Hansard: NCOP: Unrevised hansard

House: National Council of Provinces

Date of Meeting: 24 Feb 2022

Summary

No summary available.

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Minutes

UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
THURSDAY, 24 FEBRUARY 2022
PROCEEDINGS OF THE NATIONAL COUNCIL OF PROVINCES
Watch video here: PLENARY (HYBRID)

The Council met at 14:00.

The Chairperson took the Chair and requested members to observe a moment of silence for prayers or meditation.

ANNOUNCEMENTS
The CHAIRPERSON OF THE NCOP: Please allow me to remind delegates that the Rules apply and so do the processes forvirtual sittings. Hon delegates, before we proceed, I wouldlike to take this opportunity to remind you that the virtual sitting constitute the sitting of the National Council of Provinces. Delegates in the virtual sitting enjoy the same powers and privileges that apply in a sitting of the National Council of Provinces. For the purpose of the quorum, all delegates in the virtual platform shall be considered to be present in the House. Delegates must always switch on their videos and ensure that the microphones on their gadgets are muted and remain muted unless a member has permission to speak. The interpretation facility is active and that any delegate who wishes to speak must use the “raise your hand” function. Hon members are familiar with the “raise your hand”
function or icon.
Having done that, I will now go ahead and announce names of new delegates. I take this opportunity now to announce that the vacancies which occurred in the Council owing to the resignation of the hon T B Mathibe and the earlier on passing on of S E Mfayela who was replaced by Xolani Ngwezi had been
filled by the appointment of the following members. T P Mamarobela from Limpopo. So, Mamarobela becomes the Limpopo delegate and the hon N M Hadebe becomes the KwaZulu-Natal delegate respectively. The hon members were sworn in the past week.
We will now move on to a motions. We will start with notices of motion. I will now allow an opportunity to delegates to give notice of motions. Any delegates who wishes to give a notice of motion should raise their hands. Maybe just for a reminder – an emphasis - it is one and a half minute per motion and a total of 20 minutes for the respective motions. If a delegate exceeds the allocated time of one and a half minute, their notice of motion will be printed in full on the next Order paper. Are there any notices of motion? Hon members, we will start with the hon George Michalakis.

NOTICES OF MOTION

Mr G MICHALAKIS: Hon Chair, I hereby give notice that on the next sitting day of the House I shall move on behalf of the
DA:
That this Council debates the poor conditions of provincial roads.
Mr M S MOLETSANE: Chair, I hereby give notice that on the next sitting day of the House I shall move on behalf of the EFF:
That the Council –
(1) debates the issue of sewage spillages which residents of Lejweleputswa Local Municipality are constantly being objected to.
(2) notes that the constant raw sewage spills are also a problem in Mangaung, Moqhaka and Setsoto municipalities in the Free State province;
(3) further notes that this pose a serious health hazard to residents who have had to endure this
infrastructural shortcoming for more than a year.
Mr M E NCHABELENG: Chairperson, I hereby give notice that on
the next sitting day of the House I shall move on behalf of
the ANC:
That the Council debates the commitment of government to
develop a new funding model for students at institutions
of higher learning which will come into effect in the
year 2023, which National Treasury said a ministerial
task team has been set up to work on the model.
SHOCKING HIGH RATE OF CRIME IN SOUTH AFRICA CALLS FOR POLICE  EFORM
(Draft Resolution)

Mr A ARNOLDS: Chairperson, I rise on behalf of the EFF:
That the Council-
(1) notes with concern the shocking high rate of crime
in South Africa, as depicted in the latest quarterly
statistics on crime, which were released this past
Friday;
(2) further notes that the statistics point to an 8,9%
increase in murder in our country, as 6 859 people
were murdered between October and December 2021;
(3) also notes that out of the 6 859 people killed, 902
of them were women, 352 were children and 232 were
as a result of domestic violence;
(4) acknowledges that the Constitution of the Republic
of South Africa under the Bill of Rights guarantees
the right to life;
(5) further acknowledges that the murder rate has been
steadily increasing over a five-year period, and
does not seem to be affected by COVID-19 or the
extended lockdown period;

 
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(6) recognises that there are also existing increase in
violent and contact crimes, together with attacks on
property, car and truck hijackings;
(7) further recognises that the SA Police Service spend
billions of rands each year without significantly
enhancing public safety and has instead failed our
communities as criminals triumph in South Africa as
our people are not safe anywhere in the country; and
(8) calls for police reform which must begin with a
fearless assessment of the SA Police Service and its
bloated leadership.
Motion agreed to in accordance with section 65 of the
Constitution.
POOR STATE OF AFFAIRS AT KHAYELITSHA DISTRICT HOSPITAL A
CONCERN
(Draft Resolution)
Ms M N GILLION: Chairperson, I hereby move without notice on
behalf of the ANC:

 
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That the Council-
(1)
notes with concern that the poor state of affairs at
Khayelitsha District Hospital, KDH, where the
official bed capacity is 340, but which often sees
about 446 patients is far from being resolved;
(2)
further notes that according to the KDH Chief
Executive Officer, Mr David Binza, the hospital was
seeing a strong growing burden of mental health
conditions whilst there is only one specialist in
the area; and
(3)
calls on the provincial government to grant the
R100 million that the hospital management and board
had requested in order to improve service delivery.
Motion agreed to in accordance with section 65 of the
Constitution.
DA CALLS ON INVESTIGATION INTO PARTIALLY DYSFUNCTIONAL PARK
ROAD POLICE STATION
(Draft Resolution)

 
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Mr G MICHALAKIS: Chairperson, on behalf of the DA I hereby
move without notice:
That the Council –
(1)
(2)
(3)
notes that Park Road Police Station in Bloemfontein,
one of the province’s largest police stations has
been partially dysfunctional since 2007, when Public
Works was planning on doing an upgrade at the
facility;
further notes that since then, at least three
contractors had been appointed and dismissed due to
poor performance and half-dismantled buildings are
still not accessible to the SA Police Service, the
SAPS, to do their work;
also notes that an access amount of R48 million has
also been paid to contractors for work not done, and
has also not been recovered, and this is whilst Park
Road Police Station is the fifth highest volume of
serious crime reported in the country according to
the latest crime statistics;

 
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(4)
(5)
calls upon the relevant select committee dealing
with Public Works to investigate this matter and
report back to the House;
emphasise that we cannot allow poor administration
to continue putting the lives of South Africans at
risk.
Motion agreed to in accordance with section 65 of the
Constitution.
PATRIC MULLER CHARGED BY GEORGE CIRCUIT HIGH COURT
(Draft Resolution)
Ms N NDONGENI: Hon Chairperson, I move without notice:
That the Council –
(1) notes that the man accused of the rape and murder of
37 year-old Bianca Matroos, was found guilty in both
counts in the George Circuit High Court;

 
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(2) further notes that Patrick Muller was also charged
with kidnapping and robbery with aggravating
circumstances after Matroos’s body was found between
concrete blocks at an open field at the George
Riding Club on November 17 in 2019;
(3) also notes that it has emerged that the DNA samples
found on Matroos’s body matched the DNA profile of
Muller who will be sentenced in March 2022; and
(4) commends the Police and the National Prosecuting
Authority, NPA, for a job well done in ensuring that
the murderer is found guilty for committing this
hideous crime.
Motion agreed to in accordance with section 65 of the
Constitution.
SAPS ARRESTS ORGANISED CASH-IN-TRANSIT HEISTS ARMED CRIMINALS
(Draft Resolution)
Ms S SHAIKH: Hon Chairperson, I move without notice:

 
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That the Council –
(1) notes with pride the successful foiling of an
organised cash-in-transit heists where the police
met toe to toe with armed criminals;
(2) further notes the bravery and heroism of our men and
women in blue;
(3) salutes the South African Police Services, SAPS, for
countering this deadly crime; and
(4) further salute our intelligence services for the
work in intercepting this crime.
Motion agreed to in accordance with section 65 of the
Constitution.
REPORTS OF UNSAFE WATER FOR HUMAN CONSUMPTION IN THE EASTERN
CAPE
(Draft Resolution)
Mr M NHANHA: Hon Chairperson, I move without notice:

 
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That the Council –
(1) notes the reports of unsafe water for human
consumption reports in a number of municipalities in
the Eastern Cape;
(2) further notes that the Buffalo City Metro has in the
past few days issued warnings to residents to boil
their water before consumption;
(3) acknowledges that in the Nelson Mandela Bay water
has not only been declared unfit for human
consumption with traces of the deadly E. Coli
bacteria, but has claimed a life of a child, with
scores of other children in hospital;
(4) sends its heartfelt condolences to the family of the
deceased child; and
(5) urges both metros, Provincial Departments of Health
and Cooperative Government and Traditional Affairs
to take all necessary steps to correct the
situation.

 
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Motion agreed to in accordance with section 65 of the
Constitution.
LACK OF TRANSPARENCY IN HOUSING ALLOCATIONS BY THE
MUNICIPALITIES
(Draft Resolution)
Mr K MOTSAMAI: Hon Chairperson, I move without notice:
That the Council –
(1) notes the process of the housing allocation that exists
lack of transparency and ability by the municipalities
and professional officials in how houses are allocated
to the beneficiaries; and
(2) further notes that beneficiaries often apply to qualify
for housing, only to find out that once the houses are
built, they are not allocated to the rightful owner, as
is the case in ward 17 Kwamasiza, Emfuleni
Municipality, where hostels were renovated and the
beneficiaries not allocated till today.

 
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Motion agreed to in accordance with section 65 of the
Constitution.
The CHAIRPERSON OF THE NCOP: I must say that it sounded more
like Notice of a Motion, but sue, we will move on. These
issues can always be examined. ... [Inaudible.] ... later on.
Thank you very much.
EMERGING PATTERNS OF ORGANISED GRASSROOTS PROTESTS AGAINST
EMPLOYMENT OF FOREIGN NATIONALS
(Draft Resolution)
Mr E M MTHETHWA: Thanks Chair, I am struggling on my gadget
today. Hon Chairperson, I move without notice:
That the Council –
(1) notes with concern the emerging patterns of
organised grassroots protests against the employment
of the foreign nationals by our local businesses;
(2) further notes that at the core of these protests is
the competition for scarce resources;

 
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(3) cautions that if not controlled and guided, these
protests can deteriorate into violence and
lawlessness;
(4) acknowledges that the failure of coordinated and
integrated leadership in addressing the challenges
of migration by government has given rise to these
protests;
(5) calls on the Peace and Security Cluster at Cabinet
level to speedily design an integrated road map
towards addressing the problems of migration in
South Africa; and
(6) calls on the African Union to expedite the framework
for regional integration.
Motion agreed to in accordance with section 65 of the
Constitution.
DEBATE ON MENTAL HEALTH FOR ALL: GIVING PRIORITY AND GREATER
ACCESS TO MENTAL HEALTH CARE FOR ALL

 
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The DEPUTY MINISTER OF HEALTH (Dr S Dhlomo): Hon Chairperson
of the NCOP, hon Masondo, Deputy Chairperson, hon Lucas, hon
Ministers, Deputy Ministers present here today, hon Premiers
and Members of Executive Council, MECs, for Health of various
provinces, hon Chairperson of the Select Committee on Health
and Social Services, Mme [Ms] Gillion, and members of this
committee, hon members of the House, good afternoon.
Let me start by actually conveying our apology on behalf of
our Minister, Minister Dr Phaahla, who has delegated me to be
in this debate because of other pressures in the department.
We are here responding to a theme: Mental health for all:
Giving priority and greater access to mental health care for
all.
We note ... and this topic we have to do the streamlining as
the Department of Health in delivering a comprehensive
response to mental health. And I hope that my colleagues,
MECs, who are also logged in here will also be able to expand
on this topic.

 
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I’ve also noted the various topics that some our colleagues
are going to discuss: the stigmatization, substance abuse and
harnessing human potential regarding economic opportunities.
We want to start with the World Health Organization, WHO,
definition of mental health where it states that:
A state of wellbeing in which the individual realizes
his or her own abilities, can cope with the normal
stresses of life, can work productively and fruitfully
and is able to make a contribution to his or her own
community.
This is based on the understanding that the World Health
Organization puts this in their dictum that there is not
health without mental health and in the definition of health,
which actually by WHO again, states that “A state of complete
physical, mental and social wellbeing and not merely the
absence of disease or infirmity.” Which was, therefore,
adopted in 1978 in a very powerful meeting in Alma-Ata
Conference.
Several efforts have been made to pay special attention to
mental health. However, mental health conditions continue to

 
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be amongst the leading causes of ill-health and disability
worldwide.
In South Africa the latest estimates of the global burden
disease, mental, neurological and substance abuse conditions
make up to 18% of the total years of life lived with
disability.
It is estimated that about 1 in 3 persons would suffer from a
mental illness in their lifetime whilst about 16,5% from a
mental illness in 12 months’ period. This is an alarming
picture in our country.
Mental health conditions vary according to severity and
impact. For example, anxiety disorders and major depressions
are among the most common conditions while schizophrenia and
bipolar disorders are less prevalent, yet they pose the major
disruptions to households and consume a significant social
care and household economic resources.
Depression in men can manifest through a risky behaviour,
anger, aggression, agitation and rage. It may also manifest
through emotional withdrawal and hopelessness. This is where
we need universally recognized standards in mental health case

 
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for men in our country. This will at the same time address the
scourge of gender-based violence, which becomes a by-product
of an abused and a mentally unstable man.
Let’s go back to the fundamentals of this matter. It is
critical to remind ourselves that mental health conditions do
not occur in isolation. People who experience physical illness
often experience psychological and mental health difficulties.
There are high levels of comorbidity with other health
conditions such as HIV, non-communicable diseases,
communicable diseases, maternal and child-care resulting in
poor treatment outcomes.
There is a substantive research evidence pointing out that
linking people with HIV who are twice as likely to be
depressed while those with non-communicable diseases are two
to five times more likely to suffer from mental health
conditions. This consequently impacts on adherence to
medication and ultimately results in poor health outcomes,
including mortality.
Also, high levels of antenatal and postnatal depression
significantly affect the mother-infant bonding and the

 
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development of children. This burden of mental health, social
and economic system is so much unmeasurable.
Mental health has multiple biological, psychological and
social determinants which interact in a complex manner to
either provide protection of mental health or increase the
risk for development of mental illness.
This shows that the combination of genetic vulnerability,
childhood trauma and adverse living conditions which is
brought about by poverty may predispose a person to a major
depressive episode.
Literature provides detailed explanation on the relationship
between poverty and mental illness as described as a vicious
cycle.
You will recall that in South Africa these patterns have been
exacerbated by our history of violence, trauma, exclusion,
isolation, racial discrimination including separation such as
migrant workers, as detailed in the Truth and Reconciliation
Commission report of 2000.

