South African Psychiatry - November 2018

POLICY GUIDELINE
or institution-based mental health care,
admission under the MHCA surely does not
apply. Rather, if a person suffers a relapse of
their mental illness, the proprietor/ manager
would apply to a hospital for an assisted or
involuntary admission if the person lacks the
capacity to consent and their relatives are
not available.
b. the proprietor/ manager to take responsibility
for access to and provision of mental health
care appropriate to the level of severity of
the illness (15.6, 15.7, 17.7, 17.8, 17.9, 18.1,
18.2).
Access to general and mental health care
of PLWMI and/or ID appropriate to the
level of severity of the illness, in equity with
the provision of general health care, is the
responsibility of the Department of Health.
The NGO proprietor/ manager’s responsibility
is to ensure that the NGO residents utilise
the accessible mental health care services
provided by the DOH.
c. facilities to have a medical procedure room
(16.7), sluice rooms (Annexure B, page 9)
and registers for restraints and medicine
dispensing (Annexure B page 20).
The NGOs to which the guidelines are
applicable serve a predominantly social
role. Therefore, while they require a ‘first-aid’
room and an area to administer injections,
they do not dispense medication, perform
medical procedures, or use restraints.
6. There is a lack of clarity regarding financial,
asset and human resource governance, apart
from stating that the NGOs are funded by
either or both Departments of Health or Social
Development (2.3). In Annexure B pages 21
and 22, the relationship be between the ‘service
provider’, NGO manager, NGO Board, and the
Departments of Health and Social Development
is not clear. There is no clause requiring evidence
of self-sustainability without a DOH subsidy as a
requirement for licensing.
7. The Policy Guidelines do not address the need
for guardianship or custodial care of PLWMI
and/or ID who do not have any relatives, or who
are housed in NGOs at the request of social
workers or the police because of abusive family
homes or homelessness.
8. There is no guidance regarding intersectoral
responsibilities for the care, monitoring or
adjudication of the facilities.
OUR RECOMMENDATIONS ARE:
1. Guidelines must distinguish between the
different levels and types of care which NGOs
may provide, acknowledging the wide range
of individual need and the intersectoral nature
of community-based services. They should
be informed by the principles of the recovery
model and inclusive development embodied
in existing policy and legislation. Specific areas
of overlap, for example with ECD centres and
homeless shelters, should be addressed.
The role of the NGO administered facilities to
which these Guidelines are applied should not
be conflated with that of designated health
establishments:
a. If there is a need for NGOs to provide certain
health functions with the support of civil
society, this must be delineated accordingly.
Clear criteria for authorisation of individual
NGOs to perform specified tasks is needed.
b. Where the Department of Health needs
an NGO to function fully as a health
establishment, it should be designated and
funded as such.
2. There is a need for guardianship or custodial
care arrangements in the case of homeless or
previously abused PLWSMI and/or ID. Access to
legal assistance and intersectoral arrangements
between at least the Departments of Health, Social
Development and Justice are required. These
processes should be covered in the guidelines.
3. Adequate financial support and sound
governance are essential to the observance of
basic human rights of NGO residents.
a. Clearer guidelines on the financial
management by the facility and its Board, and
their relationship with the funder(s) is required.
b. The amendment of Regulation 6, Government
Gazette No. 38182 of 6 November 2014,
added “Within available resources” to
the State’s obligation to pay subsidies to
appropriate non-profit organisations for
the provision of community care, treatment
and rehabilitation. Clarification as to the
State and civil society’s respective financial
obligations is essential.
FINALLY, THERE IS NO ACKNOWLEDGEMENT
BY THE NDOH OF THEIR INTER-DEPENDENCE
WITH OTHER GOVERNMENT DEPARTMENTS,
NGOS, CIVIL SOCIETY, USERS, AND THEIR
FAMILIES, FOR THE CARE OF PLWSMI
AND/OR ID. IF THE HUMAN RIGHTS OF
SUCH VULNERABLE AND MARGINALISED
PEOPLE ARE TO BE OBSERVED, IT IS VITAL
THAT ALL ORGANISATIONS INVOLVED IN
THEIR WELL-BEING WORK TOGETHER IN A
COLLABORATIVE MANNER.
We trust that the Policy Guidelines will be revised
accordingly, and that the subsequent drafting of
regulations will be accompanied by a thorough
consultative process with all relevant stakeholders
88 * SOUTH AFRICAN PSYCHIATRY ISSUE 17 2018