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Dangerous Minds
| Date: |
24 October 2004 12:00 |
| Producer: |
Michael Duffett
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| Show: | Carte Blanche |
Dr Kannellie Hatzikontstandinou was having coffee with her father at the Cresta Centre in Johannesburg on the 27th of September this year. She got up and wandered off, and next thing she had slit the throat of 81-year-old Maureen Naughtin. Apparently Kannellie, a respected doctor of homeopathy who suffered from schizophrenia, had a psychotic attack.
The son of the murdered woman, however, bears no malice.
Grant Naughtin (Maureen's son): 'We [he and his brother] have no animosity towards my mom's killer. We feel that she's [Kannellie was] ill. The fact that it was a completely random event has helped us to deal with the whole thing.'
Dr Sean Baumann is one of South Africa's foremost experts on schizophrenia.
Derek Watts (Carte Blanche presenter): 'We've seen these patients, quiet, well mannered. What happens when their world turns upside down?'
Dr Sean Baumann (principal psychiatrist): 'At times in a full blown relapse there's a transformation. That's the nature of this illness.'
Derek: 'In another state, it's against everything they believe in?'
Dr. Baumann: 'Absolutely. And the tragedy is also that when they're well, they feel horror. 'How could I have done such a thing? It's not me!''
But the murder resulted in people questioning - are all schizophrenics dangerous? Another psychiatrist, Professor Sean Kaliski, heads up the forensic unit at Valkenberg hospital. His job is to assess the mental state of defendants who are referred by the courts.
Derek: 'What is the research saying about mentally ill people out there in the community? Is the situation getting worse when it comes to violence?'
Prof. Kaliski (forensic psychiatrist): 'Increasingly over the past 10, 15 years research in the United States, Scandinavia, Canada, the UK and Australia [have] shown quite convincingly that although 95% of people with schizophrenia are not dangerous, they're not violent, there is a hard core of between 3 to 5% of schizophrenics who are - because of their illness.'
Twenty thousand people in Cape Town alone have schizophrenia. Sean estimates that, of these, about 1 000 are roaming around, potentially dangerous
Most of these would have been discharged from Valkenberg, which once had 900 beds. It only now has 150. The majority of mentally ill outpatients now are managed at Community Health Centres where they need to be monitored and get their medication. But is this working?
Derek: 'Lillian Hare lives here at her home with her 37-year-old son Brian. At times this home becomes a prison - windows closed, doors bolted...and it's not because of intruders.'
Inside live[s] Mrs. Lillian Hare, her daughter and grandchildren. Brian, her son, has to live in a room at the back of the house. As a youngster, Brian was healthy and normal.
Derek: 'When did you first notice that Brian had a problem?'
Lillian Hare: 'A few times he used to go to work, then he comes home and says, 'Mommy, the people spit on me and laugh at me'. And so then I noticed there is something wrong with Brian.'
Lillian Hare was right. Brian developed schizophrenia at the age of 17 and has had nine admissions to a psychiatric hospital. After each discharge he's okay for a few days, but then becomes extremely violent, breaking windows, smashing doors. Lillian needs to barricade herself in
Teresa Hare: 'He'll be the one person the one minute and in a split second he'll change into this violent...it's like this animal that comes out of him.'
Brian threatens his mother, assaults her, and the community is afraid of him. When Brian's family do mange to have him committed to Valkenberg through a court order, Dr Baumann can only treat him for 14 days at the longest.
Derek [to Dr Baumann]: 'Will it be true to say that at times you have to discharge a sick patient to make way for a sicker patient?'
Dr. Baumann: 'Yes.'
Derek: 'Sean, at times do you have to take a calculated risk?'
Dr. Baumann: 'Ja, sure, of course. And sort of all the time really because - this is it... there are extremely vulnerable people and we know that often we are discharging patients into a situation that will fail.'
Mrs. Hare's situation is worsening all the time. Just a few moths ago Brian attacked again.
Derek: 'Lillian, I know it's very tough, but just take us back to what happened.'
Lillian: 'I came in and he kicked the back door open and he [get] hold of me , and he [drag] me to a room and he threw me on the bed.'
Brian tore her mother's clothes off. Miraculously she found the strength to break free. She ran naked into the streets to seek help.
Lillian: 'I was shaking, I was so afraid. I'm so afraid of my son, I just think I just want to walk and walk to my gate. I can't take it any more. It's too much for me.'
Derek: 'When patients like Brian need medication they should come to community health centers like this one and stand in the queue. But the problem is, it doesn't always happen.'
Sister Najwa Khan (mental health nursing sister): 'What [happens] is that the patients that are discharged from Valkenberg or other institutions, we make sure that they take their medication on time. They come for monthly visits.'
Sister Najwa Khan simply does not have the time to look for outpatients who fail to turn up.
