Special Hearings — Mental Health Workshop — UNKNOWN

GLENDA WILDSCHUT: I was thinking you know, how valuable will a review be because most of the people who are here in fact did the presentations. But perhaps just to remind ourselves of what areas have been covered and what were the important points made by some of the presenters. I've tried to, where presenters have, have mentioned the same issues sort of incorporated them altogether. So if I don't mention your name, I'll mention the issues.
 The presentations started, the morning started off with Dr. Saths Cooper reminding us a little bit about the status of mental health and the status of health delivery in South Africa and presented a few facts in that regard. Particularly with relation to the somatic bias in treatment and health care delivery in South Africa but also pointing to the lack of mental health delivery and the innovative mental health delivery systems within South Africa.
 With regards to mental health legislation he reminded us that we need to give consideration to issues of kinship relationships and family context and develop that, incorporate that into legislation. Also in formulating policy we need to examine other societies where innovative legislation has been developed with regard to marginalised people and he mentioned India with the programme for the Untouchables, so called Untouchables. Where there's a window period of time for preferential employment and other opportunities for those people who have been historically marginalised and excluded from such opportunities. 
 We were also reminded of the bases, particularly the philosophical bases of legislation and to remember that previous legislation, particularly mental health legislation was based on Apartheid ideology. And thus the present legislative attempts and the ways in which we develop legislation should bear that in mind. We should also look to not just making technical amendments to the Mental Health Act for example but, also look to developing legislation which will focus on wellness and well-being. Rather than just including a few, I suppose politically correct terminology to make the act look good.
 Then the question of the ownership of knowledge arose and we, I think we all agree that our academia and other discourse around mental health is based on the Euro-American paradigm and that we should actually make that paradigm shift. And develop our own indigenous knowledge and our own indigenous body of discourse. 
 We were also challenged as a commission to look at a few issues. One being that we should look to the recommendation of the rationalisation of departments and ministries that deal with human resources and human resource delivery. And attempt to bring together under one umbrella as it were, departments that deal with human resources and human resource delivery.
 We also were challenged to interact with other commissions and other institutions that deal with human rights issues and human resource development.
 With regard to human resource development there were some interesting suggestions with regard to curriculum change and new ways of producing at the end practitioners who are able to immediately go into the field and to deliver. And the example given was the - what was it (...indistinct)? The B.Psych degree where people would come out as counsellors and are able to immediately practise as practitioners.
 Lionel Nicholas presented some interesting critique on some of the work of the commission. Particularly his concern, I will raise here again is the issue of the abuse of psychological diagnosis in the attempt for people to gain amnesty. And I think that we need to really pay quite serious attention to that problem and deal with how we can highlight, how that kind of abuse needs to be dealt with.
 Professor Seedat reminded us of how we've been able to rationalise our on-going war in this country, our on-going conflict. And how as psychologists we've been able to in a sense sanitise the exploitation of blacks in labour and sanitise the issues of war in our country. He alluded to the issue of structural violence and it's relationship to interpersonal violence and also the whole notion of pathology and the issues of PTSD and how that impacts on our understanding of violence. 
 But what was also very important in the presentation, certainly in my mind was the development of knowledge from non-academic people and how one can incorporate that into the mainstream academic knowledge. Confidence boosting amongst people who are not traditionally people who write academic works and so on. And how one can engage other people in writing. And the challenge really to the TRC at that point was; how can one facilitate that exercise? And particularly since we've been forging partnerships with people in NGO's, training people to be involved in our briefing process and so on. And how can we incorporate all of that knowledge?
 I think the implications for the future in terms of Professor Seedat's presentation was how do we adapt to the new dispensation taking into account that we've come through a very violent and conflictual past and how do we deal with the issues of democracy but also deal with the issues of conflict in the past and the legacy that we, that is left behind. 
 I think the biggest challenge that came to us from the Citizen's Commission for Human Rights was the issue of the worse thing that can be done is not to do anything. And I think that the challenge there is how do we take up what has come before us in those presentations, incorporate that into our report and make very solid recommendations for good delivery and good mental health interventions in the future.
 In the afternoon's presentations, particularly by Professor Mike Simpson looked very carefully again at the issue of post traumatic stress disorder, the long term impact of post traumatic stress disorder and trauma. And also the intergenerational and multi-generational factors involved in dealing with trauma. But also looked at how we need to consider the issues of commodity and perhaps personality in the, when people present PTSD as a mitigating factor in their applications. 
 I think the presentations with regard to psychiatric care and psychiatric nursing and interventions, mental health interventions needs to be looked at critically with a view to how we can make solid recommendations about good interventions in the future. I think most of us who have been involved in working in psychiatric hospitals and elsewhere are well aware of the conditions that mental patients, psychiatric patients are subjected to. But also not just to rehash and dwell on the narrative and explaining what has happened but also to look towards how we can make recommendations about solid and good psychiatric interventions.
  Our mandate is very limited and yesterday we were getting a bit concerned about the challenges that were being placed before us as a commission. So Wendy will be talking a little bit about what our statutory mandate is. But also I think that we have accepted the challenge that we can act as a catalyst and forge together relationships with organisations and NGO's and academics and other people to continue this process into the future. Thank you.
