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HEALTH PORTFOLIO COMMITTEE
17 May 2005
RIGHTS, EDUCATION AND ACTIVISM FOR CONSUMER HEALTHCARE: BRIEFING
Acting Chairperson: Ms M Madumise (ANC)
Documents handed out:
Rights, Education and Activism for Consumer Healthcare Powerpoint presentation
Dismissals related to incapacity due to mental illness (mental handicap)
Rights, Education and Activism for Consumer Healthcare (REACH) briefed the Committee on the stigma and possible discrimination against patients with mental health problems. The long-term objective of REACH was to protect every consumer in terms of educating them about healthcare, improving their knowledge about the compliance of medical schemes and the need for access to proper treatment. REACH needed the assistance of the health authorities to educate consumers on these issues. REACH also wanted to eradicate the negative perception ("once mad, always mad") that society had of psychiatric patients. Their short-term objective was to form relationships with various roleplayers to obtain a balanced view at grassroots level.
Mr L Ngculu (ANC), incumbent Chairperson, was out of the country
The mission of REACH was to assist in the provision of sustainable and transparent healthcare. Consumers needed to understand healthcare legislation as it formed the basis of their healthcare consumer rights. The vision of REACH was to effect a paradigm shift in the management of ‘wellness’ to make it affordable and accessible to the consumer.
REACH has formed relationships with consumer, juristic and doctor groups such as the. Financial Planning Institute, the SA Medical Association, the Board of Health Funders, the Consumer Union, the Diabetes Association of South Africa, the Osteoporosis Foundation, ABSA Healthcare, Alexander Forbes, and Health Technology.
The Anti-Stigma Initiative, which included REACH, the Hospital Association of SA (HASA) and the Psychiatric Forum, had explored suggestions to destigmatise society’s perceptions of psychiatric patients. The terms of reference of their ‘shadow’ White Paper explored the discrimination in financial allocations for psychiatric patients. REACH’s premise was that psychiatric illness could be cured.
Patients needed to have access to medication to treat illnesses and side-effects. The focus should shift from hospitalised treatment to outpatient care. The quality of life of the patient would improve because the person would become a normal, productive member of society. This would have an impact on the economy and the Gross Domestic Product of South Africa.
Another objective of their work was to ensure that psychiatric benefits were adequate, readily accessible, fair and equitable. Currently diagnosis of psychiatric disorders was different at primary and tertiary facilities. The focus should be to provide facilities and services that were equitable and efficient to mental healthcare.
There was also discrimination at medical scheme level. The limitations of psychiatric benefits arose because of insufficient formulas and protocols, which formed the basis of capped benefits. A South African study was cited to explain the costs of uncapped benefits. A 50% reduction of direct utilisation costs could be achieved if the psychiatric patient was treated adequately. Sustainable healthcare needed to cut costs but the process needed to be conducted in a transparent, fair and scientific manner, especially in terms of medical schemes. The idea was to treat the patient in a cost-efficient manner where the illness was controlled, and not only the side-effects.
The premise of the Patients Rights Charter was that the patient should be part of decision-making about health insurance, medical schemes, prescribed minimum benefits (PMBs) and designated service providers (DSPs). Usually this is not the case. The law was circumvented for short-term gain and not long-term benefits.
Deputy Minister of Health, Ms N Madladla-Routledge (ANC), maintained that a good legal framework was in place in terms of the Health Act, but that implementation needed to be addressed. She recommended that REACH’s ‘shadow’ White Paper be considered in policymaking. She was interested in the medical aid schemes being regulated to remove the capped benefits, and that the essential drug lists (EDLs) be provided at primary healthcare facilities to deal with mental healthcare. She stressed the need for mass education of society and training for medical personnel in terms of diagnosing suicide cases and mental illness. She related a personal experience where a patient was shunted from one institution to another because of poor knowledge about treatment.
Ms N Khan replied that the Council of Medical Schemes needed to penalise medical schemes for non-compliance to the law, as they tended to be too concerned about short-term cost savings. The Council had admitted that they were ineffective in terms of enforcing the rules because they had no infrastructure in place.
