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

<UNKNOWN>: ... may be used as slave labour and they were literally allowed to die from what could possibly be called criminal neglect.
 These private psychiatric camps were set up with an agreement between the apartheid Department of Health and Smith Mitchell, which is now known as Lifecare.
 Subsidised by tax payers' money and hidden from public scrutiny, they remained a secret for almost a decade, before being discovered by us.  In fact the government guaranteed a 90 percent occupancy rate and to meet this demand, psychiatrists used the Mental Health Act and the country's oppressive involuntary commitment laws.
 Briefly as our submission to the TRC shows, up to 10 000 Africans were incarcerated, many were reportedly excessively drugged, the majority of the 10 000 slept on mats on concrete floors, dormitories were crowded, squat toilets ran down the middle of the sleeping quarters and up to 30 patients at a time, shared communal showers more often without hot water.
 The lack of beds was blamed on the patients.  The Department of Health said like so many Africans they preferred to sleep on the floor.
 Black patients died form easily treatable illnesses such as pneumonia or respiratory diseases.  At least 80 African patients died each year.
 The bodies of those patients who died, and whose families did not claim them, were used for anatomical studies.  According to one annual company report, a suitable cement slab with drainage has been set up in our hospital mortuary for this purpose.  Electric shock treatment was given without anaesthetic.  The reason given for this by the Chief State Psychiatrist at the time, Dr P.H. Henning, was it is simply too expensive, too slow and too risky.
 Africans appear to be more susceptible to the affects of anaesthetics and because we treat more Africans than whites, we would have to double our staff if we used anaesthetics.
 Inmates were hired out to companies to perform labour without pay.  Their days began at 05h30  am and ended at 05h30 pm.  Contracted out to local companies, the labour force made coat hangers, wire brushes, rubber leg guards for miners, mats, sheets, clothes and aprons.  This was called industrial therapy.
 In 1975 articles ran in the Sunday Times and in the Rand Daily Mail.  These articles confirmed the existence of thousands of black patients accommodated in converted mining compounds, mine hospitals and old hotels which the article concedes are a disgrace.
 Most of them ranged from the utterly dreary to the downright frightening.  I am quoting now from these articles.  Thousands of blacks who were neither criminal nor dangerous, are confined behind metal and barbed wire fences, have to use hideous single lockups and look like something out of (indistinct), have only crowded treeless quadrangles to relax in.
 The usual treatment for blacks is shock treatment.  The establishment of private psychiatric hospitals to incarcerate blacks, was one of many programmes implemented during the apartheid era to forward the suppression and the oppression of the black population.
 There is no doubt that these institutions treated blacks differently to whites.  There were in fact another facet of the primary architect of apartheid, psychologist Hendrik Verwoerd's vision of South Africa.
 With millions of people faced with substandard education, unemployment, no opportunities and subsequently low moral, it is no wonder that these psychiatric camps could be established, or that the reactions to apartheid oppression was easily defined in psychiatric and psychological terms to justify their incarceration in psychiatric institutions.
 Various reasons were given.  Because the black South African broke curfew, or were considered decedents, others physically ill from the poverty caused by apartheid, sought help from general hospitals and were in stead transferred to private psychiatric camps via State institutions where they were literally turned into institutional cases.
 Thousands of patients were syphoned out from State hospitals to use the words of a previous Commissioner of Health and contact with their families were severed.
 Because of geographical distance, or because of forced removal of the family to a destination which remained unknown to the patient and the hospital authorities, in the sense the black South African had no community to return to even if he was eventually discharged.
 I would like to put it in a little bit more human terms and use a couple of examples and I won't use the patients' names.  I will call them A and B.
 Patient A was admitted to Sterkfontein in May 1974 and transferred to Millside Hospital from Sterkfontein.  Millside Hospital complex near Randfontein that is.  In September 1974 his sister visited him and found that he was reported to have died from septicemia.   The family then made arrangements to collect the body.
 When they arrived at Millside to do so, the body identified as their son, was not their son nor were any of the other bodies in the mortuary at the time or any of the living patients in the hospital.
 In the mean time, the body labelled A had been buried by the authorities at Millside.  There was no record of an inquest into the cause of his death.
 The mystery has never been solved and A is still missing.  When he was admitted to Sterkfontein, he had sceptic sores on his ankles and these for many of you who will know, are signs of pellagra, not mental illness.
 And that pellagra is defined in the world book dictionary as a disease marked by eruption of the skin, a nervous condition and sometimes insanity.
 That A was allowed to die from an easily treatable illness and that those entrusted with his welfare and care regarded his disappearance with cold indifference, is an example of the lack of respect held for black people and how easily South Africans under the poor conditions many lived in, were frequently misdiagnosed with mental illness when the provision of proper medical care may have been all they needed.
 Then there is a case of a young black mentally handicapped male inmate, I will refer to him as patient B.
 B, a black mentally handicapped inmate of the Millside complex was taken home over a period of two years by two white male nurses and sexually abused.