 
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Under causes of mental health problems are associated with
genetics, biological and cultural risk factors. These include
hereditary, hormonal imbalance, socioeconomic stresses,
adversity into the early childhood adversity and neglect,
gender-based violence, intrautred adverse factors, migration
and immigration, and associated social aspiration culture
shock.
Children and adolescents are not spared from mental health
difficulties. Research evidence show that diagnosable mental
health conditions affect 14% of this population while suicides
tragically claim lives up to 700 000 people every year, which
equates to one person every 40 seconds universally.
Furthermore, substance abuse including alcohol, tobacco and
illicit drugs predispose people to increase risk for mental
disorders, crime, violence and injury. All these are calling
for response that is commensurate to the mental health demand
and need on the ground.
The question remains: Are mental health services accessible to
the people who need them?

 
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The mental health treatment gap has been documented
internationally and in our local context. About 70% to 95% of
people with mental orders in low and middle-income countries
are unable to access mental health services.
The treatment gap has been further put on the spotlight by
COVID-19 which further denied many people with mental illness
the treatment they are entitled to and deserve. While it also
increased pressure of many people as a result of isolation,
loss of income; of all which led to depression in some cases.
The pandemic has eliminated the urgency of a global and
population-wide approach to mental health care, treatment and
rehabilitation.
Our country has not been spared from the drastic impact of
COVID-19 on the mental health wellbeing of our people. The
pandemic has exacerbated the mental health challenges facing
our country. The impact of COVID-19 on mental health services
came through the inability of the health system to prioritise
mental health services during the pandemic.
It has further been associated with increased anxiety, loss,
social isolation, increased food insecurity, poverty and

 
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domestic violence and femicide; which are serious predisposing
factors for mental illness.
The pathology of COVID-19 is such that it has direct effects
on the brain and caused a number of mental ill-health symptoms
including anxiety, depression, psychosis and cognitive
impairments.
Scholars have projected that numbers of those requiring mental
health services will substantially increase and the demands
for mental health and psychosocial support will be greater
than ever, worldwide. It is pre-empted that mental health
systems will be overwhelmed and not cope with the demand for
mental health services due to COVID-19 pandemic impact in
society.
While the COVID-19 active cases are declining and recovery
rate seems to be promising including the uptake of vaccines by
South Africans, the physical, mental and social economic
impact and distress on our people remain. This includes the
mental wellbeing of health providers, on frontline service
providers across all levels of care. This is more critical as
efforts are underway for reset, recovery and recalibration of

 
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the health system so that it can address the fundamental
services that it put in the ... during the pandemic.
It is evident that the causes of inaction are life lasting and
substantial and that the magnitude of mental health burden
must be met with the response and attention it demands and
warrants.
As we battle the physical effects of COVID-19 we should also
strengthening our mental health services to be able to deal
the potential increase in mental health problems because of
the COVID-19 pandemic. We need to revisit the resourcing of
mental health services.
We know that perceived stigma, embarrassment of mental health
literacy are key barriers of seeking help for mental health
problems. While social support and encouragement from other
aids and helping behaviour are very critical. We need to
address the stigma associated with mental illness and
strengthen interventions to educate the public and increase
mental health literacy.
We cannot, however, Chairperson, forget the Life Esidimeni
tragedy that we recently experienced in the Gauteng province.

 
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Such events must never revisit us. We, therefore, need to
improve mental health system and improve them with speed.
We have made major strides in implementing recommendations by
the Human Rights Commission from their investigative hearings
held in Gauteng ... At the same time forensic mental health
services continue to plague the health system.
The department is faced with accumulation of referrals for
mental observation and state pensions are awaiting hospital
admissions languishing in correctional facilities. We have put
a variety of interventions to address this area. Some of which
include improved collaboration with stakeholders within the
criminal justice system. Intersectoral collaboration on mental
health is another critical aspect.
It is apparent, however, Chair, that neither the state
departments nor mental health civil society organizations are
able to provide comprehensive mental health services as
independent entities.
We need multisectoral mental health approach and stakeholders,
including mental healthcare users, to coordinate and
effectively address the service demands.

 
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Hon Chairperson, we have a total of 379 community-based mental
health non-profit organizations, NPOs, that are licensed and
funded by the provincial Departments of Health. We applaud the
men and women in these facilities as they are providing a
valuable service to our own, who are unable to do much for
themselves.
The important role played by the NPOs in providing community-
based mental health services cannot be overemphasised. Their
interventions are multipurpose and cost-effective in bridging
the gap between the medical and social approaches to care
which is central to the integrated and comprehensive
community-based models of care that underpin the recovery
approach.
Most importantly the NPOs’ services are culture sensitive and
tailor-made to the context of local communities and cultures.
Strategic partnerships with NPOs is pivotal towards attainment
of a paradigm shift towards accessing bio-psychosocial
community-based mental health interventions.
One of the recommendations of the health ombuds person
following the Life Esidimeni tragedy was that as the
department we need to review and strengthen regulations on

 
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licensing and procedures for these facilities, that it must be
adhered to and must be also keeping with the laws governing
the service.
It is my pleasure to report, Chair, to this House that we have
developed these guidelines for licensing of these facilities
in 2018 and now are in the final process of concluding the
regulations.
The health ombuds person also recommended that the SA Human
Rights Commission undertakes a systematic review of human
rights compliance and possible violations nationally on mental
health services.
Chairperson and hon members, the reviews by the SA Human
Rights Commission were undertaken in 2017 and the report was
released in 2018. The report largely found gaps in mental
health systems across all levels of health systems. These
include, among others, prolonged and systematic neglect of
mental health at level of policy implementation, considerable
underinvestment in mental health, barriers and access to
mental health services particularly in rural areas, lack of
mental health infrastructure and human resource, the poor

 
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state of mental health services in the criminal justice,
forensic and correctional services.
Chairperson, I am pleased to report that we are hard at work
to ensure implementation of these recommendations in order to
further strengthen our mental health systems.
While much still needs to be done, we have at the same time
made strides in the implementation of the national mental
health policy framework and strategic plan 2013-2020.
The outcomes include, among others, the following,
Chairperson:
Firstly, collaboration with the University of Cape Town and
the Medical Research Council to conduct a study to develop an
investment case on mental health. We are in the process of
developing a costed plan to implement the recommendations made
in the report. This will improve the resourcing models and the
allocation of resources on the key strategic programmes in the
country.
Secondly, additional funding has been allocated by National
Treasury for strategic purchasing of mental health and

 
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forensic mental health services through contracting of
additional psychologists, psychiatrists and registered
counsellors to complement the already available human resource
capacity to render mental health services at primary
healthcare and to reduce the backlog of forensic mental
observation cases. By December 2021 85 of these professionals
had been appointed in provinces using this funding. We will be
extending the professional category under this grant with
social workers and occupational therapists in this financial
year.
Thirdly, to improve integration of mental health into the
general health services environment. We have attached 40
psychiatric units in general hospitals. This will help us
improve access to mental health services, contribute to the
fight against stigma, improve efficiency in the transnational
resources and ensure that people are treated nearer to where
they live.
Fourthly, regarding capacity building on mental health we have
trained 1 660 medical doctors and professional nurses working
in mental health facilities as part of the programme initiated
in 2019 to equip them with the skills on clinical management
on mental disorders.

 
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Fifthly, as part of the infrastructure revitalization we are
incrementally renovating dilapidated infrastructure for mental
health and those that are not fit for purpose to render mental
health services. These include plans to construct forensic
mental observation units in Limpopo and Gauteng provinces.
Sixthly, we have activated section 71 of the Mental Healthcare
Act of 2002 and established a Ministerial Advisory Committee
on mental health by regulation. This 19-member committee
comprising of experts, government departments’ and civil
society representatives play a critical advisory role in the
area of mental health. This is one key intervention that is to
enhance our governance and leadership in mental health.
Seventh, in order to address substance abuse and its related
public health and social consequences the National Health
Council approved a health sector draft masterplan 2019 ...
The Chairperson of the NCOP: As you move towards closing,
Deputy Minister!
The DEPUTY MINISTER OF HEALTH (Dr S Dhlomo): Okay.

 
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This document outlines strategic activities that were
implemented to address the problem of substance abuse and its
related public health and social consequences.
I will continue, hon Chairperson, later on when I’m to
actually close ... Thank you very much for this opportunity.
Ms M N GILLION: Hon Chairperson, hon Deputy Chairperson, hon
Deputy Minister Dhlomo, all hon MECs present in the House, all
delegates and hon members, currently we are living in
societies where mental illness is prevalent amongst
individuals, and it could be our loved ones, friends or
colleagues. Recently, according to statistics mental illnesses
are leading factors to mental health disorders amongst other
problems in individuals in all their life aspects at home,
school and even in the work place.
The COVID-19 pandemic may have caused a possible rise in
incidents associated with mental health issues which may have
led to suicidal behaviours, attempts and actual suicide
worldwide. Not only did the COVID-19 pandemic impact the
economy of many countries worldwide, but it also had a huge
impact on our mental wellbeing.

 
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The unpredictable consequences and uncertainty surrounding
public safety, job security, quarantine and isolation, fake
news and myths about COVID-19, particularly abounding in
social, media may negatively impact an individual’s mental
health causing depression, anxiety, phobia and traumatic
stress.
It has been established that around 90% of global suicides are
individuals who suffer from depression. It has been summarily
reported to have been cockering in the past epidemics and
pandemics. Those suicide may not be the only result to mental
illness, there are other contributing factors like bullying,
working conditions and public shaming can also result in
mental illness. This requires serious attentions, and need to
be addressed at all levels that require partnership between
the health care sector and other sectors like schools, non-
profit organisations etc. Meaning the need for seamless links
between mental and physical health care can be of great
assistance in curbing and dealing with mental illness.
It is noted that issues of mental illness can be related to
the triple challenges of poverty, unemployment and inequality.
Whilst trying to come up with strategies that can help curb

 
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the above-mentioned challenges, mental illness becomes the
priority.
Hon members, 14 to 17 February 2022 was the Teen Suicide
Prevention Week, not only in our country but in the world. The
World Health Organisation, WHO, states that more than 800 000
people lose their lives by suicide a year worldwide, and teen
suicide is particularly prevalent between the age group 10 to
19. The South African Federation for Mental Health, SAFMH,
states that in South Africa 9,5% of teenage deaths are due to
suicide. The shocking stats illustrates that there is much
need and support that must be provided to assist everyone that
is going through challenges of mental health illnesses.
Chairperson, furthermore, dismantling the stigma surrounding
mental illness is crucial, and this requires collaboration of
government departments, parents, teachers, learners and non
profit organisations. Suicide is preventable provided that
help in the form of policies and interventions exist. This
will also enhance awareness about how, through action, we can
help support all people, especially young people who might be
struggling.

 
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Over the past decade calls to address the increasing burden of
mental neurological and substance use disorders and to include
mental health care as an essential component of Universal
Health Coverage, UHC, have attracted mounting interest from
government. With the inclusion of mental health in the 2015
Sustainable Development Goals there is now a global commitment
to include mental health amongst the highest priorities for
investment as a health humanitarian and development priority.
Moreover, research reports have found that between 70% and 95%
of people with mental disorders in low and middle income
countries cannot obtain mental health services due to
financial constraints. This includes South Africa, and we are
far from the WHO guidelines in providing adequate mental
health care. There is a huge gap to fill to redress the mental
health illness to be accessible to all.
Hon members, the WHO Mental Health Atlas initiative commenced
in 2001. Our understanding of the health systems and ability
to monitor progress towards the ambitious global mental health
goals outlined in the Sustainable Development Goals has
improved significantly, and yet significant gaps still exist.

 
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In 2019 the SAFMH reported that only three provinces out of
nine provinces have child psychiatrist working in the public
sector. These challenges are being addressed through the
Department of Health in ensuring that mental health illness
programmes are available in our health care sector. We commend
the department under the leadership of Minister Joe Phaahla in
taking critical steps forward to strengthen the mental health
system, including reforming the Mental Health Care Act 17 of
2002, and the development of the South African National Mental
Health Policy Framework and Strategic Plan 2013–2020.
The Policy Framework and Strategic Plan 2013-2020 identify key
activities that are considered catalytic to further
transforming mental health services in South Africa and
ensuring that quality mental health services are accessible,
equitable, comprehensive and are integrated at all levels of
the health system in line with WHO recommendations.
The purpose of this policy is to give guidance to provinces
for mental health promotion, prevention of mental illness,
treatment and rehabilitation. The policy is intended to be
comprehensive in its scope addressing the full age range and
covering all mental disorders, including comorbid intellectual
disability and substance use disorders.

