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

UNKNOWN: Thank you.  It is interesting that in the submission made by Sats this morning, he reminded me of something I had actually repressed quite effectively, namely my own period of incarceration which ... (tape ends) ... it seems to be for us in KwaZulu Natal, a pretty important area.
 I will talk about that just now.  Before I sort of go on, let me just give some background to this submission that I make it as a former member of Progressive Organisation, namely OASSA, the Organisation for Alternative Social Services in South Africa which was involved in attempting to provide alternative social services for individuals and communities at the time of the rule of the former apartheid government.
 In doing so, I wish to draw attention to the fact that an earlier submission was made by my colleague in Cape Town, Ann Harper.  I unfortunately was unable to get that submission to inform my own, but nevertheless.
 I also am somewhat humbled by being asked to make this presentation, because I think there are probably many individuals and organisations out there actively involved in rehabilitation  and reparation who are possibly better qualified than I am in making the submission.
 A name that comes to mind for example, is Blade Nzimandi who was clearly at the heart of the conflict in KwaZulu Natal, in terms of observing that process and so I would like to make it plain then that I do not officially represent any particular organisation.  I make this submission to add to those that came before and also in the short time that was afforded me in getting this together, which is about two days, less, I have managed to speak to a few colleagues etc and run some of this by them, but clearly the final form of submission, will come to you with lots more comment by a number of individuals.
 Let me just say that the submission I am making, is based on the information from a wide variety of documents, that OASSA itself produced and I think it probably was a pretty good tying in terms of documenting the events, experiences etc, that occurred and it was probably one of the more prolific periods around documenting issues affecting individuals, organisations, communities around of the affects of the apartheid system on the mental health of individuals and societies, communities.
 OASSA had a number of conferences, four in all in fact, annual conferences.  I have taken information from those documents as well as from mental health practitioners, involved in providing services to individuals and organisations and from academics who wrote about the influence of an apartheid system on the mental health of individuals and communities.
 The submission by SAISA provides a useful backdrop to what I am about to say.  As an Organisation OASSA was formed in 1983 to develop more appropriate mental and social health services at a time when the repression of the apartheid State had increased significantly.
 It had a broad base of activity which included research, education, media and emergency services, including what was at that time called detainee services.
 The organisation aligned itself with the Mass Democratic Movement of the time, and its mission statement if you want to call it that, was that it was vigorously opposed to apartheid and economic exploitation as well as social policies that were directly responsible for producing ill health.
 However, OASSA came into being because Mental Health Services were almost without exception unresponsive to what (indistinct) called the social context of deprivation.
 A deep cynicism of a family therapy association in the 80's, in the early 1980's, was witnessed when it decided to host its conference at Sun City while (indistinct) about the breakdown of the family system in South Africa, was I think something that resolved many individuals that this type of myopic perception of mental health in South Africa could no longer be (indistinct).
 Essentially, the connection between health, mental health and the social context of deprivation particularly, suggested that those who fell within a lower socio-economic structure, received indifferent mental health services if at all.  To this day, the provision of mental health services continues to be selectively provided to those who can pay and who are located in urban areas, while little exist for those in rural areas.
 OASSA has sought to highlight the intrinsic relationship between poor mental health and apartheid and between apartheid and poverty and to find ways of countering these influences.
 The relationship between politics and economics and its overwhelming influence in social conditions, could be seen everywhere, it was discussed nowhere.
 It was one of the other sort of real light motives to this organisation that we could talk about it as colleagues, we could talk about things that were going around, but we never actually organised around it.  There was sort of a major impetus that was building to get to the point where OASSA was formed.
 Initially, much of the work that OASSA was doing, was in support of activists in townships, direct support through counselling, training workshops and recognising and dealing with individuals, showing classic signs of trauma and together with NAMDA holding first aid workshops to deal with injuries from buckshot and the like because hospitals could not be trusted for good reasons and which have been provided at this hearing.
 One of its tasks, as one of its tasks, OASSA sought to dispel the naive contention among mental health professionals that politics and mental health practise should be kept separate as it was argued that it influences the objectivity of the professional.  This is something that Mohammed has already referred to, that the Scientism of underpending professional activity was used to advance the idea of the dispassionate, uninvolved a-political professional much like the church using its doctrines to justify its (indistinct) to the pain and suffering of South Africans.
 When OASSA entered the (indistinct), charging academics and academic departments of using science to support the work of the State.
 Notable HSRC, CSIR are organisations that had been directly involved in this type of activity.  Fortunately there had been some significant changes to that level.  But also at a level and a type of research and training that was taking place within various institutions.
 American and European psychology was pursued as the standard because it had all sorts of racial implications and that this has had an impact in terms of the psychology that is actually practised today.
 The development of an indigenous psychology is difficult to see around one.  The impetus to develop an indigenous psychology appears to be only gaining ground recently and part of the impact of the apartheid ideology and the establishment of universities which essentially were meant to produce mediocrity, was that an indigenous psychology was not readily apparent in any of the research or the material that was produced.
 It was perhaps the clear association between politics and mental health that epitomised OASSA that helped it to refocus the attention of health care workers on a need for social change as part of an effective treatment plan.
