It is two years since Northern Cape Premier Dr Zamani Saul opened the R2.1-billion Kimberley Mental Health Hospital, calling it a “monument of corruption”. At the time Saul said the hospital, which has a capacity of 287 beds, already had 160 patients and would be operationalised in phases. Yet, healthcare worker union Nehawu, community healthcare workers, activists and mental health practitioners say mental health users in the public sector are disadvantaged because the hospital is still not running at capacity.

‘As good as dead’

One employee at the hospital, who wants to remain anonymous for fear of reprisals, tells Spotlight the Kimberley Mental Health Hospital “is as good as dead”.

“I have been working here since the hospital was opened and it is still quiet. The few patients that are housed here are indeed well taken care of, but there are many people out there in the Northern Cape that need the services offered here but cannot be accommodated because there is a staff shortage,” she says. 

This month marks two years since Northern Cape Premier Dr Zamani Saul opened the multimillion-rand Kimberley Mental Health Hospital, calling it a ‘monument of corruption’. (Photo by Gallo / Foto24 / Emile Hendriks)

“The department only says there is no money to employ more professionals. The wards are empty. Currently, there are fewer than 80 people here and the rest of the wards are empty. This hospital is big and beautiful, but it is not serving its purpose. So, basically, we don’t know when this hospital will start working. None of us know.”

Spotlight asked the provincial health department for comment, but the department failed to respond.

When Spotlight visited the hospital in February last year, it had only 110 patients, who had been transferred from the West End Hospital, four psychiatrists and 80 nurses. The Kimberley Mental Health Hospital was built to relieve the pressure on West End Hospital, which is a state psychiatric facility. During the visit, Kimberley Mental Hospital CEO Albert Links said the hospital was not fully functional because of a lack of funding, staff and medical supplies.

Still no money

Isak Fritz, health spokesperson for the Democratic Alliance in the Northern Cape, says these shortages persist.

The hospital is meant to offer mental health services in the Northern Cape, which include child and adolescent mental healthcare, forensic mental healthcare and general adult psychiatric services.

Fritz says it is not fair for mental health patients to struggle for services while R2.1-billion was spent on building a state-of-the-art mental health hospital in the province. 

“The planning and management at the Department of Health are very poor. They decided to spend R2.1-billion to build a hospital but forgot that the hospital has to operate. Today as it is, the hospital is empty because they cannot afford to appoint specialists to serve the patients.”

Fritz says while the hospital is completed and equipped to deliver a full package of services, it is still only at phase one of the phasing-in of services.

“This is despite the facility having become operationalised two years ago.” Fritz attributes this to a lack of clinical capacity and over-burdened staff who have to fulfil dual roles.

“And as a result, psychiatrists have to serve as doctors and safety officers while we have state patients who are still accommodated in prison, and child admissions have yet to commence,” he says.

The hospital employee Spotlight spoke to said security guards often have to look after patients because there are not enough nurses.

Moleme Moleme, Nehawu chairperson in the Northern Cape, says the union has for a long time been pleading unsuccessfully with the department to operationalise the hospital. 

“We have been in talks with the employer [department] and they are not coming to the party. We have been asking them so many times to prioritise employing more nurses, psychologists and psychiatrists at that hospital. They say they do not have money to appoint specialists in the field of mental health,” he says.

Motshabi Thoge is a community healthcare worker (CHW) who has been based at the Ma Doyle Clinic in Galeshewe in Kimberley for the past 12 years. Thoge says she has attended at least 10 training sessions offered by the provincial health department. This training included screening mental health patients. She says despite including mental health screening in their scope of work, the department is yet to permanently employ the CHWs. 

Due to budget limitations, the Kimberley Mental Hospital still does not run at full capacity. (Photo: Emile Hendricks / Spotlight)

“I wish the [department] can notice us as the community healthcare workers. It is painful to see a luxury hospital in Kimberley not being used to its full capacity because there is not enough staff while we are here with years of experience,” says Thoge.

What mental health services look like in the Northern Cape

Spotlight asked the department what mental health clinical staff are available in the province, but got no response. According to a presentation the provincial health department made to the Portfolio Committee on Health in Parliament in 2017, at the time there were only three psychiatrists based at the government specialist hospital (West End Hospital) and only one based at the private mental health facility, the Careline Clinic Private Psychiatric Hospital. 

The figures also showed that in 2017 the province had 15 psychologists in the public sector and 12 in the private sector. There is one psychiatric nurse based at a tertiary hospital and 14 at West End Hospital.

In 2019, former health minister Dr Zweli Mkhize, in response to a written question in Parliament, said there were 12 clinical psychologists, four psychiatrists and one counsellor employed in the public health sector in the Northern Cape.

The minister cited data from the district health information system that showed the number of clients seen at ambulatory (non-inpatient) services for mental health conditions averaged 40,000 per month for the province. The average number of patients admitted to mental health units attached to general hospitals was 1,500 per month, making it the third-highest after KwaZulu-Natal and Gauteng — both of which have much bigger populations.

There is only one licensed private psychiatric hospital in the province.

As is the case in other provinces, non-complicated mental illness is managed at the clinic level. Thoge says that at her clinic, Tuesdays are dedicated to mental health patients. 

“We see between 30 and 50 patients every Tuesday.” She says she has not seen an increase in the number of patients during the pandemic, but had challenges with patients who interrupted their treatment. 

“We offer screening and treatment for mental health disorders at the clinic. We also do screening for substance abuse. When there is a severe mental problem, we refer the patient to the West End Hospital and not the new mental health hospital,” she says.

During the presentation to Parliament in 2017, the provincial health department said it had no community-based accommodation for clients with mental illness or profound intellectual disability.

Jannie van Zyl, the director of Yonder, the Northern Cape’s biggest mental health and disability centre, says mental health remains a low priority.

“It is not just a problem in the Northern Cape, it is a nationwide problem,” he says. His organisation accommodates 215 people and helps an additional 50 daily, who are outpatients. 

Hospital CEO Albert Links during Spotlight’s visit in 2020. According to the Hawks, the investigation into the construction costs is at an advanced stage. (Photo: Emile Hendricks / Spotlight)

“We help more people than the government,” Van Zyl says. “As the biggest mental health NGO in the province, we get no support from the [provincial] department of health, only the Department of Social Development. It is a sad state of affairs because even though we love to help our people we are not able to accommodate more than what we would like to. Yet there is a beautiful mental hospital that is not able to operate because of a lack of funds. 

“The Northern Cape is the biggest province in the country with the least number of people — a population of 1.8 million — and we are the most forgotten.”

Still under investigation

The 336,000m² state-of-the-art Kimberley Mental Health Hospital is said to be the most expensive mental hospital in the country, having cost R2.1-billion. The initial amount budgeted to build it was R290-million, but construction dragged on for 13 years while costs ballooned.

During the launch in 2019, Saul said the building had become a monument to corruption, and completing the hospital was full of pitfalls characterised by a huge wastage of state resources.

Nomthandazo Mnisi, spokesperson for the Hawks in the Northern Cape, confirmed that a probe to determine how the construction costs of the hospital escalated from R290-million to R2.1-billion is under way.

“The investigation is at an advanced stage. Arrests will be made as soon as the investigation is complete. People that are involved include government officials and private entities,” he says. 

“Unfortunately, we cannot give out any names or more information since the matter is still under investigation.”

This article was produced by Spotlight — health journalism in the public interest.