 
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Chairperson, lastly, the tireless work done for the adoption
of the National Health Insurance, NHI, to promote equity in
health service delivery towards universal health care will
help in ensuring that there are enough resources that will
contribute towards rapidly responding to health challenges
like mental health issues.
Hon members, infrastructure is a key pillar supporting the
fundamental aim of promoting improved standards of care and
wellbeing for all patients, together with a good experience of
the health care system. In parallel, the health care system
and staff must support elective health promotion, prevention
and selfcare of the whole population.
Subsequently, the department has made significant progress on
the 21 mental health infrastructure projects in the different
provinces. Out of 21 infrastructure projects, nine projects
are complete and 12 projects are in progress. This is a huge
achievement and good progress is forging a way forward to
tackling the mental health care in our country.
Research has illustrated the need to plan and strategize for
solutions to mental health care issues. Mental health illness
is prevalent in schools and workplaces which ultimately has an

 
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impact on our daily lives in different ways. As government, we
have various departments that can work together in making
realistic solutions in developing our country and its people
in its relation to mental health illnesses.
We still have teachers and employers that have a very
stereotypical view of issues related to mental health illness
and the stigma attached to the condition. The Mental Health
Care Act 17 of 2002 will help schools and workplaces preparing
thorough, insightful and accessible plans to all those that
are indeed of it. The Act will assist in enhancing positive
mental wellbeing and resilience for better development.
Hon members, it is important to mention the importance of
collaboration in tackling the issue of mental health
illnesses. The District Development Model was designed to
ensure service delivery, and it is now the time that the
different departments, namely, Health, Education and Social
Development, work together and merge the processes and
procedures to eliminate hindrances to services related to
mental health illnesses. Chairperson, let us use the Act to
ensure that we respond to the needs of all people in South
Africa and create a mental wellness in all our spaces. I thank
you.

 
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IsiXhosa:
Mnu M R BARA: Masibulele Sihlalo.
English:
Hon Chairperson, hon Deputy Minister, hon members, and fellow
South Africans, good day. Chairperson, it is important to
first express our sincere condolences on the passing of the
South African musician Riky Rick, namely, Rikhado Muziwendlovu
Makhado. It is alleged that he suffered from depression and
that may have led to his cause of death. However, that has not
yet been confirmed as yet. May his wonderful soul rest in
eternal peace.
Chairperson, the debate we are having today, happens at a
critical time in our country when we are confronted with high
unemployment rate especially amongst young people. It happens
at a time when leaders of this society are trying to think
deep as to what needs to be done to save our young people from
crime, drugs and focus on positive things in life.
Let me zoom in on a few areas that are critically important as
part of this debate. One of these areas or incidents is the
horrific Life Esidimeni which we must learn lessons from.
Mental health is still the stepchild of health and remains

 
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underfunded and under resourced. This is a reflection by
Christine Nxumalo who lost her sister Virginia Machpelah
during this tragedy.
[Interjections.]
I am sorry, Chair. She goes further to say and I quote:
The worst came when we were told about the closure
of the facilities. We received an SMS telling us
that she had been moved and later received a call
from Ethel Ncube, the director of Precious Angels,
informing us of her passing.
This is but one incident of many, which had occurred within
the Life Esidimeni and how the citizenry of this country looks
at politicians and government leaders.
There is a clear call on both the national and provincial
governments to do a lot to protect and cater for mental health
patients. With the COVID-19 pandemic, it is important to keep
people informed on what is happening and the wellbeing of
their loved ones kept in different institutions.

 
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Having said all the above, about 144 lives lost at Life
Esidimeni, at the very least, someone must take responsibility
for the lives lost. Any discussion about the ills and what
needs to be corrected in assisting our mentally ill persons,
cannot start in abstract; it has to be drawn from the Life
Esidimeni tragic events.
More needs to be done to address mental health issues
affecting young people. During the month of February, the
world observes Teen Suicide Prevention Week. The focus is on
adolescent and youth physical and mental health challenges, as
well as the extent to which COVID-19 pandemic increase mental
health concerns amongst young people.
According to reports, since the COVID-19 pandemic outbreak,
the mental health of young people has deteriorated
considerably with a rise in adolescent depression, anxiety and
self-harm.
The pertinent question we must ask ourselves, is how we can
effectively assist and support young people with mental health
challenges, particularly during COVID-19 in schools,
universities and workplaces that have been disrupted for a
while.

 
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We need to look thoroughly at the impact of COVID-19 amongst
young and old South Africans. In that way, we will be able to
see as to what interventions need to be undertaken urgently so
as to save lives and be a government that people are proud of.
The Departments of Health, Social Development and Basic
Education, must engage in an effort to run mental health
awareness campaigns and make sure that counsellors are
available at school in order to assist learners with these
challenges.
Data presented by the South African College of Applied
Psychology suggests that one in six Africans suffers from
depression, and that means that some people living with HIV
have a comorbid which is mental disorder and about 41% of
pregnant women are depressed. This is an indication of how
mental illness has been neglected by the health system.
Depression, anxiety and similar mental health challenges are
complex. Sometimes even when people have support, they still
struggle. There is a need for greater mental health awareness
and access to affordable, effective services. The greatest
pain with suicide is the pain left with those who are left
behind.

 
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The government has to make sure that accessibility to mental
institutions and assistance is effective and render services
to those that require them. Our government has to assist in
taking away the stigma on people who come forward needing
help.
Chairperson, I hope this is not just a debate but an attempt
to turn things around. An attempt to ensure that all South
Africans are taken care of to avoid another Life Esidimeni
massacre. I thank you, Chairperson.
Ms N METH (Eastern Cape): NCOP Chairperson, hon Masondo, hon
Chairperson of the Select Committee on Health and Social
Services, hon Gillion, Department of Health Deputy Minister,
hon Dr Dhlomo, allow me to greet all the hon members of the
House, and I say good afternoon to you all.
Chapter 10 of the National Development Plan has outlined nine
goals for the health system to be realised by 2030. Goal 4 is
about the reduction of prevalence of non-communicable chronic
disease by 28%. Goal 3 of the Sustainable Development Goals
which is about good health and wellbeing, emphasises the
importance of strengthening prevention and treatment of
substance abuse which contributes mental health.

 
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The Eastern Cape Department of Health is serious about mental
health. To this end, we are strengthening mental health team
and we have established a provincial task team. Our 5-year
Mid-term Strategy Framework eloquently articulates the state
of mental health services and plans as follows: The
infrastructure of psychiatric facilities has degenerated over
time and this is coupled with a bed shortage of 1600 in the
province, mostly the beds are concentrated in the western part
of the Eastern Cape province and also due to re-demarcation,
320 beds of Mzimkhulu hospital moved to KwaZulu-Natal.
The burden of disease has shown a radical increase of
substance abuse in the province and the country thus
increasing a need for social service and rehabilitation. There
is a critical need of facilities offering rehabilitation
services to augment the 91 beds available from public and
civil sector.
As part of strengthening the service, the National Department
of Health appointed an administrator for mental health
services to support the province. The service platform will be
strengthened through implementation of community-based
psychiatric services within primary healthcare; strengthening
of the 72-hour observation in district hospitals as well as

 
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focussing on acute and chronic in-patient management. There’s
a plan to increase acute beds in the eastern part of the
province.
During this term, the department will focus on strengthening
the prevention of mental disorders, drug and alcohol abuse and
provision of sufficient resources for mental health. Community
based approach to rendering mental healthcare will be
promoted, seeking to strengthen access to appropriate services
at the appropriate level of care. Addressing the inequalities
of mental healthcare will be a focus area, to ensure our most
disadvantaged communities have access to 72-hour acute
psychiatric care at designated facilities, as well as services
that speak to the burden of mental disease.
Mental health teams will be established. Mental illness
associated with substance abuse is a public health concern,
and partnerships will be explored to render the relevant
services to prevent and treat substance abuse effectively.
Mental health has become an important public health matter
globally, and in our country, as we attempt to strengthen our
health system and create a resilient society where everybody
is able to fulfil his or her potential.

 
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Mental health goes beyond a family or government issue. It’s a
societal issue that needs all of us. In an ideal world, we
would teach communities life skills and psychiatric skills so
that they will not ostracise people with mental illnesses.
Let’s be that generation that bites the bullet and not only
openly talk about mental health, but also join hands together
and embrace those with mental challenges or disorders.
In the Eastern Cape, we are hard at work ensuring that we
continue to turn the tide and ensure that we continue
prioritising mental health services. We are working with NGOs
that provide long term care facilities for chronic mental care
patients and halfway houses. We are currently filling vacant
posts though specialists continue leaving to join the private
sector, we are doing our level best to give the best possible
care.
Our purpose in strengthening community mental health and
ensuring that; equitable access across the province to 72-hour
mental health assessment units. Safety of healthcare workers
and patients while undergoing 72-hour assessment. To ensure
adequate infrastructure, appropriate medication, and
appropriate knowledge and skills of healthcare workers.

 
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Lastly, adequate knowledge of the Mental Health Care Act and
the correct use of Mental Health Care Act forms.
Clear pathways for district hospitals to specialised
facilities are being mapped so that referrals can be escalated
to relevant specialist care whilst stable patients can be
down-referred to the appropriate lower level of care.
We are improving access to ongoing Continuing Professional
Development activities for clinicians so that we can
strengthen the clinical management of mental health conditions
at district hospitals. Community and primary health care
clinics are also part of what we are doing. We will advocate
outreach programmes from specialised psychiatric facilities to
support to their surrounding district hospitals.
In the Sixth Administration term of government, mental health
and mental health services are receiving paramount
responsiveness in the Eastern Cape. In ensuring that we keep
track of this, we have established a provincial task team of
clinicians to drive the turnaround in an endeavour to
facilitate and co-ordinate the strengthening of mental health
services and interface with the office of the health
ombudsman.

 
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Hon members, we have covered some ground in providing mental
health services in the province where we have ensured that:
There are specialised hospitals for mental health care. We
have appointed a specialist in child psychiatry at Nelson
Mandela Academic Hospital. We will be embarking on the
renovation of Tower Psychiatric Hospital. We have concluded
the refurbishment of a child psychiatry unit at Fort England.
And, we have appointed Head of Department in Psychiatry at
Fort England.
We are also engaging with stakeholders to promote community
residential care and day care services throughout the
province. Community-based rehabilitation centres will be
established at district levels. Detection of management of
child and adolescent mental disorder will be at primary
healthcare. We will also establish halfway houses around the
province to prepare integration of patients back to their
communities.
The department also has three review boards located in
Gqeberha, Komani and Mthatha. These review boards, which each
have four members comprising of chairperson, a healthcare
professional, a legal expert and a community member, are able

 
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to service the eastern, central and western parts of our vast
province.
Hon members, 42 of our facilities have been earmarked to offer
psychological services. These will be evenly spread out
throughout our eight districts. A lot has been said about
Tower Hospital since the release of the report by Prof Makgoba
in 2018. We have also taken the recommendations of the
Ombudsman seriously, and within available resources we have
appointed a contractor for the renovation of Tower Hospital
and addressed the issue of social workers needing
communication tools.
The mental health directorate at the provincial office has
been created, although we have been struggling to find a
suitable candidate to occupy the position. Since the external
advert process was not successful, we embarked on an internal
process in an attempt to find and reassign a suitably
qualified SMS member with the appropriate skills and
qualifications.
The Eastern Cape Department of Health will continue to pursue
implementation of the rest of the Ombudsman’s recommendations,
soonest. Between our six specialised hospitals and units for

 
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mental health, we have a combined 1432 beds at Elizabeth
Donkin, Fort England, Komani, Tower, East London Mental Health
Unit and Mthatha Mental Health Unit. All what we are doing and
planning to do is aimed at ensuring mental health is
accessible for all and ensuring greater access to mental
health care for all in the Eastern Cape. Thank you very much,
Chairperson.
Ms M TSIU (Free State): Thank you, hon Chairperson of the
NCOP. The hon Deputy Minister of Health and hon members of the
NCOP, today we are discussing Mental health for all: Giving
priority and greater access to mental health care for all.
Nationally, the Department of Health has prioritised mental
health as it is the fifth burden of disease in the quintuple
burden of diseases in both the public and private health care
systems.
The Free State Department of Health provides comprehensive
health care based on primary health care principles built
around the District Health System framework, utilising the
health system government and accountability model.

 
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The provincial office, the four district offices plus one
metro within the municipal boundaries manage health care in
widely distributed and appropriate health facilities with the
support of an effective referral system. The referral system
makes use of a free commuter transport network to transport
patients between the primary, secondary, tertiary and central
health care facilities. Most of the facilities are in a
satisfactory physical condition, updated and maintained within
the limited budget allocation, and a few new facilities are
commissioned based on community needs and available funds. The
existing hospitals are regularly reviewed and upgraded under
the hospital revitalisation plan to meet the challenging needs
of communities. All facilities, some more than others, need
further improvements in physical structure and equipment. Here
we are talking especially about the seclusion rooms that are
needed within our facilities for 72 hour observations. Some
don’t really meet the standards of the health care system.
Priority has been given to establishing a fully functional
mental health care directorate. Currently, personnel have been
assigned ... as an acting senior manager ... community-based
mental health services, adolescent and substance abuse and
support services. We are going to prioritise the vacant posts
in the proposed structures of the mental health care

 
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directorate in the 2022-23 financial year. There are two
effective mental health care review boards in the province.
The one serves the metro and the northern part of the Free
State while the other one serves the eastern Free State.
The Free State Psychiatric Complex, FSPC, is the only
specialised psychiatric hospital that we have in the Free
State and it is designated in terms of the Mental Health Care
Act 17 of 2002. It is also designated as a care and
rehabilitation centre for persons with severe and profound
intellectual disabilities; for admission, care and observation
services for persons referred by a court for psychiatric
observation; as well as for the treatment and rehabilitation
of state patients and mentally ill prisoners under the
Criminal Procedure Amendment Act 65 of 2008. These are the
services that are found in the FSPC.
The allocation of beds that we have for the FSPC is as
follows. The forensic unit commissioned 144 beds but presently
uses 120. We commissioned 20 for the observation unit but
presently it uses 15. Acute psychiatric is 68. Presently it
uses 60. Long-term units are 120. Presently it uses 90. The
psychogeriatric unit is 55 and 55 are in use. The care and
rehabilitation unit is 470. A total of 420 are in use. A total

 
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of 877 beds have been commissioned while at the moment we are
using 760.
Child and mental health care services — outpatient mental
health care treatment and rehabilitation services for children
and adolescent services for users are also found here at our
psychiatric complex in Bloemfontein.
Substance prevention and rehabilitation services — outpatient
care, treatment and rehabilitation services of addicted
persons to substances who are treatment resistant are also
helped here. These are outpatients who are helped in this
psychiatric health complex that we have.
Adult outpatient services — outpatient care, treatment and
rehabilitation services of complicated or treatment resistant
adult, mentally ill service users.
District support services — that is the outreach services that
are given to our peripheral health care services.
Multidisiplinary team outreach to provincial hospitals, some
district hospitals, designated community health centres, CHCs,
and some identified clinics. We have a 24 hour telephonic
consultation, that is liaison service, support to district

