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The ‘darkness of insanity’ at Mohlomi

IF you are unfortunate to be sent to Mohlomi Mental Hospital for an evaluation, the chances of you getting discharged are next to zero. That is because a technical advisory committee that must sit and evaluate mental patients at Mohlomi has not sat in many years. The result is that patients are now kept at the hospital longer than necessary, according to a damning 40-page report by the Ombudsman released in October last year but was only seen by thepost this week.

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vocate Tlotliso Polaki, to inspect conditions at Mohlomi Mental Hospital in March last year.
It says some patients have been committed to the mental institution for 40 years.
One had been detained since 1982 and died at the hospital in December 2022.

An advisory committee is supposed to sit and evaluate assessment reports and recommend patients for pardon. That committee, however, has not sat since 2015, according to the report.

“Many of the patients are no longer supposed to be at the healthcare facility but due to the fact that the technical advisory committee charged with the function of recommending to the King, the progress and action to be taken in connection with patients committed pending the satisfaction of the King’s pleasure has not sat in many years, they are kept at the hospital longer than necessary and to their prejudice,” it says.

“Elongated patients’ detention under His Majesty’s pleasure amounts to inhumane treatment and (are) an infringement of their rights under section 8 of the Constitution,” it says.
It says the indefinite incarceration of patients “leads to the deterioration of their mentality and they are in a state where they actually retreat into a dreadful state and darkness of insanity”.

Advocate Polaki says “this situation should not be allowed to perpetuate any further and patients who are deemed eligible for His Majesty’s pardon should be released from the hospital conditionally or unconditionally by reason of their stabilised mental condition”.

Under the Criminal Procedure and Evidence (Amendment) Act No 4 of 2009, those deemed to be mentally ill were to be transferred from a correctional institution to a mental health facility where they would receive appropriate psychiatric treatment and medical care.

The report however says it would appear these patients/inmates “seem to be living under worse off conditions than they were at correctional facilities”.
The Ombudsman also took a swipe at the Ministry of Health, insisting that the ministry had “failed Mohlomi” when it could not come up with a national mental health policy framework and national strategy.

It says a developmental agency, Partners in Health, was willing to bankroll a M300 million seven-year project to “strengthen mental health services” in Lesotho.
“The project has the support of more than M300 million but Mohlomi is unable to benefit from therefrom for the mere reason that the policy and strategy remain unapproved to date,” the report says.

“The inaction on the part of the authorities involved amounts to maladministration and the barriers that limit health partner assistance have to be addressed on an urgent basis as it has led to unintended consequences.”

The report says conditions under which patients live at Mohlomi Mental Hospital are not humane and are a violation of their fundamental human rights.
The report says the human rights violations were a direct result of a “prolonged and systemic neglect of the mental health facility at a policy implementation level”.
“Mohlomi seems to have been under-prioritized and mental health services offered also seem to have perversely relapsed,” it says.

“Mohlomi is neglected and the conditions under which patients live are compounded by a lack of resources and the fact the MoH (Ministry of Health) does not seem to regard it as a priority focal area.”

The report says the toilets at Mohlomi were renovated a long time ago and most were no longer working properly. Most of them were blocked, forcing staff to pour acid in the toilets and pipelines to unblock them every day.

Even during winter, patients bath with cold water as the geysers were broken.
“It was concerning to find that there was a lack of beds and mattresses that has resulted in serious discomfort for patients and the Ombudsman was informed that patients ripped up their mattresses and blankets as a result of shortages in basic consumables such as toilet paper . . . to clean themselves,” it says.

“The rooms (reeked of) a bad foul smell and cleanliness remains a concern in all the wards. Hygiene has been compromised a great deal as a result and the same can be said of the ablution services,” it says.

The report says Mohlomi is the only psychiatric hospital in Lesotho, “which operates without psychiatrists”.

Most of the specialists in the area have since left the country for better opportunities elsewhere. The last psychiatrist left around 2016/2017, according to the report. Since then the hospital has not had a psychiatrist.

The Ombudsman was informed during the site visit that the hospital was now operating with the help of one psychiatrist from Partners in Health that is working closely with the Ministry of Health since December 2022.

The psychiatrist assists the hospital once a week.

“The Ombudsman established that the psychiatrist scope of work was however, only limited to general patients and is to the exclusion of medico-legal issues related to forensic patients requiring evaluation for the pardons committee’s assessments,” it says.

It says what is disturbing is the fact that “the tribunal charged with the responsibility of making such assessments has not been reconstituted for a very long time”.

“That committee last sat in 2015 and MoH has failed to reconstitute it primarily because there is no qualified psychiatrist to undertake this role and as such no patient evaluation reports can be produced for its consideration to date”.