 He was also used to work in the garden, run errands and clean the house and on occasion was given a bit of money for that.  As he later stated to one of the other nurses, in a full statement he gave to her, he was taken to a bed and pinned down.
 Both of the male nurses then took turns in sexually abusing him and made him sleep in bed with them.  The Mental Health Act provides for disciplinary action against staff members.  It means discharge and the removal of his name from the register of the Council with which he is registered at the bare minimum.
 Both male nurses had no disciplinary action taken against them, because the testimony of the mentally handicapped person was deemed to be unreliable and in fact from our information, they both are still working there and the one is promoted into a senior position.
 In the grand scheme of apartheid times, where can we list cases such as A or B or the statistics of hundreds of unnecessary deaths due to exposure, neglect, electric convulsive therapy and other barbaric mental health practices?
 B's case might seem like the lesser abuse, but this case shows that the Mental Health Act of 1973 and its various amendments, serve to protect apartheid psychiatrists rather than the vulnerable citizens they were given the task of protecting and helping.
 115 patients went missing from at least one private psychiatric institution over an eight month period alone.  A woman admitted her 80 year old father to a psychiatric hospital, believing he would get rest and care.
 Within 24 hours, he was missing and within a week, he was found dead.  What did the Health Authorities do about these incidents of abuse and the number of deaths that we reported to them?  They did nothing.
 What did the South African Society of Psychiatrists do and its affiliated bodies do, they did nothing.  And after they did nothing to correct the abuses, they did something.  They amended the 1973 Mental Health Act, implementing Section 66(a), making it a criminal offence to publish information or photographs about the continuing crimes and abuses committed upon people in psychiatric institutions.
 CCHR has never been one to do nothing.  We bypassed the local government authorities and psychiatric bodies, and took the matter to the United Nations which instigated a World Health Organisation investigation into the camps.  The 1977 WHO reports confirmed the high number of deaths.
 What did the Health Authorities and SBS say and affiliated bodies do about the damning report?  They did nothing and black South Africans continued to die at an alarming rate in these private psychiatric camps.
 Sometimes up to 80 patients a year.   According to WHO, the release of the WHO report and I am quoting from their statement there, the release of the WHO report was followed by a campaign  of denials and attempts to cast doubt on its validity on the part of the South African officials and representatives of the medical establishment.
 Then the American Psychiatric Association did an inspection on the camps and in its 1979 report, the APA stated the most shocking finding of our investigation was the high number of needless deaths among black patients in Smith Mitchell facilities.
 At none of the facilities did we find evidence of adequate medical care during the patient's final illness and further we saw charts of black patients in their 40's and 50's who were apparently allowed to die and further, there is good reason for international concern about black psychiatric patients in south Africa. 
 We found medical practises which were unacceptable and which resulted in needless deaths of black South Africans.  This is an indication of possible gross criminal negligence and should have sent alarm bells to the Health and Psychiatric fraternity, it didn't.
 In fact the APA report was condemned apparently because one of the APA members who officiated over the inspection, was yes, black.  A subsequent 1983 report on this issue found although psychiatry is expected to be a medical discipline which deals with a human being as a whole, in no other medical field in South Africa is the contempt of the person cultivated by racism more concisely portrayed than in psychiatry.
 Further quote - all the black patients, that is over 10 000 of them, are certified and transferred from institutions on an involuntary basis without their own or their family's involvement in the decision process.
 The report concludes this situation has no parallel in the history and present state of psychiatric care.  It certainly does have a parallel in the ownership and trading of slaves.
 The dehumanised view of Africans cultivated by racism finds various expressions in psychiatry.  One of them is the theory which relates certain forms of mental disorder to different levels of development of the races.
 The long history of CCHR's fight to expose and rectify the gross apartheid human rights' abuses committed in the name of therapy by psychiatrists, affiliated with these camps, and within the Department of Health, is detailed in our submission.
 The degree of attack levelled at us for having exposed these abuses internationally is also detailed.  Suffice it to say our members were harassed, followed and activities were monitored by the Bureau of State Security, BOSS.  It bears comment that if psychiatrists, health officials and the private psychiatric camps had nothing to hide, such a torrent of discrimination and attack, would never have been directed at us.
 We also note that no representative of the private psychiatric facilities life care, appears to have, or are giving evidence to the TRC.  Were they called to testify, have they made any approach to the TRC?
 Has David Tobasnic, Smith Mitchell's Director been called to account for what happened in his institutions?  Where is Dr J.J. de Beer, psychiatrist and former Minister of Health who reportedly set up the agreements to channel blacks through Mr Tobasnic's facilities?
 Nor has the SPSA's earlier submission to the TRC admitted any guilt or responsibility, it merely serves to continue to shoot at the messenger.  In fact it is a white wash of the greatest psychiatric tragedy in the history of this country and one which continues to this day.
 In 1991 staff at Millside Hospital complex, the Smith Mitchell or Lifecare facility, publicly complained about the high death rate from negligence and winter cold.  Reportedly 35 mentally retarded children and youths also died between July 1988 and November 1990.  24 of them, as a result of pneumonia, tuberculosis and other respiratory ailments.
