Nursing the Mentally Ill in Soweto, South Africa by Carmen Rivera
Nearly 20
years after the end of apartheid, the Soweto neighborhood of Johannesburg,
South Africa, remains a striking relic of the country’s unequal, separatist
past. Originally established as an urban district for mining workers and blacks
evicted from the city, many Soweto residents still live in poverty, suffering
from the remnants of institutional racism imposed by apartheid government.
Recently, two sexual assaults occurred in Soweto, which shed light on an alarming kind of discrimination and something not typical discussed outside of the confines of forensic nursing programs: discrimination against the mentally disabled. In April of 2012, seven Soweto teenagers were accused of gang raping a mentally disabled girl. Video of the attack was recorded on a cell phone then posted on the Internet. Shortly after that, two Soweto females were arrested and accused of raping a mentally disabled 17-year-old boy.
This disturbing trend illuminates a larger problem of sexual abuse rates and the historical oppression of the mentally disabled in South Africa. These attacks also highlight systemic problems that plague forensic investigations, education programs and ensuring victims’ allegations are adequately heeded by authorities. While forensic school programs are advancing with 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 Research Council concluded that one in four South African men admit to having sex with a woman without her consent, while 46% admit that they have done it more than once.
Until 2002, many of South Africa’s mentally disabled were involuntarily committed in psychiatric facilities as per apartheid-era legislation. Their treatment dates to the Mental Health Act of 1973, which was enacted after a mentally ill gunman assassinated Prime Minister Hendrik Frensch Verwoerd. The mobilization of this Act relied heavily on the precepts of fear to strip the South African mentally disabled of the rights given to other South Africans.
Legislation enacted in 2002 aims to right the care of the mentally disabled by drastically reducing the amount of involuntarily committed patients, essentially downsizing state-run mental hospitals. To accommodate discharged patients, the legislation seeks to provide mental health screening and treatments as part of primary care, as well as implement community-based mental health programs, both of which emphasize the role that nurses play in caring for the mentally disabled. An additional provision of the bill seeks parity in providing black and low-income South Africans, many of them based in Soweto, with better access to mental health care.
As of a 2007 study conducted by the World Health Organization, the outcome of the deinstitutionalization of mental health treatment has achieved few of its initial goals. Poverty, lack of transportation and the social stigma associated with mental disorders has all provided a serious challenge for nursing the mentally disabled. The two rape cases previously discussed provide further insight into the intolerance of the mentally disabled culled from 30 years of indignity.
Sexuality in Africa magazine links the high instances of sexual assault in South Africa to nationwide gender discrimination and a history of violence. The Soweto rapes further illustrate the use of sexual violence as a means of asserting dominance against a marginalized group, the mentally disabled.
In addition to health care reform, the South African government has taken steps to address the high rates of sexual assault within the country. The Domestic Violence Act 116 and the Bill on Sexual Offences both seek to more strictly define and prosecute perpetrators of sexual assault. Additionally, several South African-based non-governmental organizations—many of them staffed by volunteer nurses—have been established to assist victims of sexual assault while promoting prevention. Still, the reporting rate of sexual abuse remains low, and many victims do not receive the care that they need.
Nursing Soweto’s mentally disabled provides a necessary step to the prevention of sexual assault and other violent acts against South Africa’s mentally disabled. As access to community-based health care and stricter prosecution of perpetrators of sexual abuse progress in South Africa, Soweto’s mentally disabled will be better protected from these disturbing acts of aggression and violence.
