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By Rolf Rosenkranz
Mduduzi has got used to his foot chains. It is, he has been told, part of his healing process.
During the day, the 25-year-old and seven others are crammed into two small shacks of wood and corrugated iron.
They rarely speak. At night, the men sleep in blankets on the church's concrete floor, while the women stay on two beds in one of the shacks.
Mduduzi suffers from a mental disorder. His parents brought him to St John Apostolic Church in Etwatwa, East Rand, seven months ago. They hope church rituals such as induced vomiting by swallowing "holy water" will rid him of his demons.
Mduduzi hasn't seen his parents for several weeks, but hopes he'll go home soon. He knows that if he becomes hyperactive or aggressive, he'll be handcuffed. But he says he feels fine and has even stopped taking the medication he receives on his rare visits to a local clinic.
Prayers and rituals cure patients better than modern medicine, says St John's minister Lucas Kekane. "The main sickness a person undergoes is emotional and spiritual."
Kekane sees the chaining of mentally disabled people, which happens at several St John's congregations, as a last resort.
"Some of the priests chain them because they get so wild they can kill people," he says.
"Actually, we're doing some of the government's work. We take people who are criminals, and out comes a normal person. Families sort of dump them with us. They come and when they see the situation isn't improving immediately, they disappear. And we get nothing from the government."
St John's has over 300 000 members in Gauteng.
While theirs is an extreme case, it illustrates the lack of awareness and funding for mental health initiatives, which have a weak stand when competing with Aids, malaria and tuberculosis programmes for government funding.
Over five million South Africans - over 10 percent of the population - suffer from a mental disorder, according to estimates from the South African Federation for Mental Health (SAFMH).
Illnesses vary from the psychological, such as depression and anxiety, to intellectual disorders, caused by brain malfunctions and deformities.
Many sufferers are unable to hold jobs, as they need constant medication and care. But disappointed families may choose to abandon them rather than seek professional help.
As a result, many homeless people may suffer from schizophrenia, says Ruth Rensburg, the public relations officer for SAFMH member Central Gauteng Mental Health.
"The question is," she adds, "Do you force them into treatment or do they have a right to self-determination?"
Rensburg says NGOs - themselves badly funded - need to function as a "deadlock" in cases where parents and church maintain they're doing the right thing.
Etwatwa police and the department of health were informed about the situation at St John's last month but failed to take action. Central Gauteng Mental Health has now approached the Human Rights Commission.
"The people were brought there against their will," Rensburg says. "We're nowhere near the equal rights written into our constitution - due to ignorance.
"The reduction of beds in psychiatric hospitals and a proclaimed government move towards rehabilitation won't improve the situation as long as communities lack structures to embrace people with mental disorders," Rensburg says.
Crucial steps would include public education campaigns in townships and self-esteem counselling.
"South Africa lags behind the rest of the world where many organisations are run by service users," social worker Ruth Katz agrees.
"It's a bit of a Catch-22, because in this climate people are not going to come forward.
"The general public perception is that they're dangerous and you need to be afraid. But that's only true for a small fraction of people."
Symptoms for psychiatric disorders vary from hyperactivity to reclusion. If medicated, many may be stabilised. But, often, patients have to be persuaded to take daily medication.
"Many think it will extinguish their creative spark," Katz says.
"Hypermania (the "high" experienced by people with bipolar mood disorder) is good to a point, but you spiral out of control. The most dangerous part is that you can physically exhaust yourself."
Charles Knowles relapsed when he interrupted taking vitamins, mood stabilisers and anti-psychotics in 2002. He climbed onto the roof of Gordonia, the Bertrams group home he stays at. Social workers, police and a helicopter crew had to urge him down. Then he was sent to Sterkfontein, one of two psychiatric hospitals in the Johannesburg area, for a month.
"It's like a jail. You're locked up," he says.
"To heal inside isn't easy. The illness breaks you. It's like an animal that's trapped - the more it struggles, the more it gets into it. It's a life sentence. The most important thing is that I've accepted my illness. This is a safe haven here. I want to move out but there's a shadow over me that I can't get rid of.
I don't know what to do with it at the moment."
Pete (not his real name), another Gordonia resident, became schizophrenic after contracting cerebral malaria in Ivory Coast. In his psychoses, he says, he discusses the future of the planet, world hunger and education with voices in his head.
"It's adventurous, humorous, sorrowful, scary; it's hatred and love - all the emotions you can find," he says.
The 40-year-old is taking courses in furniture design and cabin-making through Intec College and plans to leave Gordonia next year, after he graduates.
Gordonia, which has 83 residents, aims at rehabilitating people within three years, but most stay for six or more.
Many return when they relapse after having moved out.
Several residents have lost contact with their families and are unable to pay the R550 monthly fee Gordonia charges as part of the R3 000 it costs to house them.
Gordonia collects either R800 or R740 per month that the departments of health or social services and population development pay, depending on a resident's degree of disability.
The homes are in constant battle against closure, since donations and work contracts for residents fail to raise enough money.
Signs of poor funding are everywhere at Gordonia. The doctor's intercom isn't working properly. Appliances are old and the last communal television set broke last month.
The institution relies on food donations.
Another problem NGOs encounter is that after having been trained, many staff leave for higher-paid wages elsewhere.
For instance, staff at the Avril Elizabeth Home, which is mostly for intellectually-disabled patients, requested a 57 percent raise this week. About 73 percent of the home's costs already go towards staff payment, according to CEO Sylvia Haywood. The union and management settled on a six percent increase for wages below R2 000 and five percent for wages above R2 000.
They are not paid market salaries, Haywood admits. "But we're not in the private sector, we're non-profit. Should we pay more, then close in six months?"
Government officials told staff that its funding covered about 75 percent of the home's costs, Haywood says. Figures indicate, however, that the contributions amount to less than 18 percent of the home's annual costs.
"I want to know," Haywood says, "who is responsible for the mentally disabled?"
What the causes are
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