In Practice

Mortality analysis of people with severe mental illness transferred from long-stay hospital to alternative care in the Life Esidimeni tragedy

L J Robertson, M W Makgoba


A mortality analysis of the Life Esidimeni tragedy was precluded during the investigation by the Health Ombud by the lack of data integrity. Information on the mental healthcare users (MHCUs) transferred out of Life Esidimeni hospitals between October 2015 and June 2016 was subsequently collected by the Gauteng Department of Health, permitting statistical analysis. Survival rates were calculated according to gender and transfer destination and adjusted for patient age. Mortality was compared with that of the general population for the calendar year of 2016. Of the 1 442 MHCUs, 15% were transferred to specialised psychiatric hospitals and 85% to a rehabilitation centre or non-governmental residential facility. By the end of August 2017, 9% (n=131) of the cohort had died. Significant predictors of survival were younger age (p<0.0001) and transfer to a psychiatric institution (p=0.004). The age-adjusted death rate was 63/1 000 and the overall standardised mortality ratio (SMR) was 4.9 (95% confidence interval (CI) 3.92 - 5.80), with an SMR of 3.9 (95% CI 2.95 - 4.86) for men and 6.3 (95% CI 4.22 - 8.38) for women. The excess deaths are therefore quantified, and the high-risk environment of the rehabilitation centre and residential facilities confirmed. High mortality among MHCUs is unlikely to be confined to the Life Esidimeni tragedy; monitoring of preventable deaths in this vulnerable population is recommended.

Authors' affiliations

L J Robertson, Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

M W Makgoba, Health Ombud, Republic of South Africa

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Deinstitutionalisation; Health governance; Human rights in mental illness; Life Esidimeni; Mortality in mental illness; Public mental health; South Africa

Cite this article

South African Medical Journal 2018;108(10):813-817. DOI:10.7196/SAMJ.2018.v108i10.13269

Article History

Date submitted: 2018-10-02
Date published: 2018-10-02

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