Special Hearings — Mental Health Workshop — 1997-11-20

UNKNOWN: Yes, there are a couple of issues there.  The last one, first.  I think it is a difficult one when we have inherited the old system and we have a (indistinct) of Ministries, particularly in the latter years of the previous government, they just started creating new Ministries.
 The approach of, well that is the suggestion if I hear it correctly from Victor Nel, is one that is akin to what applies in the United States, Health and Human Services.  That takes account of all health, all welfare, social interventions.
 But, we have got - you need to also balance that against political territorial and other realities.  Will a new government in power want to divest itself of some of those Ministries when it actually provides positions for patronage or other reasons for a lot of Ministers and a lot of Directors General and so on and so on?
 And  my sense is that is going to be one of the hardest nuts to crack because rationalising those Ministries from the almost 30, to a smaller, more manageable number for a country of a fairly small size in world standards, is going to be a very difficult task.  There is going to be all sorts or arguments when you know just four years ago, those same people were arguing what we are thinking.
 But now that they are in there, it is not going to quite happen.  So maybe we need somebody like the Commission, to actually say there ought to be some rationalisation here because we are getting fractured service delivery.  Even if we don't consider it, the issue of an underpinning threat of human rights' violations (indistinct) in the apartheid past, just in sheer deliveries, service delivery terms, it is fractured one Ministry replicates what another Ministry does, the gross wastage and so on, just doesn't bear scrutiny.
 That would feed into what the Mapaya Commission for instance is tasked with doing, in terms of suggesting a rationalised format, and maybe this Committee of the Commission, should be actually having some interaction by party interaction, in a sense, with that Commission and the Commission for Public Service at a broader level to say don't we have a gross human wastage?  Our budget when at least 60 percent of it, goes to keeping the Civil Service, how on earth are we going to create the types of job opportunities, the types of other service delivery, infrastructure issues for a society, let alone those people affected by the apartheid past in the singular way that the Commission is looking at it.
 So that may work and I think there will be support, certainly from the Private Sector and also from Sectors of the Media.  They will support a reduction in the Civil Service.
 The Civil Service will go screaming, but I think it is an issue that is so important that it may even be one that the Commission would want to ask for a National Referendum on.  Do we deserve a tax base that is overwhelmingly geared at supporting Civil Service dependency or should we be looking at turning that around and creating the majority of the fiscal base for the nation.
 It is something that the Commission could look at.  In terms of where some of these issues are going to be located, I don't think you can really legislate things out of existence, neither do I think that you are going to succeed in legislating things into existence in a very simple manner, because we have got perhaps the most advanced constitutional democracy in the world for a very underdeveloped society and you are going to have all sorts of private initiatives, individual group, institutional initiatives which you are not going to curb, but I think that diversity will actually add to the process if we have got a central grouping that succeeds the Commission to look at servicing those victims for a limited period of time, we don't want to create another bureaucracy and another tax burden for a society that is already one of the most highly taxed in the world.
 But for a very limited time, and that that should be open to appointment at that period, with some people from the Commission moving on to it, but also new appointments, but for a very temporary, fixed period of time to facilitate a process, rather than become the institution, providing it, so that they can monitor it, they can do it in different sectors in society, both private, public, the institutional other sectors.
 In terms of psychology very specifically and the whole psychiatry and psychology debate, I actually think that maybe sometimes we have overplayed this one.
 I think that there is a very important role psychiatry plays, but it is a finite role.   And psychiatry, I don't think has even pretended to want to be the (indistinct) in terms of well-beingness, it firmly rooted in the tertiary intervention modality, we don't have a social psychiatry, a primary community psychiatry movement in this country.
 And psychiatry does have a very important use, however, the other professionals allied, like psychology, social work, nursing and so on, should be playing an important role in shifting the (indistinct).  I think in the past, psychology hasn't done that, because it was under medical hegemony.
 Psychology is beginning to do that and bear in mind, we have got at least ten to one, the number of psychologists providing mental health intervention than psychiatrists, so there are more of us and we are more trained in psyco-therapeutic techniques, which psychiatrists are not.
 So, therefore we should be utilising that resource.  The Government itself, the public service administration has determined that psychology is a scare resource.  The Department of Health has prioritised psychology as second in terms of prioritising its health delivery system.
 Now, we need to use those as positive and turn them around.  What is happening within organised psychology, is we are reviewing the whole basis of our training and looking at a new training dispensation for the future, very plainly, I, many of my colleagues sitting here, and others out there, believe we are training people or rather educating people with a major in psychology who are trained for nothing.
 They annually join the list of jobless and unemployed in the country.  If we were to be a little creative about it and create for instance a B-Psyche degree in keeping with international standards, create a four year degree in stead of that honours tagged on, which also doesn't give a person any professional status, a four year degree, you will find intersectional collaboration from social work and so on, to create a mental health counsellor, an Aids counsellor, a family counsellor, a personnel counsellor rather than a lower level psychologist.
 In the second year they do a wide range of subjects in psychology.  In the third and fourth years, they start specialising in particular fields of intervention possibilities and do an internship during that time - approximately nine months over two years.
 Do away with this masters level, if we add on one more year, you would get a D-Psyche degree including an internship and then you would actually have psychologists calling themselves Doctors, like happens in the rest of the advanced world.
 So you create that stream.  That doesn't mean you take away the academic or scientist stream.  We are talking purely the practitioner route here and that is where we are making the suggestion that things should go.  However, I should point out that the city universities, significantly white universities, are the ones that are going to go screaming into the new millennium on this process.  Because in a sense they have the most comfort zones to loose, whereas the traditionally black and the newer Afrikaans institutions in a sense, they are African more than the other city Euro-American institutions.
 They want to do it and for instance Transkei University, the University of Port Elizabeth are starting with a B-Psyche degree next year.  And more people then will be employed in all sorts of areas and that group of people will be an invaluable human resource for change in the society.
 As you know, the subject that is more favoured by  first year university students, in urban and rural, black and white universities in this country, is psychology.  This large number, and then you go into second year and third year and then when you go in to honours and masters, you have to have a graph that is a few hundred feet long, because it can't contain in one small linear depiction, because it doesn't bear scrutiny.
 Our masters' training is perhaps the most expensive of all the trainings in our society.  Minister Zuma has talked about the medicals, but if you look at the psychology costs, they probably are at least one and a half times that of medicine.
 That cannot be sustained in a developing society with the types of needs that we have, so we need to be realistic.  So it has to be change that has to come from within as well.