 
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health facilities in the form of telephonic consultations
between the health professionals, which would be the medical
practitioners in the community with the specialists at the
FSPC, that is the Free State Psychiatric Complex. That would
be in the form of psychiatrists.
The contract appointments of clinical psychologists and
registered counsellors ... We have ... in our ... In order to
improve access to quality services to all eligible people with
mental health problems, we have appointed clinical
psychologists and registered counsellors. These people also
assist us in trying to deal with psychosocial problems,
especially at the time of COVID when many people were mentally
affected because of COVID infections and also the quarantine
period.
The Boitumelo Regional Hospital has 47 ... We have two
regional hospitals where we have commissioned beds for
inpatients. That is the Boitumelo Regional Hospital and
Mofumahadi Manapo Mopeli in QwaQwa. The Boitumelo hospital has
47 commissioned beds and Mofumahadi Manapo Mopeli has
30 commissioned beds. The services that are provided here are
provisioned for inpatient care to voluntary, assisted and
involuntary patients, 72 hour assessments, emergency and

 
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further involuntary care, treatment and rehabilitation,
providing designated detoxification sites for substance
abusers, the provision of secondary level outpatient services,
up referral of complicated and treatment resistant cases to
tertiary level, down referral with proposed management plans
of patients that may be managed at primary level, the
provision of support to district hospitals in fulfilling their
responsibility in terms of mental health care through the
structured outreach programme and telephonic consultation
services.
There was research done that ... it is indeed helpful if you
treat mental health care users together with the family so
that the family easily accepts the mental health care user.
They don’t really neglect them.
The 29 facilities listed ... We have 29 facilities that deal
with 72 hour assessments and here the services that are
provided are on an in-and outpatient, the care and treatment
of patients managed at the primary health care ... the
provision of 72 hour assessments, the referral of complicated
treatment and resistant patients to secondary level services,
support to district clinics in fulfilling their functions in

 
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terms of mental health care and the implementation of patient
management plans prescribed by practitioners.
The community mental health care services — We have
16 compliant nongovernmental organisations, NGOs, that are
registered with the Department of Social Development,
nonprofit organisations, NPOs, and are licenced by the
Department of Health to take care of our mental health care
users.
The provision of residential accommodation and community-based
services to 17 psychogeriatric and 15 adult mental health care
users. Monitoring and support visits to the abovementioned
NGOs providing ... This is what the department does. We
monitor and support visits to the abovementioned NGOs
providing ... [Inaudible.]
Yes, as I conclude ... providing psychogeriatric, and adult
community-based mental health care services ... are done
yearly according to the Mental Health Care Act 17 of 2002.
We believe that there is still more that needs to be done for
mental health care patients. And yes, we have seen that it is
indeed one of the burdens of diseases, now that we are already

 
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seeing many of our people committing suicide. This is one of
the things that we are really going to focus on in this
financial year ... to work very hard in order to have our
people deal with their problems without really thinking of
suicide as the only way out.
The HOUSE CHAIRPERSON (Ms W Ngwenya): Hon members, I will
continue with the speaker’s list. Before, I would like to
welcome our two members who have joined us in the NCOP. You
are welcome hon Mamarobela and hon Hadebe, Bhungane. Hon
members the next speaker is hon Christians.
Ms D C CHRISTIANS: Hon House Chairperson, hon Deputy Minister,
hon members, and fellow South Africans good afternoon, mental
health is being treated as an insignificant part of the health
sector in South Africa and sadly this has been to the
detriment of those who live with mental illnesses. This
irreverence towards mental health is reflected in the lack of
investment and limited government contribution to mental
health.
Last week was teen suicide prevention week, emphasising the
severity and concern for mental health challenges facing our
youth. Statistics show that suicide is the second most common

 
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cause of death among people aged 15 to 29. The youth in South
Africa is especially susceptible to mental health challenges
because of the many social issues plaguing the country, also
noting that 9% of all teen deaths are due to suicide.
59,5 % of youth in the country are unemployed and research
predicts that the risk of suicide in the unemployed is
elevated by 20% to 30%. This is further exacerbated by the
fact that only three of the nine provinces, at the start of
the COVID-19 pandemic, had child psychiatrists working in the
public sector. Additionally, schools in South Africa are no
longer a safe space for our children as they face further
threats to their mental health by being called derogatory
names, face fears of assault, bullying and exclusion from
activities by their peers. It is therefore of huge concern
that there are limited youth-friendly mental health care and
services in the country where the youth are overwhelmed by so
many difficulties.
People are stressed, anxious and grieving. Suicides have
escalated and it is imperative that depression is treated with
love, compassion and appropriate intervention. Lockdowns and
subsequent losses, whether personal or financial have
amplified depression. In a severely unequal society like South

 
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Africa, the virus exposed existing mental health care services
issues as well as the shocking public health crisis in the
country. This raises the critical question: Who does the
responsibility fall on to remedy the lack of counselling
resources in the country?
Research shows that prior to the pandemic, one in six South
Africans already suffered from anxiety, depression or a
substance use disorder, with 60% of people possibly dealing
with post-traumatic stress. However, just 27% of South
Africans with severe mental disorders receive treatment. The
same paper reflected that in 2019 just 5% of the national
health budget goes to mental health and only 50% of public
hospitals with mental health services actually have a
psychiatrist. To add fuel to the flames, it is estimated that
when crime and motor vehicle accidents are taken into
consideration, up to 6 million citizens in the country suffer
from stress related disorders.
The truth is that people don’t know where to get help, or are
too scared to seek it, and with the limited statistics it is
clear that the state of the country’s mental wellbeing is in
severe crisis. The South African Depression Anxiety Group
claims that less than 16% of sufferers receive treatment for

 
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mental illness. And, although over 85% of these patients are
dependent on public health-sector services, there are only 18
beds for every 100 000 people available in such hospitals and
only 1% of these are reserved for children and adolescents.
It is no secret that only a minority of gender-based violence,
GBV, cases are reported. This includes the incompetent and
unjust handling of GBV cases in the justice system, as well as
abuse and harassment of survivors by perpetrators. This
further marginalises women and children, increasing their
susceptibility to mental health problems. Once again, leaving
the most vulnerable, women and children, at the mercy of an
ailing health system.
The responsibility that falls to community healthcare
providers when it comes to dealing with mental illness is huge
and the lack of a sustainable funding model for mental health
perpetuates the lack of mental health services as there is no
clear source of funding for the implementation of policies and
plans. This is an indication of a lack of empathy for mentally
ill people and exposes the inadequacy and paucity of mental
health care services in the country.

 
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Mental health requires a focused and assertive response by
government and services should be at the forefront of this
task. Access to mental health facilities should be
prioritised. Government should ensure that facilities and
mental health practitioners are adequately equipped. Employ
more psychologists at strategic points such as hospitals,
clinics and schools. Place the 100’s of social workers who to
date have not been employed, so that communities can be
alerted, cases reported timeously and help given to those who
need it. Mental health needs to be integrated into the school
curriculum, with an emphasis on bullying and safety. Mental
health is something we should work on continuously as part of
our regular health routine. The more we talk about mental
health, the more we will see it being made a priority in our
workplaces, our communities and our own lives. I thank you.
Dr N MOKGETHI (Gauteng): Thank you very much hon House
Chairperson, hon Winnie Ngwenya, Chairperson of the NCOP, hon
Masondo, Deputy Chairperson of the NCOP, hon Lucas, Deputy
Minister, Dr Dhlomo, MECs present here, hon members of the
House, distinguished guests, fellow South Africans, sanibonani
[good afternoon], good health is a significant pre-condition
for sustainable development of society, and mental health is a
key aspect that hinges on human health in general. Mental

 
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health comprises of various mental conditions, it includes
social, psychosocial and emotional well-being. It also affects
the manner in which we think, we act and the manner in which
we feel.
Mental health assists to determine how we handle depression,
how we relate to other people and the way we make individual
choices. It is an important feature at every stage of human
existence, from childhood, adolescence and throughout
adulthood.
The World Health Organisation has previously published various
reports indicating that throughout the world, people are
affected by mental health disorders at a very alarming
proportions. The reports further illustrate that mental health
condition and psychoactive substance related disorders, are
highly prevalent and are the main contributors to disability,
morbidity and premature mortality.
Although in many instances, investment in suitable and
evidence based treatment remains extremely limited and many
people experiencing mental health conditions, suffer grave
human rights violations, stigma and persistent discrimination.

 
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In recent years, there has been growing concession regarding
the essential role mental health plays in attaining global
development goals, and this is well articulated by the UN
Sustainable Development Goals of 2019.
Hon members, the advent of Covid?19 global outbreak almost two
years ago, has intensified the risk factors commonly related
with poor mental health, attributed to unemployment, financial
insecurity, anxiety and depression amongst others. This has
resulted to an unprecedented worsening cases of mental health
challenges in our communities.
While the novel coronavirus affected South Africans in
general, the poor suffered severely as a result of poverty,
unemployment and structural socio-economic inequality.
In light of the above, Gauteng Department of Health has been
preoccupied with the provision of efficient mental health
services, through giving priority and maximising access to
mental health facilities.
The unfortunate circumstances that led to the Life Esidimeni
tragedy, will always be used as a deterrence and a constant

 
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reminder to treat mental health issues as an apex priority.
Subsequently, the Gauteng Department of Health established a
task team called Mental Health Technical Advisory Committee, to
provide guidance regarding the implementation of the Health
Ombud’s recommendations, and to develop a mental health recovery
plan.
Accordingly, a plan called “Gauteng Province Mental Health
Strategy and Action Plan 2019-2023” was developed, and it made
strong emphases on making mental healthcare broadly accessible.
The plan also incorporated a strategy to reinforce District
Mental Health Services, to successfully provide community based
care for people with various type of mental health condition.
This is consistent with the international human rights and South
African legislative framework and policy directives.
Similarly, the strategy involved an organogram with three new
human resource teams incorporated into the District Health
System. These are teams with high-level of assignments: The
first one is a District Specialist Mental Health Team, tasked
to develop a public mental health approach. The second team is
a Clinical Community Psychiatry Team, for service delivery
within the primary health level. And the third one is a team
to support Non-Governmental Organisations with governance and

 
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compliance matters, including the support of community-based
mental healthcare needs.
These three district based mental health teams, also work with
hospitals, primary healthcare or Clinics, NGOs, non-health
governmental sector and multiple community based stakeholders,
whose mandate is to provide preventive and interventional
mental healthcare. They also provide effective collaborative
and supportive interactions with every stakeholder in the
mental health fraternity.
Henceforth, as Gauteng Department of Health, we now have a
community mental health services that involve mental health
promotion, which is patient-centred and recovery orientated
therapeutic services that fosters integrated physical and
mental health care.
In addition, we ensured that we direct substantial resources
within the limitations of allocated budget in order to
strengthen all the levels of care.
The Gauteng Department of Health intends to continue to uphold
our constitutional obligations including the United Nations

 
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Principles for the Protection of Persons with Mental Illness
and the Improvement of Mental Health Care.
The Gauteng Department of Health is currently in a process of
strengthening the Mental Healthcare Directorate, which is the
key champion for oversight and support of the implementation
of the Gauteng Province Mental Health Strategy and Action Plan
2019/23, which is a key outcome of the recommendations of the
Health Ombudsman post the Life Esidimeni tragedy.
As a department, we remain committed to render a quality
mental healthcare ... [Interjections.] Chair, am I protected?
The HOUSE CHAIRPERSON (Ms W Ngwenya): You are protected, MEC.
Continue.
Dr N MOKGETHI (Gauteng): Thank you. We have prioritised the
key areas that are a catalyst in ensuring that we transform
the manner in which we provide services.
The following are our infrastructural facilities to continue
to improve access to mental healthcare for all members of the
community: Four Central Hospitals (Charlotte Maxeke at 50%
functionality). Three Tertiary Hospitals. Four Specialised

 
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Mental Healthcare Hospitals. Twenty-five Hospitals (Regional
and District Hospitals). Plus, three hundred Clinics inclusive
of 34 Community Healthcare Centres, CHC’s. We are also mindful
that there are insured members of our communities, that have
access to various mental healthcare facilities in the private
sector.
Our long term vision is to ensure that quality public mental
health services are accessible, comprehensive, equitable and
integrated at various levels of healthcare system, as guided
by the National Health Act 61 of 2003, Mental Health Care
Amended Act 12 of 2014, and all applicable regulations
including the Sustainable Development Goals from the World
Health Organisation.
This is compatible with the on-going programmes within the
broader health sector transformation process, currently being
implemented in our country. This includes the processes of the
implementation of National Health Insurance, restructuring and
enhancement of primary health care, human resource development
and infrastructure revitalisation for healthcare.
Hon members, we remain faced with historical challenges that
continue to torment our society. This include persistent and

 
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extreme levels of mental disorders, associated with social
elements such as unemployment, poverty, substance abuse,
violence and other hardships that increases exposure of
individuals to distressing mental conditions.
For us to achieve the mental well-being of all individuals in
our society, there must be collaborative effort from all
sectors, including political, socioeconomic, health spheres,
civil society organisation, educational sector and the faith
based organisations, in order to implement a positive inter-
sectoral intervention programme, to address the lingering
social anomalies.
Mental healthcare and wellness is a responsibility for all of
us, in the interest for the wellness of every community in
Gauteng and South Africa in general.
As Gauteng Department of Health, our aspiration is to create a
conducive environment for a long and healthy life for our
citizens. We are engaged in the healthcare expedition to
successfully reduce extensive burden of untreated mental
health disorders. We must reach good and reasonable levels of
mental healthcare wellness for all citizens, in the interest
of the safety, survival and recovery from Covid-19 impact.

