Hon House Chairperson, the Portfolio Committee on Basic Education convened the meeting with the Department of Basic Education and the SA Human Rights Commission. This was done in order to establish the extent to which the department has responded...
IsiZulu:
Sihlalo, awutshele le lungu elihloniphekile aliyeke ukuphapha lapha. Akakhulume le nto aze ngayo lapho. Bazosihlukumeza la.
That is not a point of order ...
IsiZulu:
... ngiyacisha.
Cha, uyaphapha.
English:
This was done in order to establish the extent to which the department has responded to the recommendations of the SA Human Rights Commission on the state of mental health in South Africa. The focus area of the meeting engagement was on the following issues: a plan for introducing stigma reduction and awareness raising national strategy on learner attainment study on the implementation of the integrated schools health programme, mental health programming and draft policy for the provision of quality education and support to children with severe to profound intellectual disability.
Section 29 of our Constitution enshrines the right to a basic education and defines the positive responsibilities and accountabilities of the state in this regard. At the core of this is the duty of the basic education sector to ensure the uninhibited enjoyment of the right to a basic education. Since the release of the report of the SA Human Rights Commission on the state of mental health care in South Africa, the Department of Basic Education has taken significant steps to ensure the proper processing of the recommendations of the report. In 2016, Treasury awarded the department a Conditional Grant to the value of R477 million over the period 2017-2020. The strategic goal of the Conditional Grant is to ensure that learners with severe to profound intellectual disability access quality public funded education and support. As part of the implementation, the department has facilitated various engagements with government departments implicated in the Western Cape Court Order of 2010 on access to education for children with severe to profound intellectual disability.
As part of this collaboration, a decision was taken to incorporate in the plans the following: introduction of stigma reduction programme in schools and increasing access to health services; and mental health awareness raising efforts aimed at educators. In addition, the department has identified a need to improve the skills of Learning Support Agents on providing psychosocial support to learners.
In order to facilitate this, the department has developed a guide for Learner Support Agents, LSA, and schools on how to support learners in need of psychosocial services. The guide clarifies what psychosocial support is about and how Learner Support Agents, school management teams and school governing bodies must go about creating a psychosocially healthy school environment in order to prevent psychosocial problems, and to address existing problems early.
The document is entrenched in the department's Care and Support for Teaching and Learning, CSTL Programme, as well as the policy on Screening, Identification, Assessment and Support, SIAS. Already, training has been conducted for LSAs and schools in the North West and Northern Cape. In addition, provinces, like Gauteng have begun to train teachers on psychosocial support within the context of training in specialised areas. The draft policy on Education for Children with Severe to Profound Intellectual Disability was tabled at the Council of Education Ministers, CEM on 12 February 2018.
The portfolio committee is convinced that the basic education sector has demonstrated commitment in addressing the recommendations where it is reasonably feasible based on resource availability. The basic education sector believes that every learner is a national asset, and therefore matters, and is thus committed to building an inclusive education and training system, which will ensure that no learner is left behind. Significant progress has been made in this regard, although challenges remain, given the size of the backlog. This is to be expected though, given the fact that the realisation of human rights is a complex endeavour that cannot be resolved overnight through simple, axiomatic solutions. I therefore move that the House accept the report. Thank you, Chair. [Applause.]
Hon House Chairperson, I move that this House adopt this report. Thank you.
Declarations of Vote:
The realisation of Human Rights is a complex topic which does not lend itself to axiomatic answers. No way is this truer when the rights of the marginalised section of the population are in question. The tragic loss of life fallen in the discharge of mental healthcare patients from the Life Healthcare Esidimeni facilities evoked public outcries and led to widespread calls for further investigations. Not only in this instance but also in relation to the broader mental healthcare system in this country; all thanks to the DA.
The World Health Organisation, Who, of which South Africa is a member emphasised that mental health is a state of wellbeing in which every individual realises his or her own potential; can cope with normal stresses of life; work productively and is able to make a contribution to his or her community. As such, mental health is not merely the absence of illness or a disease. South Africa should veer more to a right based approach to emphasise equality of people with disabilities. This approach considers the disability to be a product of an environment that first to accommodate the specific needs of a person with the disability, as already done in the Western Cape.
Prevalence psychosis relating to psychosocial and intellectual disabilities is underestimated. Studies have shown attempted suicide rates of 7,8% and rates of suicidal ideation of 19% amongst high school students, 22% post- traumatic stress amongst school children as well as post trauma depression as high as 34,7% and high depression rates of 37%. These findings indicate that South African school children face considerable mental health challenges.
