20 May 2022
Members of Fountain House, a Psychosocial Rehabilitation Programme at Cape Mental Health, designed their own posters during a campaign in October 2021 about their experience of mental health in an unequal world. Source: Cape Mental Health/Facebook
“I went to SASSA nine times last month to renew my disability grant and only on the ninth time was it approved,” says 30-year-old Howard (name changed) who was diagnosed with Schizoaffective Disorder in 2018. He is among hundreds of people with disabling mental health illnesses like schizophrenia, bipolar disorder and depression who have complained about the difficulties applying for the grant.
There are currently just over a million people across the country who receive the grant, mostly for a six or 12-month period. The South African Social Security Agency (SASSA) provides a list of eligibility criteria which includes a medical assessment from one of only 360 state-approved doctors. Unlike a physical disability, assessing a person with a disabling mental illness can be tricky for overburdened practitioners and staff who sometimes have little understanding of why the full or reduced disability grant is critical to the applicant’s wellbeing.
Dr Sean Baumann, who was a psychiatrist for 25 years at Valkenberg Hospital, said the shortage of specialists in the public sector making these assessments is a problem. “There’s a lack of understanding of how enormously stressful these people’s lives can be. The problem with mental illness is that a lot of our colleagues tend to be working in an overcrowded community clinic, mostly seeing people with diabetes, HIV and TB,” he said.
“The disability grant is an intrinsic part of the package of care in a way. The struggles that come with economic hardship from a person’s inability to access the grant could cause a relapse or hospitalisation,” he explained. “So it really is intrinsic to their management and to ensure they can take their medication.”
For beneficiaries like Howard, having to repeat this process every six to 12 months is nerve-wracking. Howard currently lives at a residence owned by Cape Mental Health — a community-based mental health service organisation — in Observatory, Cape Town and relies on the grant to subsidise his stay there among other things.
Howard said he was formally diagnosed with Schizoaffective Disorder four years ago. He has been in and out of hospital. Symptoms of this illness include hallucinations or delusions, and depression or manic periods. He will have to take medication to manage his symptoms for the rest of his life.
Howard said he and his family only discovered that he could apply for the grant after he joined one of Cape Mental Health’s programmes. “I went to SASSA with my ID and clinic card. They gave me a date to visit a SASSA doctor at the Day Hospital in Mitchells Plain with my medical documents and an affidavit to confirm my living situation. I had never seen this doctor before and the line at the clinic was so long that I knew I would have to wait almost all day,” he said.
The first time he applied, his application was granted for a six-month period. After that he had his grant renewed annually but not without hiccups. “I don’t really understand why, because my mental health condition is a permanent one. It’s not like I’ll wake up tomorrow and no longer have schizoaffective disorder. I suppose if during the assessment you appear to be more confident and engage well then they may think you no longer need it as much.”
Though familiar with the process, Howard said it took him nine visits to reapply for his grant at the SASSA offices in Cape Town. “People sleep outside from the previous day, so if you’re not in the first 70 people, then you have to go come back and try the next day. My next grant will be paid in June but I’ll only be back paid for three months even though I have been trying to reapply for longer than that,” he said.
“My advice to new applicants is to have lots and lots of patience and try their best to have all the required documents in order when they apply,” he said.
Cape Mental Health asked its social workers about their own and the experiences of their clients when trying to access SASSA’s disability grant in April 2022.
Some of the most common complaints received included:
According to Cape Mental Health, during assessments, clients are often told that they can still go out and work because the medical officers assess them based on physical appearance or mental state at the time of the assessment.
The social workers said they also found it challenging to liaise and manage enquiries with SASSA. “At the moment, when social workers call the SASSA offices, the phone is not answered, and the queues for assistance in person are very long. The reviewing process of grants already in payment is also problematic with waiting periods of at least three months for the reinstatement of the grant.”
The most common reason why applications were rejected, the organisation said, is doctors’ inadequate understanding of these disorders. “SASSA doctors complete the forms that are submitted to the security officers. Clients only discover after some time that the doctor did not recommend the disability grant. This delays the [appeals] process. In the end clients give up or it takes years to access a grant,” said the social workers.
Obsoitshepo Seleka, spokesperson for Black Sash, pointed out other common complaints, that SASSA delays or cancels appointments with applicants; and the public contact numbers are very rarely answered. The language barrier between a doctor and an applicant can also contribute to grants being denied.
Black Sash has recommended that the assessing medical practitioners receive more in-depth training on intellectual and mental disabilities as well as how it impacts a person’s ability to function.
Another issue is the mounting backlog for applicants waiting for medical assessment before their grants can be approved and then paid.
“It seems that SASSA officials give preferential treatment to applicants with physical disabilities as the disability is visible,” she said.
SASSA spokesperson Omphemetse Molopyane explained that a mental disability must affect an applicant’s ability to work. “For this reason a different decision may be made for two applicants with a similar condition.”
He said SASSA currently uses 360 medical officers for assessments. He said that the medical assessment was critical to the applicant’s success. “The value of the medical referral form cannot be overestimated. The more detail provided, the easier it is for the assessing doctor to make an informed decision.”
When asked about the current backlog, he said up to June, there are just under 30,000 applicants awaiting medical assessments. From the time an applicant requests a medical booking, it should not take longer than 30 days, but this is unfortunately not always the case.
But there is promising news. Molopyane explained that amendments to the regulations of the Social Assistance Act, to be published soon, will allow other medical health professionals to assist with assessments. “This will include, for example, assessments by occupational therapists, who are often better placed to assess the impact of a disability on someone’s ability to function,” he said.