 
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As I conclude, hon House Chairperson, the attainment of decent
mental health in our society, has prospects of contributing
sustainability to social and economic development. We need to
treat this pertinent subject with the kind of urgency it
deserves.
While we still fighting to restraint Covid-19 global pandemic,
we must not lose track with other health priority areas, which
over and above the pandemic, we must leverage to improve the
healthcare outcomes.
The Gauteng Department of Health remain steadfast in our
obligation to transform, improve and sustain the access to
quality mental healthcare provision for all citizens in the
Gauteng province and the country because, hon House Chair, we
are also as Gauteng servicing other patients from other
provinces and in the South African Development Community, SADC
region. I thank you.
Ms N NDONGENI: Thank you, House Chairperson. Hon Chairperson
of the Council, Deputy Chairperson, Deputy Minister of Health,
all members of executive council, MECs, in the platform, SA
Local Government Association, Salga, representatives, Chief
Whip, members of the council, and fellow South Africans ...

 
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IsiXhosa:
... molweni ngale mvakwemini.
English:
Drugs and substance abuse are a major social ill which has
resulted in many South Africans’ lives been destructed. The
state of our security system as a nation has a pivotal role to
play in fighting this deadly scourge of drug abuse. The fact
that drug trafficking in our country and the fact that our
police bust drug making labs show the prevalence of drugs in
our communities. Drugs have led to a lot of pain for families
and communities. These drugs are making their way to our
schools which is also alarming. Another concern phenomenon is
the abuse of alcohol which has become prevalent amongst the
youth. Alcohol and drug abuse are not only harmful at the
level of one’s life, but also has a native impact on one’s
health.
As a nation we need to ask ourselves critical questions on
these scourge which is also a contributor to mental health
depression and other socioeconomic deprivations which the
majority of youth and marginalised South Africans experience.
This also contributed to the suicidal thoughts and violence in
the society. The problem of drug abuse and substance abuse is

 
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not based on the race, class or gender, but its culture
across. It is also important to know that despite it been a
broad suicidal problem, it has more gross implication for the
poor. As a society we should also access whether we are
assisting user of drugs in addressing substance abuse or when
we have knowledge of drug dealers who are destroying the youth
crystal methamphetamine, meth, and the nyaope we cannot be
silent.
Normalising drug take and not addressing this challenge as a
community will further exacerbate the prevalence of substance
abuse in our society. Children are largely influenced to start
consuming alcohol or drug based on observation which can be
within the family or in the community or through been by peer
pressure by friends. Social media and other media platforms
are also another social influencer which normalise abuse of
alcohol and drugs through protecting them as fashionable and
also due to the influence of celebrities. Alcohol consumption
and association problems vary widely and the burden of alcohol
related disease and deaths is significant in most countries.
It has thus imperative that we ensure that government working
with civil society to continuous create awareness on the
danger of substance abuse and their impact on mental health.

 
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The expansion of awareness companies from the security
cluster, Social Development and the Department of Health, the
Department of Communications and Digital Technologies, the
Department of Sports, Arts and Culture, the Department of
Basic Education and the Department of Higher Education and
Training, should develop a coherent and cogent plan which
draws from the various capabilities of the departments to
fight this scourge of substance abuse. The Department of
Communications and Digital Technologies through its
communication entities such as the SA Broadcasting
Corporation, SABC, should be able to develop media content
which continuously campaign against the abuse of alcohol and
the use of the drugs through television, TV, and radio and the
social media platforms and developing a framework for content
creators. Government can surely begin to create much-needed
awareness for a positive influence for the people of South
Africa.
The Department of Basic Education’s higher expression is also
a major component of socialisation and it is therefore
imperative that education curriculum and schools and campus
awareness programmes always create awareness on the
destructive impact of alcohol abuse and drug use. As much as
we condemn abuse of substance it is critical that society,

 
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family, friends, religious leaders and civil society extend
their hands to help South Africans who have become addicted to
alcohol and drugs to stop abusing substance and refer them to
counselling and rehabilitation service within their
communities or their nearest rehabilitation centres. This is a
major suicidal task or if we are to reverse the growing
incidents of the mental health which also contributes in
reducing criminal behaviour depending on the context.
Rehabilitation is one amongst the intervention which we need
to create more awareness in our communities to normalise them
so that they are not stigmatised.
Hon members, our task working with the people should be
answering and acting on the question of how we can create
drugs and substance-free society through sports creational
activities and educational and work opportunities. The
Department of Sports, Arts and Culture plays a critical role
in ensuring that the youth do not have time to loiter in the
street, but to be involved and engaged in sport. Those with
creative skills the department should be able to expand its
support to artist at the ground level. The Department of
Police is one of the critical levels which should have a
specific focus on drug trafficking in our country because it
is a casual factor for many of the social ills which we

 
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experience in our society and mental health challenges faced
by men. We need to strengthen the fight on new ...
[Inaudible.] ... of drug trade working with our people. The
community policing forum should also focus on fighting drugs
trades.
The implementation of the National Drug Masterplan is critical
in the fight against drugs. The National Drug Masterplan in a
country strategic document to guide stakeholders on measures
to combat alcohol and other substance of abuse in the country.
South Africa has adopted a drastically change in addressing an
approach to drug policy. Government has embarked on evidence
base public health and social justice principle. The following
drugs are popular in South Africa: Alcohol cannabis, tobacco
pipe and nyaope or whoonga. It’s important for South Africans
to understand these facts that addiction is a disease that
affect the brain and behaviour to assist us to understand drug
use and the appropriate response. Addiction is defined as a
chronic relapsing brain disease characterised by compulsive
substance seeking. Despite the harmful consequences, repeated
use of drugs can change the structure of the brain over time,
change the way the cells normally function send-receive and
process information.

 
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Government remain resolve to tackle the scourge of alcohol and
substance abuse in South Africa in this regard. The Department
of Social Development has established the Central Drug
Authority, a multisectoral forum for tackling the scourge of
alcohol and substance abuse. The evaluation report of the
implementation of the National Drug Masterplan reflects that
the low financial allocation for the Central Drug Authority,
CDA, is a weakness on the impact of the CDA should have a
relation to implementing the National Drug Masterplan. Mental
health impact is not irreversible, but can be addressed
depending on the its nature. We need to continue mobilising
our society to protect our communities, children and youth
from this trap of abuse of substance as it has a direct impact
on their mental health. I thank you, House Chairperson.
Ms S A LUTHULI: Thank you, Chairperson, and ...
IsiZulu:
... ngibingelele wonke umuntu ... Ngingaqhubeka Sihlalo?
English:
The HOUSE CHAIRPERSON (Ms W Ngwenya): Yes, madam.
IsiZulu:

 
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Ungaqhubeka ntombi.
Nk S A LUTHULI: ... wonke umuntu okhona. sekunesikhathi eside
lapha eNingizimu Afrika abantu abanokugula ngokwengqondo
baphathwa engathi abayona ingxenye yezempilo lokho okwenza
izimpilo zabo zibe engcupheni.
English:
Under the COVID-19 lockdown period, South Africa’s mental
health has worsened as the lockdown has proved to be a
devastating time for our country.
IsiZulu:
Sihlalo, izinto zimapeketwane. Ukuqhubeka nokuvalwa thaqa
kwezwe kwenze kwaba nokungahlaliseki kahle ngenxa yokungabi
khona kwezindawo ezanele zalabo abaphila nesifo sokugula
ngokwengqondo.
English:
Ours is a society which is experiencing increased levels of
gender-based violence and femicide. This past year alone, our
country experienced unprecedented levels of poverty and
inequality as the unemployment rate rises with every quarter.
The lack of hope for the future causes anxiety amongst our

 
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youth. Protests, marches and civil unrests have become an
everyday lived reality of our people. Our current
socioeconomic issues and political unrests are enough reasons
for the increased levels of stress and anxiety in South
Africa.
We live with an ever-present fear of crime, trauma, and
violence. There is a lot to bear and it can be crippling for
our mental health and wellbeing. Our people are being
diagnosed with depression as they are impacted by the pandemic
on a daily basis, both directly and indirectly. Our people are
stressed, anxious and grieving as a result of everyday
challenges, which they are forced to live under. And research
shows a direct link between depression and suicide.
IsiZulu:
Abantu bethu bahlukumezekile futhi basezinhlungwini.
English:
While there exist many reasons for South Africans to be
experiencing a decline in their mental health, there are not
enough affordable health care solutions to help those in need.
In South Africa, there exists a lack of resources in the
mental health sector. Resources required to deliver mental

 
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health services are inadequate, particularly those dealing
with child and adolescent mental health services.
We are faced with a shortage of mental health practitioners
and there is a need for additional training. So much so that
the burden of mental health care is placed mainly on the
shoulders of the community-based providers in clinics, support
groups and counsellors are having to step in and intervene in
situations where institutionalised help is not available.
IsiZulu:
Labo abagula ngokwengqondo uma bedinga usizo abalutholi ngenxa
yokungabi khona kwabahlengikazi abaqeqeshelwe lolu hlobo
lokugula okwenza bagcine be ...
English:
... misdiagnosed and possibly relapsing of the mental
illness. The situation is much worse in the rural areas where
there exist no mental institutions. Stigma and discrimination
against people living with mental illness are widespread,
which poses a major stumbling block to treatment. Many of our
mentally ill are roaming the streets.

 
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In black communities, there exists a lack of awareness of
mental illness. Mental illness is not viewed as a real
illness, and at times sufferers are discriminated against,
disowned by their families or even fired from work should they
admit to having a problem. People with mental health problems
are often exposed to gross human rights violations, severe
discrimination and inadequate housing and nutrition. So much
so that when an elderly woman experiences mental episodes,
they are often called names and accused of witchcraft.
IsiZulu:
Futhi uHulumeni wethu uyabuka nje awenzi lutho.
English:
At institutional levels too, gross inhumanity towards people
with mental illness occurs. The Life Esidimeni tragedy bears
testimony to the lack of empathy for mentally ill people and
the neglect of mental health services. Due to the inhumane
decision of the Gauteng Department of Health, 144 patients
with mental health problems died in undignified conditions.
Over 1 400 surviving patients were exposed to torture, trauma
and severe violations of their human rights. This all because
mental health care patients were referred from a state

 
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facility to unregistered and unsuitable nongovernmental
hospitals.
The Life Esidimeni tragedy was an avoidable tragedy which will
always stand as a testament to the way in which our government
treats the most vulnerable of our people. There is still a
long way to go to improve access to quality mental health
care. The COVID-19 pandemic laid bare existing mental
healthcare service gap and the crisis that is our public
health system.
There still exists a need to develop appropriate mental health
policies and laws, but also the actual implementation of such
policies. Mental health needs to be at the centre of policy
frameworks and national strategies. Budget priority at the
provincial level still stands as a key barrier. There is a
need for improved financial investment at the local level in
order to increase access to mental health. Medical and non-
medical interventions are needed in order to strengthen our
health care system to address the large treatment gap for
mental disorders. Mental health literacy needs to be made a
priority. We need to eliminate the stigma associated with
mental health and promote a culture of acceptance. However,
this has proved difficult to achieve under the leadership of

 
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the ruling party, as there is a lack of leadership required to
undertake this simple task. Instead, inequality, crime,
gender-based violence and the neglect of our most vulnerable
in society thrive on the back of corruption and mismanagement.
The ruling party has demonstrated that they have no clear
strategy for dealing with mental health. I thank you.
Mr M SAMBATHA (North West): House Chair, I am not hon Madoda,
I am hon Sambatha, is M Sambatha not S Madoda.
The HOUSE CHAIRPERSON -INTERNATIONAL RELATIONS AND MEMBERS
SUPPORT (Ms W Ngwenya): Sorry Member of Executive, MEC, lakimi
kubhalwe [here it is written] S Madoda, I am sure nawe
uyibonile [you also have seen it.]
Mr M SAMBATHA (North West): No, it’s a mistake House Chair,
yes ngiyibonile [I saw it] House Chair. House Chairperson,
Deputy Minister of Health, members of NCOP, Chair of Select
Committee on Health, my colleagues MECs and everybody. Thank
you very much for this opportunity. The World Health
Organization concedes that there has been increasing
acknowledgement of the important role mental health plays in
achieving global developmental goals. As illustrated by the

 
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inclusion of mental health in the Sustainable Development
Goals, as I said.
This calls for member states including our country and
provinces to seriously engage on impactful programmes to deal
with mental health challenges. That is why it is important to
commend the NCOP for heightening the mental health programme
by putting it in the debate of today.
Our democratic government led by the African National Congress
saw it befitting to correct the state of mental health in the
country which was in adverse state pre 1994. It well
documented House Chair, that that pre 1994 mental health
services were primarily disintegrated and alienated from the
broader health care system of the country.
South Africa therefore, made a paradigm shift to integrate
mental health services into the mainstream health sector. The
theme which guides this debate namely, Mental health for all:
Giving priority and greater access to mental health care for
all, is a measuring stick by which we can establish how far we
have come in ensuring that our communities have access to
mental health.

 
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While much has been achieved, there are still many challenges
that need to be tackled in order to realize the vision
contained in this theme. One of the indicators under the
objective of: Universal health coverage through the National
Health Insurance Fund is mental health visits to health
facilities for persons 18 years and older. In this case, the
North West Province has seen 95 582 persons during the
2020-2021 cycle. The majority of these people 36 180 are in
Bojanala District, followed by Dr Kenneth Kaunda, Ngaka Modiri
Molema and Dr Ruth.
For persons under 18 years, House Chair, the Province’s
facilities have seen 9 724 people. In this age category, Dr
Kenneth Kaunda is leading with 4 673, followed by Bojanala,
2 990, Ngaka Modiri Molema at 1 526, Dr Ruth Segomotsi
Mompati, 535. The Province also recorded a total of 408 mental
health involuntary admissions during the same period.
Mental health services in the province are provided in line
with the Mental Health Care Act no 17 of 2002 and its
Regulation, as well as National Mental Health Policy Framework
and Strategic Plan 2013-2020 and other relevant policy
perspectives.