Despite high prevalence of mental healthcare conditions many South Africans would benefit from accessing services to not receiving treatment. Only 25% of South Africans leaving with the mental health condition access services. The most significant obstacle to mental health piracy is stigma. Stigmatisation of mental health is an excuse for an action and we are still waiting on the department for them to come up with the proposal.
Public mental healthcare systems in general lack adequate coverage of mental healthcare professions. Per 100 000 people South Africa is 0,2% at psychiatrist, 0,23% psychologist, 0,4 social workers, 0,13 occupational therapists and 10 mental healthcare nurses. As a comparison the average for the middle income country would be five psychiatrists per 100 000 people. In South Africa HIV infection, substance abuse and exposure to violence increase vulnerability to mental health challenges. Against this backdrop, it was not the stark realities of unmet needs with regards to child and adolescent mental healthcare in South Africa.
We call for the urgent scaling up of services to fulfil the constitutional rights of children and adolescents through appropriate healthcare services in the committee. LSAs in overcrowded schools will not be over be able to effectively implement guidelines presented and ultimately the onus would be on the class teachers to identify where assistance is needed. Even this will eventually lead to inadequate assessment of learners which will have long term mental effects and stigmatisation if done incorrectly. De-institutionalisation must be undertaken properly. The primary and specialist multidisciplinary teams that are community based, mental healthcare services must be focused on, must be resourced and must be developed before the process is started. It will require more financial and human resource investment. Therefore, sufficient budget should be allocated. Countless Esidemenis are happening right now to people who are still alive but the extent of neglectful and abusive care will again only come to light once they also die in starvation, dehydration, cold and infection.
The state must have the political will to avoid this tragedy from occurring and learn from your mistakes, ANC on Life Esidimeni because you are failing our children out there when it comes to mental healthcare access. We support this report. [Applause.]
Chairperson, following the Life Esidimeni tragedy that physically ended the lives of 143 innocent beings, whose only sin was being mentally sick, whilst the government of the day was only concerned with tenders, we know for a fact that mental health issues will never be resolved by the ANC government. It is even more so for children who are the most neglected group in the country and who suffer 40% of sexual violence cases reported.
Efficient mental health services are not being provided to the poor, more especially in townships and rural areas. And when those services are provided, they are below par and even a threat to the right to life.
Patients in psychiatric health care and in public schools and hospitals are treated in the most inhumane manner. The fact that they are unable to care for themselves becomes the very reason why they are exploited by government.
Ill pupils are being denied 72-hour observation and onward referral, as per mental health protocol. In one incident, a patient was denied this four times in a row at the Elizabeth Ross District Hospital and eventually met her untimely death, which is, in fact, murder by the department.
We hear of avoidable deaths ... [Inaudible.] ... young children, some even in primary school, on a daily basis. This happens because you refuse to give each school a permanent psychologist and/or therapist to assist people with mental health issues, as per the recommendation of the EFF. There are communities that are still struggling to understand the importance and nature of mental health challenges. This does not make it any better. Our youth are judged to be rebels that resort to drugs and alcohol abuse, who in fact are suffocated by depression with no outlet for redemption.
Furthermore, in the autism spectrum, only children of rich parents have access to occupational therapy from any childhood development level. This department has failed toddlers from getting an opportunity to recover and be in mainstream education, or, at least, be in daycares and public schools that cater for their needs.
The Department of Health is aware that the majority of hospitals around the country and psychiatric departments face challenges of replacement, power supply, equipment shortages, in some hospitals a vacancy rate of up to 46%, accommodation for health professionals at the hospitals, slow hospital revitalisation, geographical location of hospitals and medical depots not supplying medication on time. However, we still send our sick children to these debilitating facilities.
The Department of Health, in particular, has done absolutely nothing about this promise, a 10-year plan that does not have tangible targets of implementing this, or a plan that centres the most affected by mental issues, developmental issues and learning disabilities.
As a matter of urgency, there must be a correlation of capacity by the Department of Basic Education and the Department of Health and an implementation programme of making mental health services available on request for pupils, their parents and teachers. There must be at least one psychologist in each school in the country. They must be on site and readily available to cater for the mental health needs of pupils.
This will also assist in the early detection of sexual violence ...
Chair, can we ask hon Chirwa to lower her voice. [Interjections.]
No, that is not a point of order. [Interjections.]
House Chair, look at the calibre of EFF ...
Hon member, no. That is not a point of order. I am switching off your microphone now. Sit down. [Interjections.] Why do you disturb her?
This will also assist with early detection of sexual violence that children are exposed to and not having anybody to speak to.
A 12-month refurbishment plan must be released by the Department of Health and the Department of Basic Education that incorporates and enjoins the geographical accessibility for school children to the facilities.
