragedies in the future?
Are we really convinced that the roots of the problem can simply be found in individual, or even departmental, indifference, negligence, ignorance and greed?
Or shouldn’t we actually ask ourselves what political conviction allowed the Health Department to tramp over the dignity, and ultimately the lives, of hundreds of its citizens and their families?
It is undeniable that capitalist ideas and realities are at the basis both of the problem (mental illness) and of the failure of the solution (totally inadequate treatment).
Roots of mental illness
In his new book, Politics of the Mind, author Ian Ferguson underlines how mental distress in each of its forms, most common as depression, anxiety and suicidal tendencies, are on the increase everywhere in Europe. The numbers of individuals affected are high in particular among those who have lost their jobs or are working under pressure or are in fear of losing social benefits. Debt among low paid workers is also a cause of mental issues.
In other words, the pressures and the challenges of living in a neo-liberal society are a great cause of emotional instability which leads to disability.
Does it ring a bell? Can we somehow link this description to the millions of unemployed or precariously employed in our South African neighbourhoods? Does this remind us of the millions of our children in our townships who can’t dream of any future, due to the unaffordable costs of education? Can we apply these words to the uncountable precarious workers who die every day unreported due to the lack of minimum safety measures? And to the thousands of cancer or other chronically ill patients who have no access to treatment, unless they subscribe to pricey insurances?
The book also challenges the medical model, which suggests that mental distress, whether it’s got the labels depression, anxiety, schizophrenia or whatever, is somehow unrelated to what’s going on in people’s lives, what’s going on in society. That particular model individualises mental distress.
The medical model, followed in the last 150 years, takes away the responsibility of mental illness from society to place it on the individual, in the form of physical (brain) or moral weaknesses.
It goes without say that the individualisation, and consequent medicalisation, of distress identifies the pharmaceutical remedies as the only possible cure. This in turn leads to the enrichment of the pharmaceutic sector.
The author, like us, disagrees with the medical model and suggests that with the current levels of mental distress, the increase is very much related to the pressure that capitalism puts on people’s lives. The solution therefore is a turn from medical to social and economic interventions.
Another cause of psychosocial distress, originating from capitalistic economies, is the alienation of the workers not only from the means of production but also from their material and psychological needs, which are not taken into consideration, or get totally twisted and distorted, in the name of enhanced productivity.
In addition, patients and their families are left on their own to fight the right to their non-conformity, to their humanity, to their uniqueness and diversity. They are left in isolation to handle the inconsistent voices that psychotic patients hear, voices that translate the confusion that comes from being part of a society alienated from itself.
Cost-cutting not care
Where the families cannot take care of the “mentally ill”, as just happened in Gauteng: the government’s view is that the burden on the capitalist structures needs to be minimised, the loss of resources invested in taking care of the “non-productive citizens” (in a capitalist view) must be reduced to the minimum.
Quite interestingly, the South African Mental Health Policy Framework and Strategic Plan 2013-2020 identifies “economic deprivation, low education, unemployment, lack of basic amenities/housing” as the main generators of substance abuse and mental illness in South Africa.
The same plan proposes meaningful solutions, including community based interventions, access to education and jobs for persons with mental challenges, anti-discrimination and awareness raising activities, maximum support to families and carers, recovery and rehabilitation programmes.
Pity that they all sound utopian in a context where profitable mines close, leaving 40,000 people jobless between 2015 and 2016; where one of the main candidates to the Presidency of the country was until a short time ago a shareholder in multinationals that reap off its resources, while cleverly avoiding paying its taxes; where free education keeps on being denied to the poorest, and where 42 unidentified corpses are left unattended on the motorway for several hours, after the open trekker that was carrying them (from nowhere to nowhere, for what they matter) overturned on its way.
The Strategic Plan mentioned above repeatedly refers to the limited financial resources devoted by the South African State to Mental Health and to the need of implementing the proposed measures with the resources available. As such it accepts the status quo, it surrenders to the dictates of a capitalist state. We strongly oppose this stance.
Firstly, the numbers of mentally disabled people and of substance abusers, and therefore the relative costs, could be drastically reduced just by providing adequate housing, food, free healthcare and free education to the poor.
A Latin proverb goes: “mens sana in corpore sano” (A healthy mind sits in a healthy body). How can we have a mentally healthy population if tens of thousands of them still struggle to feed themselves and their children? How can we ask a family, and a society in general, to listen to the psychosocial needs of its members, if everybody is engaged in a constant struggle for physical survival? How can we demand from the youth not to be violent and abusive and not to resort to substances to obliterate their desperation, when not only they are deprived of a meaningful future, but their energy is constantly frustrated and redirected towards what the market wants from them?
Secondly, ownership of the means of production and participation of the workers in the management of the economy would alleviate the sense of alienation and detachment and instill life, interest, sense of responsibility, inventiveness and creativity in the workforce and would give them back their dignity and humanity. In turn, this would reduce mental health issues in society.
Thirdly, psychosocial uneasiness (I purposely refuse to use the term “mental illness”) should be considered the responsibility of the whole society, according to what the “social model of disability” proposes, in contrast to the tenets of the medical model cited above. The Social Model of Disability affirms that “disability is caused by the way society is organised, rather than by a person’s impairment or difference. It looks at ways of removing barriers that restrict life choices for disabled people. When barriers are removed, disabled people can be independent and equal in society, with choice and control over their own lives.”
Which brings to the next burning question: where were the trade unions, where was Nehawu, in Life Esidemeni’s assault on services case? A similar situation in California provoked a working class response.
In January 2015 more than 3,300 members of the National Union of Health Workers (NUHW) struck at Kaiser Permanente, the largest medical corporation in America. Despite record profits, Kaiser refused to employ sufficient staff to meet patients’ needs. In protest, NUHW psychologists, therapists, social workers and psychiatric nurses launched the largest-ever strike of mental health workers, with 65 picket lines in 35 cities.
The week-long strike was followed with petitions and a “No more Kaiser suicides” campaign to publicise the numbers of patients dying from lack of care. Finally, threatened with an open-ended strike, Kaiser agreed to the union’s demands: the right to advocate for patients; wage and pension protection; and a new scheduling ratio that enables patients to be seen more often and mandates new hires to fill the demand.
Linking the needs of workers and patients produced an unprecedented victory.
We did it with the #OutsorcingMustFall campaign. We can, we must, continue the collective fight!
Only by uniting our forces and struggling collectively can we avoid tragedies like Life Esidemeni hurting our families and our society again.