Derek: 'You've got over a thousand patients here now. Do you know how many of them aren't turning up on time for their medication?'
Sister Khan: 'I would estimate about 50% of the patients.'
Derek: 'So some of these patients are falling through the cracks?'
Sister Khan: 'Well actually, they'll come for a couple of months, stay away for a month, then come back. It's extremely difficult.'
Off camera a group of mental health nurses told us that they are never able to do follow ups; hospital cars are seldom available for house visits, anti-psychotic medication runs out, and the sisters are burning out and resigning.
Their boss, Judy Hare, a former mental health sister, takes a hard line.
Judy Hare (deputy director of Metro District Health Services): 'If I just kind of reflect back in terms of my experience, I made time as a mental health nurse to go and visit my patients. You have to manage your time efficiently and effectively, and that is do-able.'
No mental health sister had the time to do a home visit and reach out to Michael Wallace, a 48-year-old man with a long history of schizophrenia. This is him [in photograph or clipping] when he was relatively well, completing a correspondence art degree.
Michael lived here amongst other mentally ill patients in unsupervised boarding houses in Maitland, Cape Town. He has had several hospital admissions and at times even asked Dr Baumann to be admitted.
Dr. Baumann: 'This man sought help. He said, 'I'm not well, please admit me; I'm not coping.' He was admitted, he was discharged relatively well to the boarding house and then things obviously, clearly, began to break down. He did not keep his appointments.'
Everybody saw Michael disintegrating, including David Pienaar who runs a club for the mentally ill. David too suffers schizophrenia. He appeared on Carte Blanche recently.
David Pienaar: 'He completely deteriorated. He dressed in rags.'
And David knows what happens when a person with schizophrenia does not take his medication.
David: 'Every day I take drugs, that is medication three times a day, and that works for me. It's the only thing that keeps me on track.'
Living in the same complex as Michael were Mark and Pam Bennet, along with their son, a five-year-old boy, Jean. They were afraid of Michael.
Mark Bennet: 'The Thursday we tried to get him into the car. This one day he's Michael Jackson, the next day he's Jesus Christ, the next day he's God. He's got all of this...and he wraps his head up in turbans and all this.'
Two days later -on the 31st July this year - Jean went missing. While looking for him, Mark bumped into Michael.
Mark: 'And he gave me this super serious smirk and something said to me, 'Something's not right.''
Fearing the worst, Mark rushed into the cottage where Michael stayed and broke into his room.
Mark: 'And I looked down and I saw my son's little arm sticking out because he'd pulled the mattress over him and a board over his head, and all that was sticking out was his little hand.'
Young Jean had been stabbed five times. Michael was arrested. Jean was cremated after a simple ceremony a few days later.
Dr Kaliski is not surprised by these killings.
Derek: 'Do you think that if there are more instances like those that we've had over the last few weeks, do you think the authorities will sit up and take notice?'
Dr. Kaliski: 'No. In 1998 when they were trying to close down Valkenberg Hospital I did an interview with the Mail & Guardian in which I said that already at that stage we had counted at least seven to ten state patients who had to be sent out to the community because there were no beds available who actually murdered for a second time while on leave. And the Mail & Guardian printed this as a front-page story. It caused enormous turmoil. All that really happened was that I got phoned by the head of the National Department of Mental Health and Substance Abuse and he berated me for stigmatizing psychiatric patients and for setting the cause of psychiatry back by ten years.'
But care for the mentally ill in the community seems to be failing. It failed Michael, it's failing Lillian and her son and, -as yet unconfirmed - it seemed to fail Kannellie. After her release from Sterkfontein earlier this year, she was referred to a day hospital for monitoring and medication.
Grant: 'My understanding is that she left the institution, was able to get her first injection, had difficulty getting her second injection - possibly because of a stock problem - and then, my understanding is that she didn't have medication from then on. That's of grave concern to me.'
Some good news for battling parents of disruptive mentally ill outpatients - a new Mental Health Act is on the way and it stipulates that certain outpatients must take their medication.
A new system will be in place to ensure that patients who don' take their medication can be immediately taken back to hospital.
Perhaps if the act was in place now, Maureen Naughtin may be alive today.
Grant: 'I don't want my mom's death to be in vain. I would like to think that something positive can come out of this. I know that she herself would have liked for something positive to come out of this, and that it isn't simply going to be brushed under the carpet and left alone and have the possibility of someone else being attacked in the same manner.'
IMPORTANT DISCLAIMER:While every attempt has been made to ensure this transcript or summary is accurate, Carte Blanche or its agents cannot be held liable for any claims arising out of inaccuracies caused by human error or electronic fault. This transcript was typed from a transcription recording unit and not from an original script, so due to the possibility of mishearing and the difficulty, in some cases, of identifying individual speakers, errors cannot be ruled out.
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