When Marie Collitz’s huband Freddie was forcible transferred from Johannesburg to the Mosego elder care home in Krugersdorp, 41 kilometres away, she immediately knew something terrible was happening.

“Each day we would visit him, my son would request to enter the care home dormitories and inspect the food, bedding or leisure conditions. Security guards acting on instructions would block us,” Marie, 58, tells Equal Times.

Freddy, 61, suffered from depression but the conditions at Mosego made things even worse.

“We could see Freddie was losing weight horribly. The last week we visited him, he was barely himself. They had tied belts to his underwear to keep it from falling,” she says while wiping away a tear.

Freddie died on 7 August 2016. Staff at the care home said he had fallen on the lawn but the state of his dehydrated, malnourished and wounded body suggested otherwise.

“My husband’s corpse had unexplained red bruises. He had a wound to head, a sore on nose and bruises on ankles.

Freddie is one of more than 100 mental health patients in South Africa’s Gauteng province who died between March and December 2016 after being moved from a private psychiatric facility into unlicensed charity-run care homes. Fourteen other patients died at Mosego during that period.

According to Professor Malegapuru Makobga, South Africa’s Public Health Ombudsman and the author of an explosive judicial inquiry into the deaths, Gauteng’s Health Member of the Executive Council (MEC) at the time, Qedani Mahlangu, made a decision to transfer 1400 mental health patients from the Life Esidimeni Healthcare Hospital in Gauteng province to 27 other facilities in a bid to cut costs.

“The decision was unwise and flawed, with inadequate planning and a chaotic and rushed or hurried implementation process,” Professor Makgoba said in his report into the deaths titled No guns: 94 silent deaths and still counting.

Deinstutionalisation

Mahlangu’s process was termed ‘deinstutionalisation’. Based on the 2002 National Mental Health Act, this meant the gradual removal of mental health patients from South African healthcare giant Life Esidimeni, which treats, accommodates and treats mental patients on behalf of the South African government, charging a daily fee of approximately 322 rands (US$20) per patient.

According to Mahlangu, moving the patients into community-based care homes would allow patients to be closer to their families while reducing the provincial government’s mental care expenditure by an estimated 50 per cent.

But according to the report – which was based on over 80 hours of interviews with healthcare professionals, victims and their families – the moves were chaotic and the facilities were unfunded, poorly equipped and run by untrained staff where patients were underfed, beaten and in some cases, death certificates were forged.

“We warned the minister [Mahlangu] as early as January 2016 that the process of transferring patients was flawed seeing as the care homes were not staffed with trained nurses,” says Lerato Madhumo, national coordinator of Young Nurses Indaba (YNI), a nurses’ association that is helping the families affected by the scandal in their quest for justice.

“The health department chose to ignore our advice. We sensed that things like nutritious food and treatment monitoring facilities were absent in those so-called care homes. As professionals we knew this would end badly,” she tells Equal Times.

Jack Bloom, a lawmaker with South Africa’s Democratic Alliance Party who was one of the first people to blow the whistle on the scandal in September 2016, agrees. “This process was carried out in a reckless, speedy manner. The input of families and independent monitors was not sought,” he tells Equal Times. “What’s more shocking is, in my opinion, the brazen attempt to hide the true number of fatalities.”

From the onset, the health minister defied expert medical advice to halt the process, says Bharti Patel of the South African Federation for Mental Health – the largest union representing mental health care workers in the country. “There was lack of understanding among duty bearers on how the transfer process would shape up. We believe there was too much rush to take patients elsewhere. It is important to respect people’s rights and dignity.”

The fight for justice

The inquiry concluded that the families of affected patients were deliberately misinformed of the re-location of their loved ones, denied permission to enter or inspect conditions at the care homes, and either not told of the deaths of their loved ones or given false information about the true causes of death.

The 27 care homes involved in the scandal have since been closed under the tribunal’s judicial order but those running the care homes deny all liability. Various care home managers have accused the Gauteng health department of failing to pay the agreed subsidies for food, medicine or staff.

A visibly shaken George Maluleke, a manager at Precious Angels – one of the 27 now-banned care homes – tells Equal Times: “It is unfair on us. We didn’t even have money to buy pills for patients.”

The victims’ families, some of whom are still confronting the grim reality that their loved ones were buried in unmarked graves or lie unclaimed in mortuaries, are demanding millions of rands in compensation and want to see the criminal prosecution of Gauteng’s Health MEC Mahlangu (who has been suspended from her job along with two of her key aides) and those running the care homes.

Miriam Monyane, whose 32-year-old son Thabo died following a fatal bout of diarrhoea in October 2016 at the Cullinan Care and Rehabilitation Center, is still grieving.

“Did he deserve to waste away to death like this in a new South Africa? I still can’t believe he is really gone,” she says, sobbing.

Miriam’s family is one of the many being supported by the South African human rights organisation, Section 27. In a statement released after the publication of Makogba’s report in February, the NGO called for a review of mental health provisions across South Africa and the closure of unregistered institutions.

It also called on the implementation of the remedial actions outlined in the report and official inquests into the deaths of all patients: “The Life Esidimeni Case has demonstrated that the Gauteng Health Department, under the leadership of the MEC, acted in clear violation of its own well-articulated mental health policy,” said Section 27.

Gauteng now has a new health minister, Gwen Ramokgopa, who has promised to fix Gauteng’s broken mental health services. She has started with the roll out of a 24-hour hotline for affected families. “I want to account for each and every patient that was transferred from Life Esidemini,” she said a press conference on 8 March. On 22 February she also released a statement pledging: “Never again should a tragedy of this magnitude occur”.

But as Marie, the grieving wife of Freddie Collitz tells Equal Times: “That won’t bring Freddie back.” Along with a number of other families, she is planning to launch a private lawsuit in a bid for justice.