DR. ORR: Thanks Glenda. You actually took one of the words right out of my mouth, I have catalyst written down here in front of me as well. It's my task to perhaps inject a dose of realism into the proceedings and I want to do this in a way which doesn't dampen people's enthusiasm and desire to bring about change. But which perhaps underlines what the capacity and the statutory mandate of the Truth Commission is. In other words what the Truth Commission can and cannot do. It doesn't mean to say that other things can't be done through forging alliances and using or creating new organisations. And as I say catalyst is one of the words I've used. A facilitator for change is certainly a role that the Truth Commission can play. But I think it's very important that the health sector and I use this in the broader sense of the word, from mental health to doctors, nurses, OT's, physiotherapists, needs to put it's own house in order. And not look to the Truth and Reconciliation Commission to solve the problems which exist within the health sector.
 The mandate of the Truth and Reconciliation Commission is very clear. And that is to establish as complete a picture as possible of the causes, nature and extent of the gross violations of human rights committed during the period of 1 March 1960 to 10 May 1994, including antecedent circumstances, factors and context, etc, etc, etc. And the definition of a gross violation of human rights is killing, abduction, torture or severe ill-treatment of any person which emanated from the conflicts of the past and committed by a person acting with a political motive. 
 Now that's really quite a limited mandate. We've tussled with the definition of "severe ill-treatment" and have come up with one which we hope is more or less acceptable. But it does exclude for instance the kinds of things and being a doctor I'm going to use medical examples. It would excluded for instance doctors having separate waiting rooms for white and black patients. And while I believe that, that is a violation, certainly of professional ethics, it would not fall within the definition of a gross violation of human rights in terms of the Truth and Reconciliation Commission. So we need to bear in mind that our mandate is really to deal with quite a limited group of violations. 
 However the open door for us is that we are also mandated to compile a report containing recommendations of measures to prevent future violations of human rights. And interestingly enough they don't say gross violations of human rights in this particular section. So that does widen things up for us. 
 And also to make recommendations to the president with regard to the creation of institutions conducive to a stable and fair society and measures which should be introduced to prevent the commission of violations of human rights. So that's really the door which I think this workshop must be focusing on. The issue of recommendations which can be introduced and institutions which can be created in order to reassure non-repetition of violations of human rights. And I think as we look at those, formulating those recommendations we need to be careful not to throw and I think someone else said this yesterday as well - not to throw the baby out with the bath water. We have professional organisations, we have statutory bodies. Yes they have histories, they come with a lot of baggage but that doesn't mean that they are completely incapable of transformation. I think the fact that an organisation like SISA has grown out of what has existed in the past and is doing some incredibly exciting and proactive work is an example of what can be created from what was. And I think we must interact with existing statutory and professional organisations to try and bring about change within those and to really be very active in pushing for change and transformation. 
 An example; I know a great deal of negative things have been said about the South African Medical and Dental Council and I agree that their history is not one to be proud of. But as a direct result of the hearings which were held in June, they have asked for a change in the act which governs their work in order to enable them to be proactive in their investigations. Because that was one of our biggest criticisms of them. That they could only respond when a complaint was made. They have now asked for a change in the act so that they can investigate when they believe that unethical behaviour or unethical conduct is occurring. And that's a very positive change and a very exciting thing and it's a concrete step which the Medical and Dental Council has taken as a result of the catalytic, facilitating role which the Truth Commission has played. 
 And I think that's what we'd like to focus on in our workshopping today. Is how we can use existing organisations? What kind of transformation needs to take place in them? Do we need new bodies? Do we need a human rights, a health and human rights watch dog body which ensures accountability and puts in checks and balances and those sorts of things? The kind of physicians for human rights in South Africa. But we want to be very concrete in our recommendations and very realistic. 
 I think I must also remind you of the capacity of the Truth and Reconciliation Commission, it is limited. We were asked for instance to subpoena documents to investigate life care institutions and Smith Mitchell and while I agree that this is necessary, the TRC cannot do it. And I'm going to be perfectly frank with you. We had about 17 000 statements from victims which have to be corroborated by investigative unit, we have seven and a half thousand amnesty applications which have to be investigated and either ratified or proved incorrect by investigative unit. We have a number of special investigations which are going on for instance into cross-border raids, into taxi violence, into train violence. So our investigative unit does not have the capacity to do that kind of work within the health sector and it's up to us to try and work out how that could be done by another body, be it an existing one or a new one. So as I say a very strong reality check that I'm giving you here. 
 Also in terms of amnesty I want to remind you that the cut-off date for amnesty has passed. So we cannot call for people to apply for amnesty now. The cut-off date was the 30th of September this year. So if people have not applied for amnesty it's too late and we need to explore other ways of finding out what for instance psychiatrists or doctors or nurses or whatever did during the period under review. Amnesty is no longer an option.
 As I say I hope this hasn't thrown a whole lot of cold water on your enthusiasm. I think there is still tremendous scope in our final report for making really creative, concrete, viable recommendations to ensure that the human rights violations which we spoke about yesterday are not repeated in the future and I look forward to our deliberations this morning, coming up with those kinds of recommendations. Thank you.