Dr Eugene Allers, head of the SA Society of Psychiatrists (SASOP), concurred that implementation was problematic. Psychiatrists were not sitting on EDL Committees where changes in psychiatry were being effected. Medication was important in dealing with psychiatric illness. The Council of Medical Schemes did not have enough guidance to look after the rights of patients in terms of benefit design, as only four out 140 medical schemes adhered to the financial management requirements.
Ms M Manana (ANC) concurred with the Deputy Minister in terms if EDLs, training and mass education. She felt that mental illness had been neglected for too long. She pledged the Committee’s assistance to the Deputy Minister regarding the improvement of mental healthcare.
Ms D Kohler-Barnard (DA) wanted a breakdown of areas where the public healthcare system was failing because the manner of treatment was an indictment to South Africa as a whole.
Dr Allers responded that the Western Cape "was not too bad off", with two psychiatric institutions in operation. Northwest Province had two psychiatrists in private practice, Mpumulanga had one in private practice, Limpopo Province had seven in private practice, and the Northern Cape had one psychiatrist in private practice. Most of the hospitals were derelict and lacking staff. There were 310 – 330 active psychiatrists in SA with 84 in state hospitals. The 84 were academic posts so involvement in clinical work was limited.
The Acting Chairperson wanted to know what PMBs stood for and was the condition of bipolar disorder hereditary.
Dr Allers responded that PMB stood for ‘prescribed minimum benefit’. There were 271 PMBs, but that this list was inadequate as it did not include emergencies like suicide. Bipolar disorder was hereditary. If one parent contracted it, ones chances of acquiring the condition were eight times higher than the broader population. If both parents were diagnosed with bipolar disorders, the prognosis was worse. Without good medication in the first or second episode, the disorder would develop into a cognitive problem. One percent of the population had bipolar disorders.
Mr I Cachalia (ANC) felt that psychiatry was an auxiliary and not an essential service. In developing a White Paper, they needed to address concerns like the lack of appropriate drugs in facilities, General Practitioners (GPs) lacking training to diagnose mental illness in both the public and private sector, and a comprehensive approach involving psychologists, occupational therapists, community support from family and community groups.
Dr Allers concurred that a psychosocial approach was crucial. Alliances should be formed with other disciplines. A psychiatric facility should follow a therapeutic programme.
Ms B Ncgobo (ANC) wanted to know whether psychiatry was part of the syllabus when studying medice. Did these problems emanate from the old apartheid era?
Dr Allers explained that psychiatric disorders were the fastest growing illness worldwide and that psychiatry was a respected discipline abroad. It had become stigmatised in South Africa, and that perception needed to be removed.
Mr S Njikelana (ANC) concurred about treatment, cure and rehabilitation in family and community. He wanted to know whether there was a difference between psychiatry and mental illness; with which organisations REACH had relationships, and whether alternative therapies like traditional healing methods were used.
Dr Allers responded that alternative treatments were crucial because the illness was determined by perception. There were different approaches in terms of religion, families, culture, and traditions.
Ms Khan replied that with the adoption of the Traditional Healer’s Bill, the public would be educated about psychiatry. Alternative medication required mandatory registration in terms of safety for the public sector. The word ‘mental’ had a negative connotation, whereas when using the word ‘psychiatric’, people did not know what you were talking about. The words would be interchangeable until such time that one term could be used. REACH worked with non-governmental organisations as a short-term resource to obtain a reality check of healthcare at grassroots level.
Ms Madladla-Routledge stated that the health policy was to move from an institution to community care.
Dr Allers responded that psychiatric facilities needed to de-institutionalise patients, that the psychiatric nurse formed the backbone of care for the patient, that primary healthcare needed to be supported, and that facilities needed to be upgraded for acute treatment. By its very nature, private practice was better equipped and managed as an outpatient facility. New thinking placed the psychiatric patient under social, community-based care and not psychiatrists.
The Acting-Chairperson said that the government had instituted a Mental Health Act, which meant that it cared for the mentally ill. If there were 800 000 suicide cases worldwide, how many were there in South Africa?
Dr Allers replied that there were 20 000 – 100 000 cases - which was ‘normal’ by international rates. Gauteng had the highest number of cases. The Act was difficult to implement as the licensing criteria were different in each province. The rural areas seemed to be protected as more solid family structures were in place, and illnesses were managed better by private practitioners.
The meeting was adjourned.
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