 It also marked a shift towards a more humanitarian mental health practice.  The problem was not always one of bad genes or bad luck or even just a poor environment, but one that the majority of South Africans found themselves in through the systematic application of the apartheid ideology.
 I have a number of objectives that OASSA actually outlines and I am not going to go through all of them and I am just going to pick just on a few here in the interest of time.
 But clearly it was to provide a better mental health service to individuals who had no access to such services.  To help other progressive movements in dealing with its own fallouts.  Today we talk about burnout, it those times we talked of people who were severely psychologically damaged as a function of torture etc.
 There was a strong debate that occurred within OASSA about should we do research on the affects of apartheid on individuals and the concern was that this research would simply be used by the State in furthering its own ends.
 And that debate obviously meant that some of the research that would have been done, was not done.  Nevertheless, it did clearly see the need to redistribute and develop knowledge, experience and skills, workshops, conferences, publications and by the collection and dissemination of relevant information.
 It also saw the need to unite health workers across the specialised fields of activity, social workers, nurses, psychologists, psychiatrists, doctors all tended to operate in terms of their own particular training and philosophy and there was a need to see that health was not the prerogative.  Any one of those and there shouldn't be a pecking order and so that is one of the things that was also attempted.  I am not sure to what extent this was successful.
 Another objective was to develop structural models of appropriate social services, to assist wherever possible with the implementation.  When we look at these, and I have a number of them here, these objectives, it is evident that  many if not all of these needs are even more evident today.
 The advent of democracy in South Africa has had the effect of refocussing the energies of progressive organisations from challenging the State to find ways of cooperating and assisting the newly elected democratic government to provide many of these services.
 The destructive forces of apartheid had held together many ideologically individuals and there were clearly many people within OASSA who could be at completely different acts of the spectrum ideologically, but who together in the interest of fighting against the oppressive system of apartheid.  Once the system disappeared at least in terms of a significant event, the cohesiveness that characterised most progressive organisations at that time, appeared also to have disappeared.
 While new progressive groupings have emerged, the single minded focus and energy of early organisations appear to be lacking.  The way forward was now faced with innumerable permutations and never ending rounds of workshops which served merely to signify that there was great uncertainty about how to proceed.
 I can say this with some degree of certainty for example the Mental Health Act and what should go into the new Mental Health Act, etc.  Neither government nor progressive groups could foresee the enormous difficulties involved in social transformation.  It is one thing making an argument, an eloquent one at that for change, it was quite another to produce change that would have the desired impact.
 The challenges facing mental health services, can be seen everywhere from Health, Welfare and Education to Housing and Safety and Security.  I believe though that progressive organisations have yet to find their voice in this new dispensation.
 An independent and critical Mental Health grouping is vital in ensuring that there is continued focus and providing services to those who are marginalised.  I believe the legitimising of SAISA was an important step in beginning to address some of the issues relating to providing services especially to the poor and those who are not urbanised.
 Ironically the need for mental health services is as great today as it was prior to 1994 if not more so.
 In KwaZulu Natal, youth who had given up much in the struggle for liberation, today find themselves unskilled, unemployed and psychological defeated into personal violence, substance abuse and crime, are (indistinct) to their lives.
 These individuals feel little hope, because little has changed for them, but also because there has never been available mental health services that would help them to heal and I think this is the point I made with the personal statement about many of us that may have gone through a period when we directly faced the oppressiveness of the apartheid system, but were made to deal with it or dealt with it or did not deal with it, but it became or was repressed.
 For many of these individuals the period in which the experienced repression in massive amounts, the ability of OASSA to respond or of any progressive organisation, including NAMDA etc, to the needs of these individuals was sharply limited.
 In 1986, at the first OASSA conference Patel reflected on the issues confronting black families at that time.  These words that she spoke at that time, represent a painful reality of problems of old, that are still very much with us.
 I quote - in the present South African conflict a new generation is emerging who knows only violent conflict, rather than how to express their feelings or to love.  The task is to fight and to survive.  The social milieu is one which encourages the suppression of feelings as being heroic and the expression of it as cowardice.
 No doubt, the effects of the present conflict will leave lasting scars on generations to come.  In a personal communication with Freddie Staborough who is the co-ordinator of a group that runs trauma workshops, counselling groups etc, in Port Shepstone area on the south coast of KwaZulu Natal, told me about how the effects of the lack of services is having accumulative effect on individuals.
 If you will recall, the recent bus accident where in a number of Inkatha Freedom Party members died, threw up a host of underlying psychological problems among the families and survivors.
 What really was going on here, was that earlier traumas experienced in the bitter political fighting leading up to the elections and since then, had never been resolved.
 The trauma suffered originally was not dealt with because of a lack of mental practitioners who work in rural areas, inadequate mental health services in general, as well as the historical neglect, not to forget destructiveness of the policies of the apartheid system enforced by the previous elite.
 Culture demands that individuals learn to cope with such events, further contributes to a (indistinct) attitude of trauma.  In keeping with the classic trauma model, poor coping and a lack of support to ensure the wellbeing of this individuals, have led to a decrement in coping resources thereby making them even more vulnerable to minor or unexpected stresses.
 Lack of resources and the almost complete  absence of any psychological services for such individuals ...