Clinical psychologists at each clinic and health facility must be included and secured urgently and must also be able to report to nearby schools when the need arises.
Mental health care education should be mainstreamed to suit pupils and pensioners or grandparents. Most households spend a lot of time with children, but do not have the relevant knowledge and language to detect symptoms of mental health issues. Proper diagnosis and detection systems must be strengthened to promote commitment to medication and progress, instead of regression that results in further mental damage of patients and children. This means also dropping out of school before reaching matric level.
That one out of four people would be affected by mental health issues at some point in their lives should be reason enough that this matter must be prioritised by government. Health communities, ... We reject the report.
Hon members, can you lower your voices before the next speaker.
IsiNdebele:
USIHLALO WENDLU (Ksz M G Boroto): Malungu ahloniphekileko ngibawa nehlise amazwi ngaphambi kobana umma akhulume. Ngiyanibawa noke.
The DEPUTY MINISTER OF AGRICULTURE, LAND REFORM AND RURAL
DEVELOPMENT: Chair, I agree with you. Hon Paulsen is walking barefoot here and that is why there is a problem.
What is that? That is not a point of order. Order!
Hon House Chair and members, again the consideration of this report, quite obviously, requires the concerted efforts of both the Minister of Health and the Minister of Basic Education to protect those who are most vulnerable in our communities. The finding of the South African Human Rights Commission highlights a longstanding point of the IFP, in which we call for the interdepartmental collaboration and knowledge sharing in the realm of mental health care and service provision.
The collaborative efforts by departments help to spread the funds for expenditure and assist with the reduction of the duplication of the skills, as each department has strengths of their own in addressing the problems.
The poor state of services in South Africa leaves one to wonder how the National Health Insurance will take into account the high demands for the infrastructure and programmes needed to address mental health issues. Government needs to lay a stable ground before we can embark on the universal system of health care. We see that there are material challenges with regard to the state of mental health in South Africa and support the call for greater control to be decentralised into local government.
Local government must be sufficiently empowered to respond to the needs of the individual communities, so that rural areas like Jozini in KwaZulu- Natal receive sufficient funding in terms of mental illness. The IFP supports this report.
Afrikaans:
Agb Huisvoorsitter, funksionele gemeenskappe het maniere om mense wat ander vermons as die standaard het te akkomodeer en om hulle in te sluit. Dit is hoe dit is. Met die persoon - soos dit hier genoem word - wat grondliggende intellektuele gestremdhede het kan die klem op die stremming gel word, maar die vermons word buite rekening gelaat. Vir dieselfde prys as wat ons s dat elke mens 'n nasionale bate is, het elke mens bepaalde vermons.
Dit is so dat die moderne wetenskap ons help om hierdie selfs beter te verstaan. Met ander woorde, mens wil nie idealiseer hoe persone met nie- standaard vermons traditioneel hanteer is, asof dit altyd goed en met wysheid hanteer is nie. Die mediese en die sielkundige wetenskap help wel baie om dit beter te verstaan. Ongelukkig, ...
Agb Voorsitter, ek wil net weet of agb Boshof 'n vraag sal beantwoord.
Ek weet nie of ek kan nie. Ek kan nie. Ons kan kyk of daar tyd oor is aan die einde. Dit het wel daartoe gelei dat mense met gestremdhede eenkant geplaas is, dat hulle uit die gewone samelewing uitgeskuif is en dat dit vir baie gesinne of families 'n verleentheid geword het om te s dat hulle iemand met 'n gestremdheid in die familie het. Daarom stuur hulle hul eerder weg om elders onder gespesialiseerde sorg te wees. Daardie gespesialiseerde sorg mag gespesialiseerd wees, maar dis nie liefdevol nie. Dit is ook nie altyd goed nie.
Nou moet die gemeenskap in hierdie proses waar die staat eenvoudig nie meer die vermo het om die verantwoordelikheid vir almal te neem nie, deelneem. Daarom is dit belangrik dat ons as gewone mense nie net eise stel en skree dat die regering dit of dat moet doen nie, maar gemeenskappe moet moue oprol en saamwerk. Die sielkunde het 'n manier om te kyk na wat die gestremdheid is of wat dit is wat iemand nie kan doen nie. Een sielkundige het gevra wat mense makeer om altyd te vra wat fout met hulle is. Wat is fout met mense dat hulle wil weet wat fout is met hulle. Die positiewe seilkunde fokus op wat mense wel kan doen, omdat elke mens werklik wel iets goeds kan doen.
Gemeenskappe met wetenskaplike kennis toegerus en met 'n onderwysgemeenskap wat toegewy is daaraan om saam te werk kan die waardigheid van mense met gestremdhede herstel, en dit is noodsaaklik.
