Special Hearings — Mental Health Workshop — UNKNOWN

PARTICIPANT: I mean this morning there was a concern about a split. Can we just ask people to report on behalf of their groups? Before they do that, let's be in agreement as to how we are going to take the process forward. We will let, are we going to allow a person to go through everything and then start checking each and every point? Okay it's like most people are happy with that. So can we get a reporter of group 1 and 2?
DR. ORR: I by default and to my surprise and (...indistinct) for  group 1. We spent some time with the (...indistinct) looking at the old mental health act and then were very helpfully advised by the representative from the Gauteng Mental Health Services, what's his name I can't remember I'm afraid. That the new Mental Health Act in fact doesn't even deserve that name yet. It's still very much in the process of being thought about. A draft hasn't even been produced which is actually good news for us because there's still a lot of time for us to make input and suggestions as to what the new Mental Health Act should look like.
 We found it difficult to come to consensus on this issue. The two kind of diverse opinions which were represented was 1: that without a doubt we do need a new Mental Health Act which should be separate. Which should be, which should take mental health out of the purview and dominance of the medical profession. On the other hand we had a point of view that said the Mental Health and the Health Act should be combined. So that we have one comprehensive act which puts everyone on the same footing and which covers health (...indistinct) in terms of both of those recommendations. I think we did reach consensus on the fact that the old Mental Health Act certainly needs a great deal of revision. But whether it becomes part of an overall health act or not we were unable to decide.
 We then discussed the issue which was also raised yesterday of instead of having a Department of Health and a Department of Welfare having a Department of Human Services. And again we discussed whether this should be a separate new department or whether it should be a, whether we should set up a multi-disciplinary committee with representatives from all the ministries involved, which meets once or twice a year to discuss the issue of human services. To ensure that people are viewed as whole beings rather than as bits and pieces and that we look at the issue of well-being in the overall, holistic sense. So that was another suggestion that we really explore quite thoroughly the issue of a department or a committee on human services.
 We were also reminded that traditional healers should not be left out of this equation and we must bear in mind that they are on the ground and available already. And they need to be brought into whatever service provision is planned for the future.
 We then looked at education and training and I think the consensus was that without a doubt doctors dominate the health care sector because they are taught to dominate the health care sector. Because in their training they only interact with other health care professions in an hierarchical, autocratic kind of way and we would encourage the creation of multi-disciplinary training where there are issues which are cross-disciplinary. Students are brought together from nursing, OT's, physiotherapy, wherever to undergo training together, to interact with each other. To talk to each other and to realise in fact that medicine is not necessarily a hierarchy. That we all have particular skills and knowledge and those should be used appropriately in multi-disciplinary teams where the doctor is not necessarily the head of the team.
 It was pointed out that perhaps one of the reasons why the medical profession has dominated for so long is that it has received most of government funding, both in terms of training and service provision and that issue needs to be looked at. Whether it's appropriate in fact for us to, for the government to be putting so much money into the training of doctors and the provision of what has been really Euro-Western type biological model of medical care. Because looking back over the last forty years we must agree that medical dominance has not resulted in good health care for the vast majority of the South African population. So training and research funding need to be re-examined. 
 Rural areas need a particular focus in whatever services are provided and also in the training of health professionals. They need to be made aware of what the particular needs are in rural areas and how to consult with communities in those areas as to what the needs are.  Wherever health services are offered so should mental health services be offered. Mental health is a primary health care concern and should come out of the kind of mental institution and into the primary health care clinic. 
 The last issue we looked at was that of custodial care which includes the issues of dual responsibility. Does the doctor, nurse, psychologist's primary responsibility to his or her employer or to his or her patient? And we all agreed entirely that the primary responsibility is to the patient or client. And that confidentiality is paramount and that this should be protected by law.
 We also proposed the setting up of some sort of independent - I hate this word - whistle blower network. But some (

LAUGHTER: ) (...indistinct) system in which independent reportage of abuses and unethical behaviour can take place in a confidential way. So that the person who is reporting is not subsequently intimidated or discriminated against but the issues are brought to the attention of a body which can take action around the unethical behaviour. So we're talking about some kind of watch dog body, ombudsperson, you know you can name it what you like. But we feel it's very important that this kind of system be put in place. And we believe that we should be encouraging the professional organisations to be playing a proactive role in setting up these kinds of networks. And we feel that they have neglected this role in the past and should be taking this up as part of showing their commitment to transformation.
 We believe it's important that custodial institutions be open to public scrutiny and reportage and that section 66 A of the Mental Health Act should be scrapped. The new act is non-existent at the moment.
 We briefly discussed medication and with the implementation of the Essential Drug List we hope that every institution will have access to those drugs which are on the EDL. And I can't believe that, that won't be the case but it's certainly an absolute recommendation that, that is the case. That every institution no matter what it is or where it is or what it does should have access to the same drugs and that very clear guidelines should be drawn up about the appropriate usage of drugs. The input was that particularly in mental health care  drugs are often used as punishment or for the convenience of the service provider rather than for the well-being and for the health of a patient. And that is a situation which needs change.
 I don't know if there are other members of my group who feel that I've missed something out who want to add things.

PARTICIPANT: (

INAUDIBLE: )
DR. ORR: Oh, yes. We talked a little bit about the example which Saths gave yesterday about the untouchables who, where a window period is being created. Where they were given preferential access to training, education, learning and jobs and suggested that should be an issue which is considered in South Africa for victims of human rights violations.

PARTICIPANT: Maybe this group should assist us to look at areas which you think needs a discussion. Like this whole notion of the relationship between different professional grouping.