Mental health care in South Africa 1904 to 2004: legislation influencing ethical patient care

Abstract

Mental health in South Africa has undergone many changes since the pioneering work of colonial doctors in the early 1900’s. With the advent of a human rights based constitution in the 1990’s, mental health was forced to review its methods of care and the political motivation behind many long-term hospitalisations. Because of these practices, government mental health structures maintain and fund institutions that warehouse a legacy of institutionalised and disenfranchised patients from the apartheid area. A number of these patients have been hospitalised for over forty years – some without an appropriate psychiatric diagnosis. Many of these patients cannot be discharged back into the community, as their families have been lost over time. Many patients are institutionalised to the extent that they are unable to manage even the most menial of personal tasks and thus cannot leave the safety of the centres in which they are housed. International developments in the field of Eugenics underpinned much of the sweeping social change that was embraced by Europe and the USA. Germany based many of its policies of eradication of the ‘unfit’ on eugenic principles that could comfortably accommodate the rejection of racial differences. The profound effect that eugenics exercised in the medical and social spheres internationally drove the development of many apartheid-based government policies in South Africa. These included reform in the areas of education, mental health, social development, group areas etc. This research report briefly explores some of the social, medical, political and legislative influences active in the field of mental health from 1904 to 2004.