Patients at Mohlomi can only be released once that technical committee, made up of a psychiatrist, two social workers and two others appointed by the King, has sat and recommended their release following an assessment.

“The lack of medical officers trained as such has exacerbated the challenges related to overcrowding at this facility and there are no other decongestion mechanisms that have been employed save for occasional court orders sourced by affording patient families,” it says.

Patients who cannot afford to secure assistance from lawyers cannot secure their release, the report says.

The Ombudsman says the continued detention of the patients is a violation of their fundamental rights and “the delays caused by the elongated detention has led to them suffering from bouts of severe stress and mental fatigue”.

“The Ombudsman is of the view that patients continued incarceration without any medical and or other treatment is inhumane and degrading contrary to the provisions of section of the Constitution, the Human Rights Act 1983 and International Conventions to which Lesotho is signatory to,” it says.

In her recommendations, the Ombudsman says the Ministry of Health should source a qualified psychiatrist(s) within six months of the issuance of the report to undertake assessment reports of patients at the hospital and make recommendations to the advisory committee about those eligible for pardon.

She also recommends that patients “who are deemed eligible for His Majesty’s pardon should be released from the hospital conditionally or unconditionally by reason of their stabilised mental condition”.

“Within 180 days from the issuance of this report, all patients should be medically assessed and examined by experienced medical officers to establish their present mental condition and suitability of their release or further detention,” says the report.

The Ombudsman also ordered the Ministry of Health to “ensure that conditions under which patients are kept at Mohlomi are improved and (are) humane”.

It is not clear if these recommendations have since been implemented or whether the Ministry of Health is working on a plan to implement them.

At the time of the inspection on January 27, 2023, there were 77 patients at Mohlomi, 74 males and three females. The facility was built to host only 35 patients.

“The overcrowding has placed patients at the risk of infecting each with communicable diseases such as tuberculosis, Covid-19 and sexually transmitted diseases,” it says.

Most of the patients at Mohlomi were detained for charges such as assault with intent to cause grievous harm, sexual offences such as rape and murder.

Most of the patients had been deemed by the courts to be unfit to face trial while others were said to not have been criminally responsible for their acts.

The Ombudsman says he had an opportunity to engage some of the patients’ representatives some of whom had been awaiting the King’s pardon for years.

“They, on the face of things, were lucid and complained that they were fit to be considered for an assessment and for pardon but their future seemed bleak as it could not be determined as to when the Ministry of Health would be in a position to appoint a psychiatrist and reconstitute the technical tribunal,” he says.

He cites the case of an elderly woman who had been committed to Mohlomi in 2019 over a contempt of court case and another inmate who was committed in 1998 over a case of statutory rape. The third inmate was accused of arson which he committed in 2017.

They told the Ombudsman that “some of us have mentally healed but we end up relapsing as a result of rubbing shoulders with mental patients and the uncertainty of not knowing when we will ever be discharged”.

The report says the patients at Mohlomi are starving.

“Patients do not receive adequate food of a nutritional value and in a majority of times, are provided with pap and beans throughout,” it says.
In most cases, they are left famished.

“Although they may indicate that they are hungry, they are locked up even under these circumstances,” it says.

“Diet is such an important component of mental health and it is not irrational to suggest that hunger and stress related to not getting enough food to eat may actually lead to depression and anxiety,” it says.

“The Ombudsman is therefore of the view that deprivation of adequate food and a balanced diet meal is a violation of patients’ fundamental human rights.”
Staff working at Mohlomi have not been left untouched.

They told the Ombudsman that they were concerned with the lack of psychosocial support to staff “who work under very dire conditions and have to support patients living with mental illnesses”.

They say they need counselling from therapists to cope.

The report says some of the psychiatrist nurses manage highly violent and aggressive patients on a daily basis and that they faced the risk of physical injury, anxiety and stress from interacting with these patients.

The nurses are currently being paid a risk allowance of M12 per month.

The Ombudsman says the M12 risk allowance “is too low, (and) a mockery” and must be reviewed within a year to between M300 and M500 a month.

The report comes after the Ombudsman embarked on an inspection programme of hospitals countrywide and Mohlomi Mental Hospital last year.
The objective of the inspection was to ascertain if conditions at Mohlomi were fit for human habitation.

The last inspection at Mohlomi was carried out in 2015.

Spokesman for the Ministry of Health, Tumisang Mokoai, told thepost yesterday that they had just met the Social Cluster of parliament and “this very issue was among those discussed”.

“We will prepare a proper, detailed, response next week,” Mokoai said.

Abel Chapatarongo

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