This month it is two years since Northern Cape Premier Dr Zamani Saul opened the multimillion-rand Kimberley Mental Health Hospital, calling it a 'monument of corruption'. By then, Saul said the hospital, which has a capacity of 287 beds, already had 160 patients and will be operationalised in phases. Yet, healthcare worker union Nehawu, community healthcare workers, activists, and some mental health practitioners insist mental health users in the public sector are disadvantaged because the hospital is still not running at capacity.
'As good as dead'
One employee at the hospital who wants to remain anonymous for fear of reprisals tells Spotlight the Kimberly Mental Health Hospital "is as good as dead".
"I have been working here since the hospital was opened and it is still quiet. The few patients that are housed here are indeed well taken care of, but there are many people out there in the Northern Cape that need the services offered here but cannot be accommodated because there is a staff shortage," she says. "The department only says there is no money to employ more professionals. The wards are empty. Currently, there are fewer than 80 people here and the rest of the wards are empty. This hospital is big and beautiful, but it is not serving its purpose. So, basically, we don't know when this hospital will start working. None of us know."
Spotlight asked for comment from the provincial health department, but the department failed to respond.
When Spotlight visited the hospital in February last year, it only had 110 patients who were transferred from the West-End hospital, four psychiatrists, and 80 nurses. The Kimberley Mental Health Hospital was built to relieve the pressure on West-End hospital, which is a state psychiatric facility. During the visit, Kimberley Mental Hospital CEO Albert Links said the hospital is not fully functional due to the lack of funding, staff, and medical supplies.
Still no money
According to Izak Fritz, health spokesperson for the Democratic Alliance in the Northern Cape, these shortages persist.
The hospital is meant to offer mental health services in the Northern Cape, which include child and adolescent mental health care, forensic mental health care, and general adult psychiatric services.
Speaking to Spotlight, Fritz says it is not fair for mental health patients to struggle for services while R2.1 billion was spent on building a state-of-the-art mental health hospital in the province. "The planning and management at the department of health are very poor. They decided to spend R2.1 billion to build a hospital but forgot that the hospital has to operate. Today as it is, the hospital is empty because they cannot afford to appoint specialists to serve the patients."
Fritz says while a new mental health hospital is completed and equipped to deliver a full package of services, it is still only at phase one of the phasing in of services.
"This is despite the facility having become operationalised two years ago." Fritz attributes this to a lack of clinical capacity and over-burdened staff who have to fulfill dual roles.
"And as a result psychiatrists have to serve as doctors and safety officers while we have state patients who are still accommodated in prison and child admissions have yet to commence," he says.
According to the employee at the hospital Spotlight spoke to, security guards often have to look after patients because there are not enough nurses.
NEHAWU chairperson in the Northern Cape Moleme Moleme says the union has for a long time been pleading with the department to operationalise the hospital without any luck. "We have been in talks with the employer (department) and they are not coming to the party. We have been asking them so many times to prioritise employing more nurses, psychologists, and psychiatrists at that hospital. They say they do not have money to appoint specialists in the field of mental health," he says.
Motshabi Thoge is a community healthcare worker (CHW) based at the Madoyle Clinic in Galeshewe in Kimberley for the last 12 years. Thoge says she has attended over ten training sessions offered by the provincial health department. This training included screening mental health patients. She says despite including mental health screening in their scope of work, the department is yet to permanently employ the CHWs. "I wish the [department] can notice us as the community health care workers. "It is painful to see a luxury hospital in Kimberley not being used to its full capacity because there is not enough staff while we are here with years of experience," says Thoge.
What mental health services look like in the Northern Cape
Spotlight asked the department what mental health clinical staff is available in the province, but got no response. According to a presentation the provincial health department made to the Portfolio Committee on Health in Parliament in 2017, there were only three psychiatrists in the province at the time that were based at the government specialist hospital (West-End Hospital) and only one based at the private mental health facility which is the Careline Clinic Private Psychiatric Hospital. The figures presented also showed that by 2017, the province had 15 psychologists in the public sector and 12 psychologists in the private sector. There is one psychiatric nurse based at a tertiary hospital and 14 of them were based at West-End Hospital.
Former Health Minister Dr Zweli Mkhize in 2019 in response to a written question in Parliament on the number of mental health professionals across provinces said there were 12 clinical psychologists, four psychiatrists, and one counsellor employed in the public health sector in the Northern Cape. The minister cited data from the district health information system that showed the number of clients of all ages seen at ambulatory (non-inpatient) services for mental health conditions averaged at 40 000 per month for the province. The average number of clients of all ages admitted for mental health problems in mental health units attached to general hospitals stood at 1 500 per month, making it the third-highest after KwaZulu-Natal and Gauteng - both of which have much bigger populations.
There is only one licensed private psychiatric hospital in the whole province.
As is the case in other provinces, non-complicated mental illness is managed at the clinic level. Thoge says at her clinic Tuesdays are dedicated to mental health patients. "We see between 30 and 50 patients every Tuesday." She says they did not see an increase in the number of patients during the COVID-19 pandemic but had challenges of patients who interrupted their treatment. "We offer screening and treatment for mental health disorders at the clinic. We also do screening for substance abuse. When there is a severe mental problem, we refer the patient to the West-End hospital and not the new mental health hospital," she says.
During the presentation to parliament in 2017, the provincial health department also said that they have no community-based accommodation for clients with mental illness or profound intellectual disability.
Jannie van Zyl, the Director of Yonder, the Northern Cape's biggest mental health and disability centre, says mental health remains a low priority.
"It is not just a problem in the Northern Cape, it is a nationwide problem." He tells Spotlight. His organisation accommodates 215 people and helps an additional 50 daily who are out-patients. "We help more people than the government," van Zyl insists. "As the biggest mental health NGO in the province, we get no support from the [provincial] department of health, only the Department of Social Development. It is a sad state of affairs because even though we love to help our people, we are not able to accommodate more than what we would like to. Yet there is a beautiful mental hospital that is not able to operate because of a lack of funds. The Northern Cape is the biggest province in the country with the least number of people - a population of 1.8 million and we are the most forgotten."
Still under investigation
The 336 000 square metre state-of-the-art Kimberley Mental Health Hospital is said to be the most expensive mental hospital in the country having cost R2.1 billion. The initial amount budgeted to build it was R290 million, but construction dragged on for 13 years as costs ballooned.
During the launch in 2019, Saul said the building had become a monument for corruption, and completing the hospital was full of pitfalls characterised by a huge wastage of state resources.
Spokesperson for the Hawks in the Northern Cape, Nomthandazo Mnisi confirmed that a probe to determine how the construction costs of the hospital escalated from R290 million to R2.1 billion is still underway.
"The investigation is at an advanced stage. Arrests will be made as soon as the investigation is complete. People that are involved include government officials and private entities," he says. "Unfortunately, we cannot give out any names or more information since the matter is still under investigation, Mnisi says.