 
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The province has two specialized mental health hospitals,
House Chair, against the target of two. These are Bophelong
Provincial Psychiatric Hospital and Witrand Hospital. We also
have two designated mental health units in general hospitals
against the target of two and these are Taung District
Hospital and Job Shimankana Tabane Provincial Hospital. As
part of broadening access, Tshepong Hospital and Mafikeng
Provincial Hospital have provision for 72-hour observation.
The North West Department of Health issued licenses to Private
hospitals to render in-patient mental health services. These
are currently private facilities; Beethoven Private Hospital,
Multi-Care Hospital in Potchefstroom, Parkmed Hospital in
Klerksdorp and Kgatelopele Wellness Centre in Mahikeng.
The Province has also achieved the target of rehabilitation
centres for substance abuse which are three and they are JB
Marks Rehabilitation Centre in Potchefstroom, Social
Development Centre and San-Park Private Rehabilitation Centre
in Klerksdorp, White House Private Rehabilitation Centre in
Rustenburg.
Mental health services are integrated into the Primary Health
Care Services. We have ensured that primary care services for

 
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mental health care are provided as an integral part of Primary
Health Care in all the 18 sub districts of the province. The
services are at this levels entail visits from patients who
are either discharged from hospitals to community care or
initiated on treatment within primary health care.
In terms of bed distribution by specialty at Witrand Hospital,
we have a total of 982 beds with 851 used. For Bophelong
Psychiatric Hospital we have 384 beds with 234 in use.
Designated units, House Chairperson, in general hospitals
accounts for a total of 80 beds while the 72-hour observation
units, accounts for a total of 76 in total.
The province has a quality assurance mechanism for mental
health in all designated licenced facilities, including
hospitals.
The province has two Mental Health Review Boards, which are
appointed according to Mental Health Care Act requirements.
The Boards are composed of four persons that include, a legal
person, two mental health care practitioners and one community
member. The Review Boards contribute to the quality of
services provided by reviewing documents and records,

 
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conducting oversight on mental health facilities across the
province.
The Provincial Inter-Sectoral Committee was established in
October 2019 led by the Department of Health and consisting of
the following departments, Social Development, Education,
Correctional Services, South African Police Services and
Justice and Constitutional Development.
Infrastructure remains a challenge and a limiting factor in
increasing the number of beds. However, there is a plan in
place for this. The designated 72 hour facilities have been
prioritised for maintenance and refurbishment and they include
Taung District Hospital, Klerksdorp-Tshepong, Bioitekkong and
Job Shimankana Tabane Provincial Hospital.
Plans are also underway to increase capacity of Bophelong
Psychiatric Hospital beds. Patient related factors like
noncompliance to treatment aggravated by poor family support
remains a challenge. The department remains committed to
strengthen community based mental health in the next financial
year. The mental health human resource challenge is largely as
a result of difficulty to recruit and retain psychiatrists,

 
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psychologists and registered counsellors are in demand across
the country, due to the rural nature of our province.
The department however, continues to work in collaboration
with training institutions in order to address this challenge.
I appreciate our collaboration with various stakeholders and I
believe that if we can continue as a department to work
together to address the challenges, then our vision of Mental
health for all: Giving priority and greater access to mental
health care for all will be realized. Thank very members and
the House Chairperson, thank you.
Mr M A P DE BRUYN: Hon Chair, as stated by members today, we
all know that the impact of the Covid-19 pandemic on the
mental state of South Africans was tremendous. We also know of
the unfavourable socioeconomic circumstances that our citizens
face each day. Through studies and countless reports, we know
that more and more South Africans fell victim to one or the
mental disorder yearly in the past decade. It is also a well-
known fact that psychiatric institutions across South Africa
are severely understaffed and ill-equipped and simply does not
have the infrastructure and the capacity to deal with the
great demand of mental disorders.

 
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Afrikaans:
Wat skokkend is is die feit dat die regering reeds vir dekades
bewus van die feite is, maar steeds geen daadwerklike of
konkrete plan ter tafel kon lê om die situasie op te los nie.
Sekerlik was daar in 2013 rooiligte toe die raamwerk vir die
psigiese gesondsheidsbeleid- en strategiese beplanning op die
been gebring is, met die belofte dat daar teen 2022,
verbetering en verligting in hierdie verband sou wees, maar
soos oudergewoonte met die tipiese onsuksesvolle ANC-projekte,
is daar ongelukkig geen vrug van sukses gewerp nie.
Inteendeel, was daar nie eens gepoog om die tydperk van
hierdie projek te verleng nie om die tekortkominge daarvan reg
te stel nie. Die tyd het eenvoudig net verstryk en dit is daar
gelaat.
Selfs na die uitbreek van die Covid-19-pandemie, wat talle
mense, as gevolg van bykomende druk, weens finansiële
onsekerhede, isolasie en toekomsonsekerhede, geestelik verwelk
het, en toe daar ’n skerp toename in selfdoodgevalle,
alkoholmisbruik en gesinsgeweld was, was daar geen nuwe
pogings of selfs net beplanning om die psigiese gesondheid van
Suid-Afrikaners te verseker nie.

 
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Meeste, indien nie al die psigiatriese sentrums en hospitale
onder staatsbeheer is in haglike toestande met vervalle
infrastruktuur en ’n tekort aan toerusting en opgeleide
personeel. Die gevalle van aanranding en mishandeling van
pasiënte in hierdie instansies is skokkend en die algehele
higiëniese toestande is kommerwekkend, om die minste te sê. Ek
wonder wanneer laas ons Ministers en LUR’re hulself verwerdig
het om die instansies te besoek en self te sien wat die
omstandige is?
English:
Surely, the Department of Health must realise that 18 beds in
mental institutions per 100 000 citizens in South Africa is
inadequate, to say the least. Also, 0,04 psychiatrists per
person institutionalised in South Africa is unacceptable, not
to mention the shameful budget allocated to mental health, as
one in six persons in South Africa suffer from some form of
mental disorder.
The fact is that the department and the government do realise
these facts and challenges. The problem, however, is that they
simply do not care enough or have the political will to make a
difference. For the sake of every South African, I plead that
the Department of Health take responsibility and ensure

 
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sufficient budgets, equipment, staff and training for mental
health as a whole in South Africa. Please, don’t continue to
forsake the mental health of our people. Thank you.
Ms W F PHILANDER (Western Cape): Hon Chairperson, according to
the World Health Organisation, depression is the leading cause
of disability worldwide. Moreover, it is considered to be a
major contributor to the overall global burden of disease, in
which 5% of all adults are affected, with women being the
worst off.
It has also become abundantly clear that Covid-19 has worsened
the pre-existing challenges we see in South Africa. In 2020,
our country ranked 103 out of 149 on the happiness index. A
measure of population well-being derived from six factors: GDP
per capita, social support, healthy life expectancy, personal
freedom, the goodwill of others and trust in the government.
The Covid-19 crisis has also further heightened the risk
factors generally associated with poor mental health:
financial insecurity, unemployment, fear, employment and
educational engagement, access to physical exercise, daily
routine, access to health services.

 
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All of this has led to a significant and unprecedented
worsening of population mental health. In every country, the
decline in mental health has been directly linked to those
experiencing financial insecurity – a trend that predates the
pandemic, but seems to have accelerated in many cases.
And yet, we find ourselves asking the same question for the
past three years: What is South Africa’s decisive efforts to
scale up mental health services and what are the measures that
the South African government has put in place to protect jobs
and incomes?
The scale of distress since the start of the pandemic requires
a whole-of-society approach to mental-health support. High-
risk groups are those with greater mental health problems,
including women, youth and poorer people. In their concluding
observations on South Africa in 2018, the UN Committee on the
Rights of Persons with Disabilities expressed grave concern
regarding the rights of people with psychosocial disabilities.
Our medical model of disability and mental health legislation
were criticised, and the needs of women and children were
emphasised. [Interjections.] Chairperson, can I be protected?

 
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The HOUSE CHAIRPERSON (Mr A NYAMBI): You are protected. Hon
members, please, can you mute your microphones? You are
protected, hon Philander. I’m sorry.
Ms W F PHILANDER (Western Cape): Our medical model of
disability and mental health legislation were criticised, and
the needs of women and children were emphasised. As South
Africans, we need to change the way we live, so that people
with psychosocial disability may also live lives of dignity
and wellbeing.
The Western Cape Government’s recovery plan, called on Premier
Alan Winde and the province to address the difficult
circumstances that people of the Western Cape are confronted
with. This speaks to a caring government that, notwithstanding
the ever-increasing budget constraints, still needed to assess
the great need among all Western Cape residents and to face
these challenges head-on. This plan reflects the latest
research, and the impact Covid-19 has had on society. As such,
we are able to prioritise those interventions outlined in the
provincial strategic plan, in order to maximise the positive
impact on crucial matters affecting residents.

 
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The Western Cape government outlined the following four themes
in the recovery plan.
Firstly, in term of Covid-19 recovery, in the midst of the
pandemic, existing health services continue, with a great
focus on implementing improvements.
Secondly, in term of jobs, the economic impact of Covid-19 has
been severe. Recovery is only possible when our economy grows,
and our citizens are able to generate an income once again.
Thirdly, safety is linked to wellbeing, and cannot be achieved
if basic human needs are not met.
Lastly, in term of wellbeing, we focus on the realisation of
the basic human needs of all citizens, as reflected in the
Constitution
For us to be the change, government need to comprehend what
life was like before Covid-19 and the impact it has on the
everyday life, moving forward. Quality care must be accessible
to all, in order to positively impact the lives of all South
Africans.

 
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Through you, Chairperson, the ANC-led national government has
failed our nation dismally during a time in which we needed a
caring government to put South Africa first. The SA Social
Security Agency reported to the Parliamentary Select Committee
on Health and Social Services, hon Gillion, that they lost
approximately R11 million when 31 955 people improperly
benefitted from the Covid-19 social relief of distress grant.
This is the grant that was aimed at providing assistance to
persons in dire material need that were unable to meet their
families’ obligations and most basic needs. To this day, we
wonder what actions have been instituted against government
employees who unlawfully benefitted from this grant. We know
nothing, as usual.
I’ve dealt with factors concerning and impacting every citizen
in this country, and it is once again the Western Cape, which
is the only province that has actually dealt with these
factors. National government neglect, through incompetence and
thievery has left no room for the state to even consider the
mental health treatment gap in South Africa.
As with most things in South Africa, while public policies
exist, it fails to be implemented. It is only in the face of
tragedy that we saw the strengthening of mental health care,

 
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after nearly 150 patients died after being moved from the Life
Esidemeni Hospital to unlicensed facilities in 2017. As
mentioned by Deputy Minister Dhlomo today, regulations are
being concluded five years later. Yet again, these experiences
speak to a failing national government.
The National Health Insurance Act, which the ANC persists on
pursuing, has already shown inconsistency with the strategic
plan and its limited integration of mental health as a
priority into the system. South Africa spends 5% of the total
health budget on mental health services, equivalent to the
lower end of international benchmarks of the recommended
amounts countries should be spending on mental health.
Right now, there is an alarming estimated 92% treatment gap,
which means that less than one in 10 people living with a
mental health condition in South Africa receive the care they
need. This reflects a reactive mental health care system that
is focused on treating the most severe conditions, rather than
preventing or providing necessary early interventions.
Mental illness is not a death sentence and most people who
experience mental illness will, if given the right support, be
able to recover sufficiently to be able to live, work, learn

 
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and participate fully in their communities. The Western Cape
Department of Health addresses the growing need for care of
patients with mental illness, by improving access to treatment
and counselling at the primary healthcare level.
In line with the Mental Healthcare Act 17 of 2002, various
facilities make provision for admissions and have added
support, which is provided by the Mental Health Review Board.
In the Western Cape, various outreach initiatives are done
together with psychiatric hospitals and mental health
professionals, which include psychiatrists, psychiatry
registrars and psychologists who provide care at clinics,
regional and district hospitals and community health care
centres. In addition, the primary health care also offers
mental health services.
The Western Cape is a testament of a caring government in
action and the Western Cape remains the only province which is
serious about the wellbeing of all its citizens. I thank you.
Mr N M HADEBE: Thank you so much hon Chair. According to a
2019 article by the SA College of Applied Psychology, about
one in six South Africans apparently suffer from anxiety or

 
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depression. Unfortunately, the high cost of accessing mental
health care services means it is simply not an option for most
South Africans.
Good mental health and wellness are essential for navigating
today’s world. It helps us and relates well to others and
generally make choices that are good for our ourselves as well
as for society at large.
The World Health Organisation defines mental health as a state
of wellbeing in which an individual realises his or her own
abilities, can cope with normal stresses of life, can work
productively and is able to make a contribution to his or her
community.
The World Health Organisation further emphasises that good
mental health is more than just the absence of mental
disorders or disabilities.
In South Africa, universal access for all in respect of health
care and particularly in these uncertain and devastating times
since the advent of Covid-19 in respect of mental health care
remains of utmost importance.

 
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Hon Chairperson, today marks day 701 of South Africa’s
declared State of National Disaster due to Covid-19 and its
resultant lockdown. Seven hundred and one days ago as we know,
the world changed forever and we have all had to adapt to
these changes as best as we can.
As a result of forced isolation, social distancing and house
arrest with the only exception being local grocery shopping
most South Africans faced a lived reality they have never
encountered before. Home schooling and remote work became the
norm and many industries such as tourism were brought to their
knees. Millions lost their jobs and to this day remain without
gainful employment. Financial difficulties increased and
millions could not meet their personal debt servicing costs.
Attending of funerals was limited and family members were
unable to say goodbye to their loved ones who succumbed to the
disease. The psycho-social cost experienced because this is
much more difficult to quantify than the economic losses
suffered. It remains hidden within the minds of many and much
be acknowledged by this government and in particular the
Department of Health.

