Social injustice: The Gauteng health department transferred mental health patients to unregistered NGOs to save money, resulting in the deaths of 144 people. Picture: SOWETAN/ANTONIO MUCHAVE
Social injustice: The Gauteng health department transferred mental health patients to unregistered NGOs to save money, resulting in the deaths of 144 people. Picture: SOWETAN/ANTONIO MUCHAVE

The Life Esidimeni tragedy, which led to the deaths of 144 mental health patients, caused national outrage and highlighted the neglect of mental healthcare in SA. Following the termination of the contract between the Gauteng health department and the Life Esidimeni Care Centre in October 2015, about 2,000 people were scheduled to be moved out of the care centres to their families, acute psychiatric hospitals or allocated nongovernmental organisations.

The motivation was SA’s commitment to the deinstitutionalisation of mental healthcare: the replacement of institutional treatment with community-based care.

The Gauteng health department has argued that handing over the care of these patients to communities and NGOs had their needs at heart, allowing them to be reintegrated back into their communities, rather than remain isolated from society in institutional hospitals.

However, the health ombudsman’s report into the Life Esidimeni crisis found that little investment was made into adequate community alternatives for care. The report concluded that the transfer of patients to the ill-equipped NGOs was financially motivated. It cost the Esidimeni facilities R320 per patient per day, whereas the NGOs charged only R112. This is just one example of how the department of health has cut mental healthcare budgets under the guise of "deinstitutionalisation", while not providing sufficient investment in community-based alternatives.

Why is there a fatal lack of investment in crucial community-based alternatives for healthcare? The answer may lie in the impact that a neoliberal and market-centric value system has had on social care in SA. Since 1994, South African policy has aligned itself with two competing values: rights-based social democracy, which puts people first, and neoliberal market-centricity, which puts money first.

Within a social democratic system, the country commits to welfare and grant delivery as a right for citizens and promotes social care that is focused on community development, redistribution of wealth and empowerment as key areas of change. A neoliberal and market-centric system, on the other hand, promotes "the survival of the fittest" over and above collectivism and principles of ubuntu.

It shifts blame onto the individual rather than the state. It pays little attention to the broader, unequal socioeconomic system that ensnares many marginalised South Africans, while it puts in policies that favour the rich and cultural elite. It sees inequality as a driver/needed consequence of economic growth and regards welfare as an unnecessary cost that creates dependency.

In SA, the fostering of competition and inequality as drivers of economic growth resulted in a widening gap between the rich and the poor and the consolidation of wealth and power in the hands of the corporate elite. It encouraged the prioritisation of economic development over matters of social justice and assumed the market as the primary redistributive agent.

It placed individualism over collectivism and supported the commodification and privatisation of care.

As the Life Esidimeni disaster shows, a neoliberal system creates barriers for social intervention. It reduces welfare, increases financial vulnerability and shifts the responsibility of social services to private and community-based organisations and NGOs. It uses employment efficiency and cost-effectiveness as its yardstick.

Such an environment of competition and profit-centric accountability has overridden the human element of social care. Over the last few years, services that were previously a human right have been translated into commodities to be bought and sold for profit.

Households are forced to participate if they want to access basic care and attain a state of wellbeing.

Even though South African policy still shows elements of its commitment to the equitable distribution of money, land, opportunity, education and healthcare, it appears that economic growth has been prioritised over social justice.

The government assumes that state spending on welfare services is responsible for economic recessions and downturns, and that the provision of social security leads to a culture of dependency that is not conducive to economic growth.

After 1994, true equality and redistribution of resources never took place. Instead, profit and finance generation were the primary goals, often at the expense of the wellbeing of vulnerable communities. Political freedom was attained economic freedom was not.

The economic and social vulnerability of households continues to rise while social protection decreases.

SA’s neoliberal compromises are converting social care into a battle field of competition and individualism. The government’s market commitments compromise our post-1994 developmental rights and we must call it as it is: the prioritisation of economic gain over social justice. It is the responsibility of citizens, as well as social care professionals who have committed to the protection of human rights and dignity, to hold the government to account. We need to say that we will not allow our care, a right as South African citizens, to be made into a commodity that is stripped from us if it is not seen as cost-effective.

 •  Dr Ornellas is a postdoctoral research fellow in the department of social work at Stellenbosch University. This article is based on her doctoral thesis.

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