Health workers at the Zithulele provincial hospital in Mqanduli, Eastern Cape, watched in horror two weeks ago as a mentally ill patient scaled the hospital roof.
Nurses, speaking on condition of anonymity said, “He was not only endangering his own life but was also a danger to other patients and staff members.”
Security coaxed him down, but it was not an isolated incident.
Zithulele serves a population of 130,000 but has no psychiatric unit.
“Sometimes mentally ill patients jump out of windows trying to escape,” said a nurse. “They are mixed with other patients because we have no dedicated psychiatric ward. None of us are trained psychiatric nurses. We have to call security to administer injections to some patients.”
About 200km away, nurses at Komani Psychiatric Hospital said for two years patients had no toiletries and bathed in cold water due to budget constraints.
“All the hospital beds are full. Some patients are sent to Frontier Provincial Hospital. Doctors have to travel between the two facilities. We work under immense pressure because of a chronic shortage of nurses.”
Eastern Cape health spokesperson Siyanda Manana said to improve safety in facilities without dedicated mental health units, staff are undergoing training.
“This training was conducted last year and is once again under way this year, with assistance from the Foundation for Professional Development."
He said safety concerns at Zithulele Hospital will be mitigated by upgrades including two secure seclusion rooms to contain unmanageable patients.
Manana said 56 listed district hospitals were meant to admit acute mental health patients, but did not meet standards to safely accommodate all mental health conditions.
“However, the [provincial health] department over the past months has contracted Coega Development Corporation [CDC] with plans to roll out acute mental health observation units across the province’s district and regional hospitals. CDC has conducted detailed assessments at more than 25 hospitals across all eight districts for purposes of establishing proper acute mental health units.”
Facilities such as the Frontier, Bhisho, Nompumelelo, Butterworth, Glen Grey and Malizo Mpehle hospitals have already moved into advanced planning stages with proposals tailored to their unique needs and capacities, he said.
The plight of Zithulele and Komani hospitals lays bare the depth of a mental health crisis due to a chronic staff shortage, lack of specialised facilities, collapsing infrastructure, and unequal access to psychiatric specialists, particularly in rural areas.
Studies show South Africa’s public sector averages just 0.31 psychiatrists per 100,000 people, with far fewer in remote areas.
Dr Kathleen Mawson, a specialist psychiatrist and senior lecturer at Tygerberg Hospital and Stellenbosch University, said without access to medication, patients’ recovery prospects were limited.
Manana said the department was drafting a new organigram to focus on strengthening district mental health services and community-based services. The department of health in collaboration with Walter Sisulu University, Rhodes University, Nelson Mandela University and Lilitha Nursing College are training psychiatrists, psychologists, social workers and psychiatrists nurses.
The department is drafting its new organigram where plans are already in motion to focus on strengthening district mental health services and community-based services. The department of health in collaboration with Walter Sisulu University, Rhodes University, Nelson Mandela University and Lilitha Nursing College are training psychiatrists, psychologists, social workers and psychiatrists nurses.
Manana said doctors, psychologists and social workers from Fort England Hospital conduct outreach services to district hospitals.
“Every clinic has basic mental health medication for dispensing purposes and refers to the upper level of care when need arises,” he said.
But in March health ombudsman Prof Taole Mokoena released findings from an investigation into psychiatric patient neglect in Northern Cape hospitals citing leadership failures, staff shortages and collapsing infrastructure. Two psychiatric patients died, one was left bedridden.
South Africa’s mental health system is governed by the Mental Health Care Act of 2002 and the National Mental Health Policy Framework and Strategic Plan 2023—2030, which calls for better funding, integration of mental health into general health care, and expanded community-based care.
Yet the country spends only 5% of its health budget on mental health, the lion’s share going to inpatient psychiatric hospitals, not preventive or community services.
Cassey Chambers, operations director at the SA Depression and Anxiety Group, said access remains “shockingly” limited: “Only one in 10 South Africans with a mental illness receives treatment. In rural and underserved areas, services are severely limited or non-existent."
Mawson said the Mental Health Care Act required district hospitals to have psychiatric wards, but only about 13% did.
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