As agb April in 25 sekondes 'n vraag kan vra sal ek dit graag antwoord.
Afrikaans:
Ek weet nou dat daar net wit skole in Orania is, maar weet jy wat die verskil tussen oranje en groen is?
Wel, ek is oranje en groen. Waarmee kan ek help?
House Chairperson ... [Interjections.] Afrikaans:
Ja, ek kan ook praat.
English:
... three years ago the Human Right Commission, commissioned a report to look into the mental health care status in South Africa. The report, amongst others, found that a rights-based approach to mental health recognises and respects diversity between persons with psychological and intellectual disabilities and broader society, and within a group of people with psychological and intellectual disabilities.
The Life Esidimeni tragedy, for instance, was characterised as a harrowing account of death, torture and disappearance of utterly vulnerable mental health care users in the care of an admittedly delinquent provincial government by the Life Esidimeni arbitrator.
This brings into sharp focus of the Department of Basic Education's preparedness to deal with mental health care in public schools. The Human Rights report correctly recognises the central pillars underpinning mental health care, which includes inclusion and participation. The commission's recommendation is that a properly devised plan must be introduced by government to deal with cases related to stigma and conditions of mental health, including broadening access into schools for mental health care related services such as counselling and therapy is overarching.
We are however disappointed that it took three years after the release of the commission's report for this debate to take place. We support the report. Thank you.
House Chairperson, I rise on behalf of the ANC to support the portfolio committee's report on the SA Human Rights Commission's report into the status of mental health care in South Africa.
Health is defined by the World Health Organisation, WHO, as a state of complete physical, mental and social wellbeing. Mental health is therefore, an essential element of health and it is crucial to the overall wellbeing of individuals and society. Most mental disorders have their origins in childhood and adolescence. Approximately 50% of mental disorders begin before the age of 14 years. The relationship between poverty and mental ill health is a vicious cycle. People living in poverty are at risk of developing mental disorders through the stress of living in poverty, lack of social support, increased exposure to violence and worse, physical health.
The ANC welcomes efforts of the Department of Basic Education and Health to reduce the stigma attached to mental illness in schools and increasing access to health services, including counselling through formal referral pathways accessible to educators. The various relevant departments have an obligation to source out the necessary funds and ensure execution of these programmes.
A long and healthy life requires us to invest in mental health so that we not only reduce the substantial burden of untreated mental disorders but reach levels mental health that are higher than the mere absence of disease or infinity. Good mental health, no doubt, contributes substantially to our social and economic development.
Many schools do not recognise the consequences of suicidal tendencies in children. Depression is one of the most common emotional disorders in children, affecting as many as one in every 33 children. Depression can produce serious difficulties and interfere in the child's life and development.
Studies have found that the burden of mental illness in the great DA-run Western Cape province. In this province, mental health illness is closely associated with the scourge of substance abuse and gang-related crimes. The Western Cape government turns to ignore the plight of the poor in favour of policing solutions. The Western Cape government must instead invest in social assistance programmes for youngsters and adults struggling with mental disorders and drug addictions.
One of the most devastating consequences of depression in children is the high rate of attempted and successful suicides. It has been estimated that between 90 and 97 suicide victims have suffered from mental illness. In almost half the cases, a diagnosis of depression has been found.
In South Africa, a research indicates that one in five teenagers think about harming themselves, with 7,8% of these young people attempting to carry out their wish to harm themselves. Other studies have found that 24,5% of attempted suicide cases amongst black South Africans have occurred in young people aged 17 or below. These devastating statistics highlight the need for early identification of possible emotional problems in children; thus, preventing these children from carrying out suicidal inclination before it is too late.
Mental health is part of the general health. It should be integrated into the general health care and people with mental disorders should be treated in primary health care clinics and in general hospitals. Mental health services should be planned at all levels at the health services centres and be treated as a matter of priority in all sectors of the society, school in particular.
The ANC believes that every learner is a national asset. We are, thus, committed to building an inclusive education and training system, which will ensure that mental illness challenges are treated rather than criminalised.
The national Department of Health has placed the National Mental Health Policy Framework and Strategic Plan 2013-20, which is currently being implemented in all nine provinces. It identifies the key activities that are being implemented in all the provinces. The ANC recognises the burdens of mental strain our people feel today. As South Africans, we have always being able to come together to overcome local, national and global challenges. With increased suicide rates and depression in the South African population, the ANC appeals to all communities to stand together in times of difficulty.
To the Western Cape government and members of the DA, no amount of grandstanding in this House can hide what is happening here in the Western Cape. ... [Interjections.] ... Thank you very much, Chairperson. [Applause.]