Once a beacon of excellence that attracted top clinical professionals, the departure of several senior specialists may jeopardise Fort England Hospital’s status as South Africa’s maximum security forensic assessment facility, its crucial role as a forensic clinical training facility and its capacity to provide quality care for forensic patients.
By the end of August, four senior psychiatrists had left Fort England Hospital, including the head of psychiatry, and Grocott’s Mail understands the departure of other key staff is imminent. Some local mental health professionals blame the exodus on the “toxic” grip of disruptive unionised labour in the institution. Trade Union Nehawu says a shortage of specialist staff is the result of poor management by a bloated and costly District administration. And the South African Society of Psychiatrists says institutions in bigger centres easily attract top professionals, leaving institutions in smaller towns and rural areas competing with each other as they head-hunt to fill positions.
Local mental health professionals have warned that the exodus of key staff could compromise care at Fort England and the institution’s statutory responsibility as the country’s maximum security forensic facility. A new child and adolescent care facility will be a white elephant without qualified staff to run it; and the institution’s capacity to mentor and manage the psychology internship and the psychiatry registrar training programmes is hobbled.
The hospital houses around 300 patients with mental disorders. Some of these patients are extremely disturbed and require constant supervision. The hospital also manages South Africa’s most challenging state patients in its national maximum security unit.
The maximum security unit (MSU) holds the most complex Forensic patients from all over South Africa. In addition, it serves as the provincial referral centre for remand detainees who require psychiatric observation as part of the trial evidence. A waiting list that took six months to work through is now more than a year long, according to insiders.
Moreover, the patients under forensic observation require psychiatrists on the assessment panel. The three specialist posts currently vacant are Head: Clinical Department / forensic psychiatrist; Head: Clinical Unit / forensic psychiatrist and Head: Clinical Unit / general psychiatrist. With only two general psychiatrists left at Fort England, forensic expertise has dwindled and so has the capacity to cope with demand as the waiting lists grow.
“The loss of the only two forensic psychiatrists and the most senior general psychiatrist is a cumulative loss of many decades of clinical experience,” said the mental health professional.
“This makes it very difficult to run a forensic hospital or train registrars and impossible to train forensic subspecialists as things stand,” they said.
Forensic assessment is a crucial part of the justice system and they warned that this has Implications for the High Court and the Magistrate’s Court, as well as the legal profession in Makhanda.
In addition to being flagged as a violation of human rights, of serious concern is the possibility that a delayed observation period may call into question the legitimacy of these trials. Those under observation are accused of serious violent crimes and considered dangerous.
Child and adolescent unit
Fort England also offers general psychiatry and psychology and is the only public health substance abuse treatment centre in the region.
“There was a strategic plan with motivated staff and expanding clinical service platforms including the child and adolescent services,” said a source.
Professionals in the institution had specified for more than a decade that a child and adolescent unit was desperately needed, but that it couldn’t function without a dedicated child and adolescent subspecialist and a dedicated child and adolescent clinical multidisciplinary team.
One of the buildings in the hospital is currently being adapted to serve as a Child and Adolescent Mental Health Unit. It’s expected to be complete by March 2021.
However, said one of the mental health professionals consulted in its planning, “Any expectations that the facility can somehow open before the requisite clinical personnel posts are funded, advertised and filled are misplaced and ill-advised.”
One of the senior professional staff is known to have retired due to ill health. None of the others was prepared to comment on the reason for their departure; however, local mental health professionals claim the destructive grip on the institution of certain union officials sanctioned by the Department of Health has made the environment “toxic”.
In his February 2019 Labour Court ruling on former fort England CEO Roger Walsh’s challenge to the Department of Health, Judge Andre van Niekerk noted, “When an employer allows itself to be held hostage to a concerted campaign of violence and intimidation conducted by power-hungry union officials, the basis for any semblance of a system of industrial relations is compromised.”
“It was one of the best psychiatric hospitals in the country, and critical in the Eastern Cape. It was a shining star – a centre of excellence capable of attracting people to go and work there.”
The senior specialists who have left this year, or are about to, would be almost impossible to replace, the professional said.
“There’s a depth of experience in that cohort that’s been squandered. Filling those posts with people as highly experienced will be a challenge.”
Critical shortage
The South Africa Society of Psychiatrists Eastern Cape Secretary, Dr Ntandazo Puzi, agreed that filling the vacant senior posts would be difficult.
“I know there have been some issues at Fort England and I’m not familiar with the exact details. But it’s also true that there is always a critical shortage of psychiatrists,” Puzi said.
“They gravitate to Gauteng and the Western Cape. In the other provinces, there are simply not enough.”
“It’s very difficult to get psychiatrists to come to the Eastern Cape, to the small towns here. I’m aware that there are many posts, but that when they’re advertised there is a low response rate. So they opt for head hunting,” Puzi said.
The Eastern Cape Department of Health responds
Grocott’s Mail sent questions to the Eastern Cape Department of Health about staff vacancies at Fort England Hospital. The Department responded as follows:
- One doctor’s contract ended on 31 August 2020 and the contract has been renewed for another year.
- Two officials have retired, one end of December 2019 and one end of January 2020 and those posts have been advertised.
- Three psychiatrists have resigned: One end of May, one end of June, one end of July. All three posts have been advertised.
- One medical officer resigned and a transfer in was appointed on 1 September 2020.
- On 1 September, three doctors were appointed:. 2 medical doctors and 1 registrar .
- None of the psychologists left the institution this year; instead, two more psychologists were absorbed.
Currently there are no vacant posts for psychologists. All our posts are full.
- 46 (40 contract nurses and 6 community service nurses) Nurses have been employed since January 2020 and 15 have left the institution and 2 deceased.
- The newly built child & adolescent unit is still in progress. The construction company is still on site since November last year. The expected date of completion is end of March 2021.
- The ECDOH is responsible for staffing for all health care workers in the province.
https://www.grocotts.co.za/2020/10/01/bloated-administration-overloaded-staff/
