Psychiatric treatment at a forensic psychiatric hospital in South Africa : an ethnographic inquiry

Abstract

The tragic deaths that resulted from the closure of the Life Esidimeni mental health facility in Gauteng, South Africa, questioned many facets of mental health care, patients’ rights, and the agents of power in health care. It also revealed a division between government officials, high level decision-makers, and hospitals responsible for day-to-day care. This caused me to question how mental health care facilities function in South Africa, the power dynamics within and over these institutions, the extent to which patient support networks are recognised, clinicians’ interactions with those patient support networks and within multidisciplinary teams, human rights issues, and the adequacy of funding of mental health care. I also became interested in how mental health care facilities coped with and adapted to COVID-19. With these questions in mind, I focused my research on a forensic psychiatric hospital in KwaZulu-Natal, South Africa, with clinicians in the multidisciplinary team as my participants. I set out to conduct the research using traditional ethnographic fieldwork methods, which characterises anthropological research. However, due to the restrictions imposed by the COVID-19 pandemic I modified my approach, because I would not be allowed entry into the hospital due to the lockdown. I, therefore, employed a virtual ethnography approach, conducting interviews using digital videoconferencing platforms, and developed a loose set of questions to guide my interviews. The broad themes that emerged threw light on the multidisciplinary team functioning, the agents of power within State mental healthcare and within the hospital, human rights issues affecting mental health care, funding concerns in mental health care, and the hospital’s adaptation to the COVID-19 pandemic. Several sub-themes emerged within these thematic areas. Among the broad areas of concern were patients’ rights to discharge and freedom, patients’ right to participate in the country’s elections, and problems related to the funding of mental health care in South Africa. From the perspective of critical medical anthropology, it seems evident that political and economic forces negatively influence patient care, and that change is needed. However, it also seems evident that clinicians coped well with the COVID-19 pandemic, despite financial and structural constraints.