 Children dying from the same conditions that patients 20 years ago, were dying from, is a disgrace.  Tax payers' money was used to fund these death camps and while today, State facilities such as Valkenberg are to be closed down, these private psychiatric institutions with their sordid history of gross human rights' violations, remain open and profit from State subsidies.
 There should be no compromise on this.  These private psychiatric facilities must be shut down.  Certainly there should not be State subsidies for these facilities at all.
 Section 66(a), the provision of the Mental Health Act which provides for the legal cover up of abuses being committed in psychiatric institutions generally, must also be abolished.
 Finally, and 27 years later, we are still waiting for answers.  We are still waiting to see honesty, to hear admissions, to know that there is nothing left to hide and to see the SPSA, the Medical and Dental Council and individual psychiatrists who treated at the Smith Mitchell, Lifecare facilities, take responsibility.
 In particular, we reiterate sections of our recommendations.  Point 1, that all psychiatrists and psychologists found to have committed patient abuses in violation of a hypocritic oath, and other ethical codes during the apartheid era and especially in the Smith Mitchell psychiatric facilities, and who have not availed themselves of the TRC amnesty, be investigated and where there is evidence of criminal abuse or neglect, be prosecuted.
 Point 2, in light of a gross human rights' violations committed in the private psychiatric institutions, all records and documentation must be subpoenaed from the Department of Health, Lifecare and formerly Smith Mitchell and the individual Lifecare psychiatric facilities which would cover and determine how many death occurred in the private psychiatric facilities over the last 20 years, what drug experimentation and sexual abuse of patients in these facilities, has occurred.
 From these, there should be an investigation of (a) the drug practices within these facilities and any cause or link to any death, (b) who the medical officers were who had the responsibility to investigate and report on each death and who did they report to and what annual reports exist on the deaths in psychiatric institutions, (c) all records and documentation regarding the burial of patients who died at the Smith Mitchell facilities should be subpoenaed from funeral parlours and a determination be made as to where there were communal burials, and if so, where these are, (d) all records, memo's, correspondence and reports held by the SPSA in relation to this Smith Mitchell facilities, during apartheid, should be subpoenaed to determine to what degree the failure of the SPSA to carry out proper, independent review of the medical records of patients who had died in private psychiatric facilities, may have contributed to prevailing human right's abuses and deaths occurring in these institutions.
 We have made many recommendations for reforms based on our history of successfully fighting for patients' rights.  We are not anti-medicine.  We believe in proper and competent medical care.  We believe in the right for people to seek help from traditional healers and all this we will present at the workshop tomorrow, under the heading of the way forward.
 The continued silence by South African psychiatrists with the exception of one or two, like Professor Simpson and especially by the SPSA in the face of gross human rights' violations, having been committed within their camp, is unconscionable.
 During apartheid, the SPSA claimed that it inspected the Smith Mitchell facilities, and found no support or allegations of inadequate psychiatric care and that extensive and advanced psychiatric services were given to all South Africans without reference to colour or creed.
 This was a lie when you review this against the findings of the World Health Organisation and the American Psychiatric Association reports.  During the American Association for the Advancement for Science's visit in 1989, the Statement released by the society again echoed the lack of responsibility and contradicted their constitution which is to uphold the principle of human dignity and psychiatric ethics.
 The society stressed to the AAAS delegation that although they were inspecting the facilities, the responsibility for psychiatric care was not that of the society and it distanced itself completely from the treatment and handling of patients in these institutions.
 This too is false.  If the SPSA monitors the ethics and practises of psychiatrists, it should be ensuring that proper care is being given by them.  The Nazi holocaust and apartheid have common realities.  Without the driving forces of psychiatry and psychology, the holocaust and apartheid would simply not have happened.
 And I think our next submission will give you more information on that.  While we certainly believe in forgiveness, the first step towards this, is for psychiatrists and psychologists who actively participated in apartheid, to come forward to the TRC and to admit their crimes.
 Those who remain complacent or justify their actions as just doing their job, or claim that psychiatrists were a tool of political corruption, should be rooted out to meet criminal, not disciplinary charges.  They must not be able to evade the consequences of their actions.  As a protection against current and future psychiatric and psychological abuse, CCHR recommends that a loyalty oath of mental practice be implemented which we will present at the workshops tomorrow.
 All available medical, professional and ethical codes have failed to ensure compliance by professionals in South Africa's Mental Health industry.
 CCHR's loyalty oath of mental practice should be signed by all psychiatrists and psychologists, psyco-therapists etc, before they are allowed to practice, especially when employed by the State.  The oath requires the practitioner to sign this and as a legal document,legal action can be taken against the professional who violates it.
 Finally today, we call on the TRC to unequivably condemn the psychiatric abuses that have been committed against South Africans in psychiatric facilities and condemn those professional bodies, health authorities and practitioners, who were a party to them.  Thank you.