 
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The psychological pain and suffering continue to be
exacerbated by the fact that we do not have a complete
solution to the coronavirus yet. Vaccines remain experimental
with no medical liability on the manufactures in the event of
the debilitating side effects and in some cases even deaths.
Many post covid sufferers continue to experience the
debilitating effects of the coronavirus long after they have
recovered. Ten percent develop what we know as post-covid
syndrome or covid long-hauler syndrome. These could last up to
two years and costs a small fortune in respect of medical
bills and medication. Symptoms of long-hauler syndrome include
mental health issues, such as depression, anxiety, psychosis,
and mania. Treatment for such conditions is simply not
currently available for all South Africans.
We remain one of the most unequal societies in the world, with
high rates of metal health disorders even before the advent of
Covid-19. Unemployment was high, crime was out of control and
domestic violence was a common occurrence in many families.
Covid-19 only added fuel to the fire.
Poverty-stricken South Africans remain the collateral damage
of a healthcare system orientated towards those who have

 
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private medical aid, or who can afford the exorbitant costs of
seeing medical professionals. The costs of western medication
are also exorbitant in this extreme.
The question must be asked as to why this government allows
such medical profiteering to occur and more importantly, why
South Africa does not have its own medical innovation and
research centres to explore both pharmacological and
traditional medicinal solutions. Is our medical regulator
captured by big pharma? This must be investigated.
The IFP remains a strong supporter of the principle of
universal health coverage. Every person in our country
regardless of their financial situation has the right to
access to quality healthcare services without financial
hardship.
However, we do not believe that the current proposal by the
governing party to create a centralised fund, the National
Health Insurance, NHI, Fund, to procure healthcare services on
behalf of the public is the solution.

 
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The NHI Bill, in our opinion has serious flaws pertaining to
governance aspects which raises serious questions on the
constitutionality of the proposal.
Furthermore, the governing party has failed to indicate how
our country will be able to afford and sustain this very
ambitious project. We cannot continue on this path, as we
urgently need to address the enormous gap in equality of
healthcare provision in our country.
We strongly believe that government should first rebuild and
invest in existing public healthcare facilities to ensure our
people receive quality and efficient healthcare services.
It is also common knowledge that government has paid very
little regard to ensuring adequate access to mental healthcare
services in the public healthcare sector especially in rural
areas. This must be addressed immediately, hon Chairperson.
If we have learned anything from this pandemic, it must be
that we are beings with fragile physical bodies and sensitive
minds. We must adopt a holistic approach to universal
healthcare going forward, in which mental healthcare can and
must play an integral role.

 
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Let us be united in our common humanity and strive towards
good healthcare for all South Africans irrespective of race,
colour, creed or economic status. I thank you hon Chair.
Ms S J MANZINI (Mpumalanga): Chairperson of the NCOP, hon Amos
Masondo, Deputy Chairperson of the NCOP, hon S Lukas, Chief
Whip of the Council, hon members, Deputy Minister present,
members of the executive council, MECs, from other provinces,
fellow South Africans, it gives me immeasurable honour to
participate in today’s debate on mental health, a day after we
celebrated the 154th birthday of one of the greatest Pan
Africanist to ever lived and struggled for social justice and
the wellbeing of Africans, Dr William Edward Burghardt Du
Bois, who is also respected for being the first African to
obtain a PHD from the prestigious Harvard University.
Dr Du Bois was not only a champion of social justice, the
overall wellbeing of Africans including, mental health but
also our teacher on how we should understand and view the
world. Amongst other things he taught us that and I quote:
Education is that whole system of human training within and
without the school house walls, which molds and develops men.

 
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I want to make education on mental issues both formal and
informal the central thesis of my message today.
It is important for society to understand and appreciate
mental health issues from all angles especially the causes,
impact and possible ways of overcoming it. It is through
educating each other and everyone in both formal and informal
platforms that we can be moulded successfully and overcome
this scourge of mental illness.
Chairperson, allow me to express extreme glee at the fact that
South Africans from different corners are starting to
highlight the issue of mental illness as a societal problem
which requires our collective might to overcome. This is also
demonstrated by the fact that this august House is having a
debate on the mental health outside of the traditional debates
which only happens in July, which is recognised as Mental
Health Awareness Month. This is progress, and we must commend
and build from it a solid machine that will fight mental
illness daily in our communities.
As highlighted earlier that this debate is extremely important
for raising awareness and educating about devastating impact
mental health has on society and the general wellbeing of our

 
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population. Experts say there is a very thin line between
normal and abnormal behaviour, creating a possibility that all
of us might have at one point in our lives suffered from
mental illness. The magnitude of this societal problem demands
that we participate in today’s debate not as philosophers who
Karl Max argue they have only interpreted the world in various
ways. The point however is to change it so we should debate
not with the point of only analysing and educating but with
the higher aim of producing practical and implementable sought
solutions to overcome the scourge of mental health in our
communities.
Prof Karl Sepes, the Dean of Humanities at Wits University in
his inaugural lecture at Wits University in 2018, recognises
mental illness as a real experience that people endure. He
also offered an understanding of it being influenced by
society as well as culture. In simple terms, his argument is
that one of the greatest contributors to mental health issues
are the things we do daily as a way of living and the value
system which guides our action daily.
Hon Chairperson, at this point, I will request you to allow me
to elaborate on the assertion by borrowing on the ...
[Inaudible.] ... society by the Fourth Nelson Mandela Annual

 
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Lecture Address and argued that we need to change our value
system through an Reconstruction and Development Programme,
RDP, of the soul. Former President Mbeki argued and I quote:
It is perfectly obvious that many in our society, having
absorbed the value system of the capitalist market, have come
to the conclusion that, for them personal success and
fulfilment means personal enrichment at all costs and the most
theatrical and striking public display of that wealth.
This means that many in our society have come to accept that
what is socially correct is not in line with the proverbial
expression that “manners maketh the man” but the notion that
each one of us excel as a human being as our demonstrated
wealth suggest. This argument correctly locates the
contribution of culture and our value system in the high
number of mental illness we are experiencing as a country.
As we speak today, we have more than 10million South Africans
who are willing and able to work but are not finding jobs. It
also argues that more than half of our population live in
poverty. So, it is an inescapable reality that many people
will suffer from mental health issues as they are desires for
what appears necessary for them to be considered as human

 
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being is unrealisable, and far from reach at the present
moment. This derives from hopelessness and unmatched levels of
mental health issues which at worst result in people giving up
and resort to action like suicide. This is a clear
demonstration of how ... [Inaudible.] ... culture and value
system drives people into mental health issue.
As part of educating society about the issues of mental
health, we must reaffirm our original value of Ubuntu amongst
our people which is echoed on a value system which say you are
human by making valuable contribution and the progress of
humility and not by the depth of your pocket or design clothes
that you wear or the car that you drive.
The “new normal” under COVID-19 lockdown has not only affected
the country economically, but also on the strategy to curb its
spread. It also presented us with a new spike in mental health
illness as an after-effect, as most of the people lost their
income. Those that have to isolate develop some form of mental
healthcare problem. Which included depression and anxiety ...
[Inaudible.] ... self-care. Healthcare workers also suffered
from mental and psychosocial wellbeing. Hence, as a province
and as a department we tried to make sure that most of our
healthcare workers and frontline workers we support them so

 
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that as much as they are assisting our people in terms of
COVID-19, they themselves are also looked after. This has
highlighted the much needed focus on mental health care and
for us to pay careful attention to those that suffer from
mental health.
The recent release of the South African Human Rights
Commission Report on the status of mental health service on
the 28th of March 2019, should cause all of us to pause and
reflect on what needs to be done to provide quality rights
base on mental health services for the people of South Africa.
During the World Health Organisation May 2021, government from
around the recognised the need to scale up quality mental
health services at all levels. As government of the day we
have adopted a human right ... [Inaudible.] ... in developing
a mental health care as well as drafting a National Mental
Health Policy Framework and Strategic Plan 2013-20, that is
currently under review.
The strategy seeks to address the mental health care services
in the country and has put mental healthcare at the epitome of
the departmental priorities. All provinces are to strive in
ensuring that the set targets are met. I’m pleased standing
here to report that as a province we are also committed in

 
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ensuring that we meet those targets. Hence, the hon Premier
has pronounced the building of a psychiatric hospital in
Mpumalanga. This shows the commitment we are having in
increasing access to mental health care services.
We have also taken a conscious decision that all hospitals
that are to be built or refurbished going forward will have
the mental health care unit that meets the set standards of
mental health care. This financial year, we are commencing
with the construction of the psychiatric unit in Kwa-Mhlanga
using the newly approved prototype plans for district
hospitals. Currently, the department is having 28 hospitals
providing the 72-hour mental health care assessment. After 72-
hours of assessment, the patient who still need to be admitted
is then transferred to one of the three of our regional
hospitals, which is Themba, Mapulaneng and Ermelo, where we
are having dedicated mental health wards.
In increasing the number of beds, and access for mental health
patients, the province also constructed a Sedibeng Life Care
that is assisting the province on the provision of mental
health care services for long term care and patria chic mental
care services.

 
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We are offering bursaries to doctors to go and specialise,
building our own cadre of specialists. We are expecting to
receive the first psychiatrist that has come out of the
provincial project. His presence will partly address the need
we have of psychiatrists in the province and increased access
to mental health care. As you know that we are a royal
province, it becomes difficult hence we have taken a decision
as a province that let’s take our own and make sure that they
go and specialise and come back and serve the province of
Mpumalanga.
We have advertised the post of a mental health care provincial
director to be in line with the recommendation from the
national strategic plan on psychiatric and all our sub
district are having mental health co-ordinators to strengthen
the community mental health care service in the province.
As an intervention to community level following the impact of
COVID-19, the province contracted psychologist and registered
councillors who are based at primary health care level to
ensure that community members can access services on mental
health counselling in rural areas where they are staying.

 
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The quality of mental health care services provided is vital
to us hence the province has appointed three review boards,
one for each district will provide an oversight on mental
health care services and reviewed the quality of care given.
The province is striving in ensuring that all communities are
also empowered on understanding and preventing mental health
illness through community campaigns and community dialogues.
We agreed Chairperson that mental health services in South
Africa need radical transformation to provide significantly
improved access and quality of care to patients and the
population at large. This aligns with our call for movement
towards universal health coverage which provides an
opportunity for strengthening mental health services.
Practically, this means that as we design our National Health
Insurance System, we need to agree on a package of mental
health services to be provided including a focus on prevention
and wellness. At each level of care, equally we need to deal
with the social determinants of mental illness with an
intersectoral focus on reduction level of poverty and
inequality, increasing gender equity, improving access to
employment and educational opportunities and decreasing level
of interpersonal violence. I have already mentioned that we

 
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are having only 27% of South Africans with severe mental
disorder receiving treatment. One of the contributing factors
being the stigma associated with mental health care services.
Hon Chairperson, scholars define stigma as the mark of
disgrace because of stereotype and misunderstanding. The
fundamental question is how do we break the vicious cycle of
stereotype and misunderstanding. A simple act of cyberbullying
and also internet can easily result to loss of life and we
have to see happening especially for school children at
adolescent stage. Hence our programme will go down from
primary level because we can’t assume that children they can’t
have mental problem hence our programme goes down to the level
of children.
In the society, mental health is stigmatised more than
prevailing challenges that humankind face. We need to change
this and we appeal to the nation and members of the community
to tackle mental health related issues with extreme caution.
We as leaders and lawmakers as well as stake holders, mental
health care fraternity need to join heads and double our
effort in dispelling the myth, misinformation and stigma
associated with mental health care. People suffering from
mental health are not mad as the stigma goes. We need to

 
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dispel this urban ... [Inaudible.] ... and we stand a good
chance to win the fight against mental health care if we join
hands and dispel as the communities and the people of South
Africa.
The fight of mental health and its stigmatisation should start
in our communities and schools in particular. Institution of
learning should include mental health care in their
curriculum. I’m happy that in the province we know that they
are also having dedicated people especially at the level of
higher institution of learning of which we want to partner
with the chief executive officer, CEO, of the Tvet to make
sure that we take the programme as a province also at the Tvet
level. So that when we start there even those ordinary people
at the community level will be able to understand that it can
happen with anyone young and old. So this is where our
programme are going to go.
Few weeks ago I visited Siyathuthuka in Belfast, one of our
facilities, I found out that there are close to 90 health care
users who were discharged to be reintegrated to the community.
Because they were assisted to be able to function well at the
community setting. But their families are not accepting them
back. Some of their families are no longer traced. And I am

 
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aware that this is now a social issue that we are trying with
our social workers to resolve it. The point here is that we
cannot have communities who are stigmatising one of their own
because of mental illness. That can affect anyone any time. We
need to be able to embrace each other. So families need to
play a very important role for us to be able to deal with
mental health.
One of the misconceptions we need to dismiss with the contempt
it deserves is that being admitted to a psychiatric hospital
means having your freedom taken away and being secluded from
society. In fact, this will allow patients to appreciate and
to have an encounter with those that may be experiencing the
same related challenges. It also gives the person time to
recollect themselves with the support of expect who are
dealing with mental health issues.
Chair, there is a thin line between mental health and gender-
based violence. Most victims of gender-based violence
experience horrific abuse at the hands of those that ought to
protect and incubate them. More often than not victims of
gender-based violence take time to heal from the brutal ordeal
that they experience. Some of the mental health challenges are
engineered and are the consequence of gender-based violence.

 
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As a province we are happy that our Department of Community
Safety Security and Liason are able to go and make sure that
they work with the victims of gender-based violence. As a
department we also work with them to make sure that we are
able to deal with the problem of gender-based violence in the
province.
Hence, we mobilise all and sundry that while we deal with the
mental health challenges which is undoubtable one of the most
brutal silent killers. Let us tackle the struggle of the
gender-based violence pandemic. We need to strengthen our
system in all sites to identify, monitor and report suspected
acts of gender-based violence if we are serious of overcoming
mental health challenges. The World Health Organisation, WHO,
has advised that and I quote:
During times of stress, pay attention to your own needs and
feelings. Engage in healthy activities that you enjoy and find
relaxing. Exercise regularly, keep regular sleep routines and
eat healthy food. Keep things in perspective.
Thus, are calling for all to preach this message to our
communities and society at large so that those in health care

 
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sectors would encourage everyone to heed the call from the WHO
for their own mental wellbeing.
Chairperson, as I conclude, I want to end by quoting Dwain
Johnson popularly known as ‘The Rock’ who said and I quote:
I found that, with depression, one of the most important
things you could realize is that you’re not alone. You’re not
the first to go through it; you’re not going to be the last to
go through it.
Thank you very much, hon Chairperson.
Mr J J LONDT: Hon Chair, hon Ministers, hon members, as is
often the case with debates such as this, there are many valid
points made by speakers across the political spectrum. If I
had just come to this country and didn’t know much about its
history, I would’ve been encouraged about the bipartisan
approach that this debate is taking.
In – if I may use the term, hon Manzini – a normal society,
there would still be thousands if not millions of individuals
who struggle with various mental health challenges.

