The forgotten folk: Plight of patients at Mohlomi Hospital

Ntsoaki Motaung

The Ombudsman, Advocate Tlotliso Polaki, has raised critical issues concerning the living conditions and treatment of patients, especially in the Forensic Unit of Mohlomi Mental Institution.

The Forensic Unit houses individuals at His Majesty’s discretion under the Criminal Procedure and Evidence (Amendment) Act No 4 of 2009 with the aim of streamlining the transition of mentally ill inmates from a correctional facility to a mental health institution throughout all phases of criminal proceedings.

The goal is to safeguard the rights of individuals with disabilities and protect them from potential abuse.

However, prolonged detentions in this unit have been flagged as inhumane treatment and a violation of their constitutional rights, as per section 8 of the Constitution.

Polaki pointed out that extended periods of incarceration lead to a decline in mental health, pushing individuals into distressing states of mental instability.

This situation, she said, contradicts both the Constitution and international treaties endorsed by Lesotho.

The Ombudsman emphasised that such conditions should not persist in a democratic state, urging the conditional or unconditional release of eligible patients based on their stabilised mental state.

Beyond extended stays, Polaki highlighted broader health concerns within the forensic unit. Overpopulation has led to an infestation of lice, resulting in patients contracting scabies.

While measures have been taken for treatment, the issue persists due to overcrowding.

“Yes there were measures taken by the Ministry of Health to take those patients for treatment but they were not cured because after the treatment, they went back to the same place with lice,” she explained.

She described the state of mental health services in the forensic unit as generally poor, with multiple human rights violations apparent.

Interestingly, the initial objective of transferring mentally ill inmates to this unit was to ensure they received proper psychiatric treatment and medical care.

However, the reality for these inmates appears to be harsher than their previous conditions in correctional facilities.

“On summary findings, with ‘the forgotten folk’ at Mohlomi mental hospital (forensic unit), the numerous human rights concerns that have been highlighted in the investigation can be said to arise out of a prolonged and systemic neglect of mental health at the level of policy implementation,” Polaki said.

She indicated that her investigation revealed systemic neglect of mental health at the policy implementation level.

Issues such as resource inadequacy, substandard physical facilities, technical capacity gaps, and a lack of concern for patients’ mental health have been identified as the root causes of these failures.

Polaki stressed that Lesotho must make substantial progress to fulfill its obligations under the Convention on the Rights of Persons with Disabilities (CRPD).

She stressed that the Mohlomi facility faces challenges related to patient care and the criminal justice system.

“The facility suffers from over congestion, patients seem to lack the support necessary and we established that most have been kept longer than they should be incarcerated for the reasons that inter alia, there are no psychiatrists to undertake their evaluations and this is a human rights issue and violation that requires urgent redress,” she said.

The Ombudsman’s Hospitals’ Human Rights Inspection Report for 2023 presents key findings that demand particular attention from the Ministries of Health, Justice, Law, and Parliamentary Affairs, as well as the Ministry of Defence and National Security.

Chapter 12 of the Constitution establishes an ombudsman that has the authority to investigate complaints against the government, government officers, and any statutory corporation and the members and persons in the service of a statutory corporation. 

The Constitution prescribes that the Ombudsman shall make a written report of every investigation undertaken by the office which shall include a statement of the action if any, taken by the officer or authority concerned as a consequence of such investigation and may include a recommendation as to what remedial action, including the payment of compensation, should be taken.

“In the exercise of his functions under this section, the Ombudsman shall not be subject to the directions or control of any other person or authority,” reads the Constitution.

The last round of inspections at hospitals by the ombudsman, including Mohlomi Mental Institution, was carried out in 2015.

Subsequent follow-up inspections faced delays for various reasons, including the Covid-19 pandemic. These resumed in February of this year, alongside other ongoing investigations.

In the meantime, Tumisang Mokoai, the Public Relations Manager for the Ministry of Health, mentioned that they have recently received the ombudsman report.

Mokoai said they were currently reviewing its contents to provide an appropriate response.

However, he pointed out that some of the concerns may no longer be relevant, as the investigations were conducted earlier in the year, and certain issues have already been addressed.

Mokoai explained: “The report might be irrelevant to some extent as we speak because the investigations were done long ago from the beginning of the year. An example would be the issue of lice infestation, which was dealt with and patients were taken for treatment. Meaning we do not have such a concern at the moment,”

To support his statement, he noted that during the Mental Health Awareness Day celebration held at Mohlomi Mental Institution this year, a tour of the facility was conducted, and no signs of pest infestation were observed.

The Mohlomi situation is reminiscent of the South African Life Esidimeni tragedy which involved the deaths of 144 people at psychiatric facilities in the Gauteng province of South Africa from causes including starvation and neglect.

The tragedy took its name from Life Esidimeni, a subsidiary of Life Healthcare, the private healthcare provider from which some 1,500 state patients were removed in the first half of 2016.

The patients were relocated to cheaper care centres, many of which were later found to be unlicensed and grossly under-resourced. The incident has been called “the greatest cause of human rights violation” in democratic South Africa and stimulated discussion about the care of psychiatric and other state patients.

As of 2021, no criminal charges had been laid against any individuals involved, but a judicial inquest into the deaths was ongoing.