Sense of purpose: The Spring Foundation’s Brian Joffin shows Western Cape Premier Helen Zille the vegetable garden at Lentegeur Hospital. Patients who work there are calmer and more focused. Picture: DAVID HARRISON
Sense of purpose: The Spring Foundation’s Brian Joffin shows Western Cape Premier Helen Zille the vegetable garden at Lentegeur Hospital. Patients who work there are calmer and more focused. Picture: DAVID HARRISON

For 25 years Maria Adams has opened her home in Mitchells Plain to patients who have been discharged from Lentegeur Psychiatric Hospital, offering a secure and loving environment to people whose families cannot or will not take them in.

If the Life Esidimeni scandal epitomises the worst of state neglect for deinstitutionalised mental patients, then the care she provides under the banner of the Rose Parent Project is the polar opposite. It is a well-established initiative with strong oversight from authorities intent on safeguarding the interests of people with mental illness or intellectual disability. Over the past three decades it has placed more than 200 patients with over 100 foster families in 14 suburbs around Cape Town.

"My granny always helped people and that spirit was in my mother too. I didn’t think I had it, until I had a dream in which I was wearing white like a nurse. That is what inspired me," says Adams, 80, who was married with three children when she took in her first patients.

One of them was 74-year-old Victor (not his real name), who has lived with her since she took him in. The trust between them is evident in the anecdotes they relate about his role in the family — from walking her grandson to and from school, to collecting medicines for patients from the local day hospital.

"I’m part of the family. We even argue," he laughs. His biological family is ashamed of him and make little effort to visit, says Adams.

Foster families help tackle the stigma attached to mental illness, educating their friends, family and communities. It is no small task, given that Lentegeur has been dubbed "die malhuis in die ghetto" (the madhouse in the ghetto) by local residents.

There is no other project of this nature and scale in SA, in which foster families provide care to mental patients with virtually no compensation, says Rose Parent Project co-ordinator Esterline Martin, who is also Lentegeur Hospital’s social work supervisor.

Patients receive a monthly state disability grant of R1,600 and their Rose Parents are eligible for a modest R380 grant in aid. It is a vital part of Lentegeur’s work to rehabilitate psychiatric patients and reintegrate them into the community.

"We don’t place aggressive, revolving door patients with Rose Parents. We start slowly, with weekend visits, building up to longer stays," says Martin.

"We require regular reports, we do spot checks and we have had situations where patients were unhappy and were removed from the Rose Parent."

Roughly a third of South Africans will develop a mental disorder requiring treatment during their lifetime, according to the 2003 South African Stress and Health study. It found only about 11% of people living in the Western Cape were likely to get the health services they need.

The study was conducted before the Western Cape’s methamphetamine (tik) epidemic took hold, so those figures are likely to be an under-estimate of the current need for psychiatric services, says Lentegeur Hospital psychiatrist John Parker.

Demand for mental services runs high, even in the relatively well-resourced Western Cape, where a quarter (54) of the 207 state-employed psychiatrists worked in 2014, as per the most recent national figures.

"Our bed occupancies across the service are generally at 100% or more, and we have long waiting lists for beds in psychiatric hospitals," says Western Cape health communications officer Bianca Carls. She says all levels of service are under strain and even the sickest patients with psychotic conditions may not get immediate admission.

Lentegeur tries to reintegrate patients with their families, but many cannot or will not re-establish relationships.

In places like psychiatric hospitals, boarding schools and the army, every decision is made for you: what time you wake up, what you do when you wake up, what you eat. People who live in places like that for a long period of time lose the ability to take initiative and to make decisions for themselves

"I have no contact with my family. I don’t know why they don’t want to be in touch," says Janine (not her real name), a forensic patient who was discharged from Lentegeur Hospital nine years ago and taken in by Valecia de Beer Swano.

Forensic patients are people who committed crimes but during the legal proceedings are found either to not have the capacity to understand the trial or not to understand that they were committing a crime.

Janine is one of four women living with Swano, a devout Christian who struggles to articulate what motivates her despite having been a Rose Parent for 10 years. Eventually she says she is following in the footsteps of her mother and her grandmother.

Ground-breaking work is also under way at Lentegeur Hospital to try to "deinstitutionalise" patients still living within its high walls.

"In places like psychiatric hospitals, boarding schools and the army, every decision is made for you: what time you wake up, what you do when you wake up, what you eat," says Parker. "People who live in places like that for a long period of time lose the ability to take initiative and to make decisions for themselves, and become institutionalised. It makes it very difficult for these people to [return] to the community."

He established a market garden in the hospital grounds that is helping to undo some of the damage wrought by living in a psychiatric institution.

Initially, the initiative was just about making "this big prison-like place look and feel better" but has evolved into a programme that has helped bring down the readmission rate, says Parker. Tackling the revolving-door syndrome among psychiatric patients who repeatedly relapse is vital if the state’s limited resources are to be used more effectively.

He established a nonprofit organisation, Spring Foundation, to raise funds for a variety of projects, including a more ambitious take on a small vegetable garden that had been established by occupational therapy technician Elsa Michaels.

She is a self-taught gardener, who saw first-hand the therapeutic benefits of spending time connecting with the earth. "It’s like a light goes on," Michaels says. "Patients become more focused and aware of their surroundings and are calmer and less aggressive." Gardening provides patients with meaningful, productive work and equips them with skills they can put to use in their communities.

"This is particularly important for forensic patients who, in order to be discharged, need to show that they can be productive members of society," says Parker. The garden helps to educate patients about healthy diets and exposes them to a wider variety of fruit, vegetables and herbs than many of them previously encountered.

"People generally don’t know much more than onions, tomatoes, spinach and corn. Even the hospital staff were unfamiliar with much of the produce and had never eaten herbs or berries," says Michaels.

The patients get a small stipend for labouring in the garden and as the project has grown they have been taught to budget and set financial goals. For many patients, the experience has been transformative.

"We have one young patient who was struggling to fit in. He surprised us all by using his money to buy a watch. Until that point no one thought he could even tell the time," says Michaels. The patient plans to join his uncle’s building business when he is discharged "He is no longer regarded as a nuisance. For the first time in his life he is seen as an adult," says Michaels.

kahnt@businesslive.co.za

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