 
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Unfortunately, in our beloved country, it cannot be described
as normal that we have one of the highest unemployment rates
in the world, even worse amongst the youth. The mental turmoil
that millions of South Africans have to go through because
they cannot find a decent job to look after their loved ones
is not normal and not acceptable.
The constant strain South Africans are under, whenever they
step out of their homes, having to be vigilant for their own
safety because of a violent and dangerous society, is not
normal and not acceptable.
Even worse, this strain is often experienced in our very own
homes. This is not normal and not acceptable.
We despair because the leaders in the majority of towns,
provinces and this country seem not to care. They seem only to
look after their own corrupt interests and those close to
them. This is not normal and not acceptable.
Getting back to the point about unemployment, many of our
citizens experience the anxiety that comes with poverty and
how that translates to future generations who are educated in
a schooling system that is generally skewed to cater for those

 
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who have instead of those who have not. It is a fact that many
of our children, despite their abilities and hard work, will
generally struggle to lift themselves out of their
circumstances due to an incompetent and corrupt education
system. This is not normal and definitely not acceptable.
If we South Africans or our loved ones become sick in this
country, we have to hope and pray that maybe there is an open
bed, medical professionals that are not at the end of their
tether and, hopefully, also medication available. This is so,
all because our health system has been allowed to deteriorate
more and more over the years. This is not normal and not
acceptable.
We are being abused as a country by the current leadership. It
is a leadership that does not value and appreciate that this
country belongs to all of us who live in it. This is not
normal and not acceptable.
There is, however, hope. We have an opportunity to care for
one another. We have an opportunity to look after the well-
being of one another. It is a normal and acceptable way to
change the trajectory of our country. It is not normal that we
ignore all the strain we are put under; we must face up to it.

 
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Hon members, all of the beautiful words we have said today
cannot become reality unless we change the way the current
government operates. Therefore, it is normal and it is
acceptable to register to vote.
Because only when we have a change in national government will
we have a caring government that uses state resources to look
after the most vulnerable of the most vulnerable, which are
those who suffer with mental health challenges. It is normal
and acceptable to look after such individuals.
As it should be. Thank you.
Mr M E NCHABELENG: Hon Chairperson, let me take this
opportunity to say good afternoon or good evening to the team
from the Ministry of Health led by the Deputy Minister, Dr
Dhlomo, Chairperson of the NCOP, chair of chairs, team of the
NCOP and all MECs who gave inputs from their provinces, it is
an imperative of our constitutional democracy to ensure that
all our people reach their full potential and have equal
opportunities. Social transformation is anchored and ensures
that our people are able to liberate themselves.

 
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I was listening to hon Londt. For some time, I agreed with
some of the things he was raising. He showed concern that as
South Africans we see South Africa as a whole, as one country
and that the solutions that we come with should be those that
will be able to benefit all South Africans regardless to where
they stay and to which corner of South Africa they live in.
But he got lost in the process because of his hatred of the
ANC. He misses the point and joined the wailing team.
While listening to members who were debating here there were
points raised by hon Bara. Hon Bara, the Esidimeni will always
remain as a sad moment in our history. What do we do from here
going forward to ensure that what happened does not recur? The
Deputy Minister, who is leading the Ministry, mentioned steps
that they are taking as a department to ensure that we
turnaround the Department of Health particularly the mental
health area that we are debating upon. The challenge with us
is how do we as leaders of political parties, as Members of
Parliament and at the same time as society as a whole through
nongovernment organisations, NGOs, and other mass-based
organisations in the country input this task team established
to turn things around. That should be everybody’s concern –
how do we reach this body and make our inputs into it? Instead
of doing that we just go on criticising and not coming up with

 
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solutions. The critical question and the content of this
debate is, what is government and society broadly should be
doing in order to create a conducive environment to harness
the human potential of all South Africans in the midst of the
declining economic opportunities, the increase in
unemployment, growing poverty and deepening inequality.
The deepening inequality is so glaring in the Western Cape
where you can see where black people live. That is where the
poor people live, in poor infrastructure and all. You look at
the Western Cape in terms of how people live in that province.
When everybody talks about the Western Cape the first thing
that comes to mind is drug trafficking, drug abuse,
gangsterism and all these. All these combined with the
economic depression will lead to challenges in mental health.
The social reality of all South Africans cannot be isolated
from the economic reality of all South Africans. Unemployment
and poverty are one of the factors which induce a lot of
depression for the youth particularly those young people who
have to at an early age after losing their parents take
responsibility of being parents and having to fend for
themselves and their siblings. This could also lead to severe
depression and mental challenges for children. This is not

 
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only happening in Gauteng or other provinces, but it also
happens in the Western Cape where unemployment is also high.
This calls for a multidimensional intervention on the causal
factors which contribute to mental health which is as a result
of external factors rather than medical or biological factors.
I want to refer our friends from the DA to listen to one of
ours, Shudufhadzo Musida, “khaladzi yanga” [my sister], who
place mental health as a core focus. She highlighted key
issues in order to address mental health. The facts she
advances are critical. They inform us one of the most
challenging things about mental health that it is not spoken
about enough. Mental health conversations are needed in order
to promote wellbeing and to diagnose. One in four people are
expected to suffer from mental health issues in their
lifetimes. This is what former Miss South Africa said. Again,
she said there is a common misconception that mental illness
does not affect children. It is difficult to identify mental
illness until you know how to look for it. Separating the
person from the illness is key to ending the stigma. One
common sign of mental illness is that the daily activities you
do become hard to achieve. That’s where you know that it is
creeping in.

 
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Working environments are also another factor which contributes
to stress and frustrations which result in mental health
challenges for many employees. It is for this reason that
health and wellness divisions in all workplaces are a
necessity in this regard. Part of responding to mental health
is through ensuring that all workplace health and wellness
units focus on the mental health of their workers.
The call for psychosocial support in our schools is another
call which should be realised because at school children
experience bullying and various pressures which are also
induced by inequalities. A child who comes from a family where
they live in a shack and share a room being five would be
different from a child who has a room for him or herself. The
nation was in pain last year when a learner from Mbilwi
Secondary School, in Limpopo, committed suicide due to
bullying. What is evident is that bullying is not located in
schools, but broadly also in society.
Abuse and gender-based violence are amongst some of the
factors which contribute to mental health. The persons with
mental illnesses should be supported in our society and all
should not be treated in a discriminatory manner. Ensuring
that all our health facilities and special schools have the

 
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necessary facilities to support persons with psychiatric
problems is critical. Government needs to intentionally
streamline persons with mental illness into productive
economic opportunities. At least all these socioeconomic
factors contribute in exacerbating mental health problems ...
[Audio stopped.]
... social media platforms, cyber bullying and grass
materialism is another growing phenomenon which fits into
social pressure amongst the youth and those in the social
media platforms. Cyber bullying particularly in social media
platforms have destroyed many lives and led to many into the
path of depression whilst others have committed suicide. In
one of the education portfolio committee meetings a kid in the
Eastern Cape committed suicide because of bullying. She had
ancestral spirits and she was seen as being evil. That is
another form of bullying that leads to mental illness that
leads to people committing suicide.
The United Nations International Children's Emergency Fund
defines cyber bullying as bullying with the use of digital
technologies. It takes place on social media messaging
platforms, gaming platforms and mobile phones. It is a
repeated behaviour aimed at scaring, engaging, angering or

 
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shaming those who are targeted. Examples include spreading
lies about, posing embarrassing photos or videos of someone on
social media. Another will be sending hurtful, abusive or
threatening messages, images of videos via messaging platform
impersonating some and sending many messages to others on
their behalf or through shared accounts. We have all
experienced this. We have seen it in social media where people
post as others insulting others on social media.
It is important that families and various social institutions
such a schools, religious organisations and civil society join
effort of supporting mental health affected persons. A
societal response to mental health problems will first and
foremost require awareness of the people. Our interactions as
human beings should be guided by values of compassion and
solidarity. This means that when someone looks distressed or
frustrated in our homes, in our schools, in our churches in
the mosques, at our workplaces in Parliament or other spaces
of close interaction, we should always be concerned about the
wellbeing of others. The spirit and values of ubuntu which
have characterised the civilisation of Africa should be
reinvigorated in our society. Our civilisation should
encompass high level of social relations and harmony which
remains an imprint of Africa and its renaissance.

 
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In order to respond to problems of mental health a
comprehensive approach in addressing mental health through
creating a conducive socioeconomic condition is critical. This
means that the urgency of implementing the economic
reconstruction and recovery plan should be expedited to change
the living conditions of the marginalised who are strained by
their conditions.
The MEC Mme Mokgethi from Gauteng has summarised it by saying
that mental health is a responsibility of all citizens of this
country. I thank you.
The HOUSE CHAIRPERSON (Mr A J Nyambi): Hon members, allow me
to invite hon Dr Dhlomo who is the member of executive
council, MEC, of Health in our beloved South Africa. The hon,
Dr Dhlomo.
The DEPUTY MINISTER OF HEALTH (Dr S M Dhlomo): Sorry,
Chairperson, I am not the MEC for Health.
The HOUSE CHAIRPERSON (Mr A J Nyambi): I am saying, hon Deputy
Minister, hon Dr Dhlomo. I am sorry if I said MEC. Sorry,
Deputy Minister, DM.

 
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Mr M A NHANHA: What is in the name, Chair? What is in the
title?
The HOUSE CHAIRPERSON (Mr A J Nyambi): Hey, hon hot chocolate!
Let us allow the Deputy Minister.
The DEPUTY MINISTER OF HEALTH (Dr S M Dhlomo): Now, thank you
very much, Chairperson. I would like to thank all the members
who participated in this debate. It is actually clear from
this debate that mental health is a critical matter and
probably across various sectors in our society.
Nevertheless, before I just deal with all my closing remarks,
I wanted just to start by saying that I want to give hon
Luthuli a benefit of doubt that probably she logged in late.
She had not heard my speech because she then said that there
is no strategy on the issue of mental health. There is, hon
Luthuli, we can forward it to you and look at it and find it
worthwhile to read.
To hon Bara, yes, it is true and I agree with you. It is the
worldwide phenomenon where we seem not to be paying much
service to mental health and that is why I think this debate
was critical because all of us, not just South Africa, the

 
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whole world is really behind in terms of dealing with it in
its best in terms of that. However, I want to say, yes, maybe
Life Esidimeni was a turning point for our country.
I was the member of executive council, MEC, for Health in
KwaZulu-Natal at that time. The former Minister of Health at
that time, Dr Motsoaledi, called all of us as MECs to actually
unpack the situation. From that day onwards, we then knew that
we have to do something very different about mental health.
So, all the programs that MECs have outlined here actually
have been accelerated especially after Life Esidimeni. We
would want to say – as we were saying – it should not happen
again.
The comments from hon Londt I think are unfortunate. From our
debate, we are also raising the issues of migrant workers has
an impact on mental health. This is a privilege that white
males never had and probably for his society he has not been
aware that a lot of us were raised by single moms, not because
our parents were not there, our fathers were in the mines.
Therefore, we had to actually remain ... [Inaudible.] ... That
sequel of a mental illness in families and children who are
raised by single parents - because this apartheid government

 
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had decided that all males who were black must go into the
mine - is something that we must not underestimate.
It had an impact. It was a very inhumane process. I also want
to add that some of us are learned coming in from a Bantustan
system. That, a white man would never understand what it is
and what impact it had. All that, again, those inequalities
had a sequel in terms of poverty and unemployment that we see.
While we covered some ground on mental health and substance
abuse, particularly on legislation and policy development, it
is imperative that we put systems in place to continue to
improve.
Yes, COVID-19 has eliminated some of those steps. We need to
move with speed to actually adopt a public health approach in
order to comprehensively respond to the social determinants of
mental health. This includes poverty, illiteracy, unemployment
and inequality. We have highlighted that mental health
promotion and prevention of mental illness is a game changer
and that is why we talk about the public health approach. This
includes the public education initiatives to improve knowledge
about mental health and illnesses, reduction of stigma and
also what hon MEC Manzini was talking about, the gender-based
violence.

 
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We further recognise the need to improve the mental health
human resource capacity. Hon Chair, we are concerned about
these issues, that is why we continue to work on this. I was
actually happy that MECs were here indicating their strengths
and their problems in the various departments and provinces. I
just want to end by really cautioning hon Hadebe of the IFP in
his maiden speech that the National Health Insurance Bill is
still to come to the NCOP. It is still at the level of the
National Assembly. I am surprised to hear what he is saying
because as a former chairperson of that portfolio committee,
we had the support of the National Health Insurance from the
IFP members in the National Assembly.
Anyway, I would not want to debate that. Nevertheless, I just
want to raise that, that is an equaliser. The National Health
Insurance will be an equaliser of all these inequities. All
these abnormalities that we see in health where the haves will
always be privileged and we want to say that health including
the mental health will be a public good. That will actually
be accessed by those who have money and those who do not have.
So, that is actually embedded in that policy including the
mental health. As I close, we take all the concerns and all
the comments that were raised by the members. They are very

 
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constructive quite a lot of them. However, some of them, yes,
were just politicking and which we can always discard.
Nevertheless, those which were very constructive, which we got
from the members, as a department we are going to take and
make use of them in advancing and improving our ... We never
said that as a government or as the ANC we have all the
wisdom. We welcome these ideas and we will take them all on
board, hon Chairperson. I thank you very much for holding this
debate in the NCOP. Thank you very much.
The HOUSE CHAIRPERSON (Mr A J Nyambi): Thank you, hon Deputy
Minister, hon Dr Dhlomo. Hon delegates, that concludes the
business of the day. I wish to thank the Deputy Minister, hon
Dr Dhlomo, the special delegates, our MECs from our respective
provinces and Salga representatives for availing themselves
for this important debate. The Council is now adjourned. Thank
you very much.
Debate concluded.
The Council adjourned at 17:09

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