Nursing the Mentally Ill in Soweto, South Africa

I am pleased to introduce readers to Carmen Rivera, a nurse with interest in forensic nursing and violence prevention.  Carmen has a BS in Nursing and has discovered a love for writing... and is currently a freelance writer who is passionate about issues concerning mental health and how they affect communities worldwide.  Please email if you ever want to discuss the article:

Nursing the Mentally Ill in Soweto, South Africa  by Carmen RiveraNearly 20years after the end of apartheid, the Soweto neighborhood of Johannesburg,South Africa, remains a striking relic of the country’s unequal, separatistpast. Originally established as an urban district for mining workers and blacksevicted from the city, many Soweto residents still live in poverty, sufferingfrom the remnants of institutional racism imposed by apartheid government.

Recently, two sexualassaults occurred in Soweto, which shed light on an alarming kind ofdiscrimination and something not typical discussed outside of the confines of forensic nursing programs:discrimination against the mentally disabled. In April of 2012, seven Sowetoteenagers were accused of gang raping a mentally disabled girl. Video of theattack was recorded on a cell phone then posted on the Internet. Shortly afterthat, two Soweto females were arrested and accused of raping a mentallydisabled 17-year-old boy.

This disturbing trend illuminates a larger problem of sexual abuserates and the historical oppression of the mentally disabled in South Africa.These attacks also highlight systemic problems that plague forensicinvestigations, education programs and ensuring victims’ allegations areadequately heeded by authorities. While forensic school programs are advancingwith every class of students, there are still areas in which they can improve,something prevalent in these cases.

A 2009 study conducted by South Africa’s Medical Research Councilconcluded that one in four South African men admit to having sex with a womanwithout her consent, while 46% admit that they have done it more than once.

Until 2002, many of South Africa’s mentally disabled wereinvoluntarily committed in psychiatric facilities as per apartheid-eralegislation. Their treatment dates to the Mental Health Act of 1973, which wasenacted after a mentally ill gunman assassinated Prime Minister Hendrik FrenschVerwoerd. The mobilization of this Act relied heavily on the precepts of fearto strip the South African mentally disabled of the rights given to other SouthAfricans.

Legislation enacted in 2002 aims to right the care of the mentallydisabled by drastically reducing the amount of involuntarily committedpatients, essentially downsizing state-run mental hospitals. To accommodatedischarged patients, the legislation seeks to provide mental health screeningand treatments as part of primary care, as well as implement community-basedmental health programs, both of which emphasize the role that nurses play incaring for the mentally disabled. An additional provision of the bill seeksparity in providing black and low-income South Africans, many of them based inSoweto, with better access to mental health care.

As of a 2007 study conducted by the WorldHealth Organization, the outcome of the deinstitutionalization of mentalhealth treatment has achieved few of its initial goals. Poverty, lack oftransportation and the social stigma associated with mental disorders has all provideda serious challenge for nursing the mentally disabled.  The two rape casespreviously discussed provide further insight into the intolerance of thementally disabled culled from 30 years of indignity.

Sexuality in Africamagazine links the high instances of sexual assault in South Africa tonationwide gender discrimination and a history of violence. The Soweto rapesfurther illustrate the use of sexual violence as a means of asserting dominanceagainst a marginalized group, the mentally disabled.

In addition to health care reform, the South African government hastaken steps to address the high rates of sexual assault within the country. TheDomestic Violence Act 116 and the Bill on Sexual Offences both seek to morestrictly define and prosecute perpetrators of sexual assault. Additionally,several South African-based non-governmental organizations—many of them staffedby volunteer nurses—have been established to assist victims of sexual assaultwhile promoting prevention. Still, the reporting rate of sexual abuse remainslow, and many victims do not receive the care that they need.

Nursing Soweto’s mentally disabled provides a necessary step to theprevention of sexual assault and other violent acts against South Africa’smentally disabled. As access to community-based health care and stricterprosecution of perpetrators of sexual abuse progress in South Africa, Soweto’smentally disabled will be better protected from these disturbing acts ofaggression and violence.