Bridging boundaries and bisecting binaries: New openings for drug rehab and drug-related mental disorder at the Sultan Bahu Drug Rehab Centre
Tariq Toffa, Cape Town Community Manager
In South Africa, many factors including disease, poverty, abuse, violence, and changing social structures contribute to the high occurrence of mental health issues (over 16.5 percent of adults). Another contributing factor is substance abuse, as South Africa is one of the top ten narcotics and alcohol abusers in the world (15 percent of the population has a drug problem). In many ways a legacy of apartheid's disenfranchisement and dislocation, substance abuse in the Western Cape is higher than any other South African province, particularly in Cape Town's non-white urban hinterlands known as the Cape Flats; and has been linked to cognitive deficits, mental health problems, aggression, depression, anxiety, sexual risk behavior, crime and violence.
Within such harsh conditions, one notable project on the Cape Flats is the Sultan Bahu Drug Rehab Centre in Mitchell's Plain, which has achieved the highest drug addiction recovery rate (87 percent) and retention rate (83 percent) in the entire province (its three drug rehab centres in the Western Cape also form some of the only internationally accredited facilities of their kind on the continent). This is all the more remarkable given that most rehab centers have a success rate of less than 3 percent.
The success of the facility, in part, lies in attending to both the complex needs of the individual (based on 'cognitive behavioral' therapy constructs) as well as to the affected families at all stages of the rehab process, and in appropriateness to context, culture, and religion. Thus, within a generally poor community, the services are made physically and financially accessible; and both the two primary religious affiliations of Mitchell's Plain (Christian and Muslim) are accommodated, by providing for an imam and a priest to serve the interests of both Christian and Muslim patients — a pluralism that startled parliamentarians in a recent visit to the facility. Practitioners at the Centre are also enrolled for post-graduate studies in addictions care — a first in South Africa.
The Rehab Centre is a social outreach project of the Sultan Bahu Centre (SBC), a faith-based NPO which provides a wide range of social projects throughout the country, and its achievements have not gone unnoticed by Provincial Government. To improve service delivery to the poor, the government has increasingly recognized the need for partnerships with other stakeholders, such as faith-based organisations (FBOs) or NGOs. Thus, the Department of Social Development in the Western Cape recently announced that the Rehab Centre would be awarded the first pilot outpatient opiate replacement program in the country, which allows patients "a fine line of functioning" not based on intoxication and withdrawal. With this the SBC will form one of the beneficiaries of the R87 million (US$ 8.7 million) pledged to fight the province's drug scourge. Moreover, National Government has requested that it provide rehab programs throughout the country.
While in some respects the SBC example may be a hard one to emulate (its open door policy, free treatment to the unemployed, etc.); yet in providing a complex synthesis of services appropriate and sensitized to multiple contexts (physical, psychological, social, economic, religious), the SBC appears to be charting a new and multifaceted model for social service provision in a 'new' democratic South Africa. As an FBO that now extends the most current modern rehab treatment in South Africa, it also positions a middle path to the taboo issue of mental disorder in South Africa, often viewed solely as a spiritual problem to be solved by traditional healers or church alone. In bisecting such modern-traditional binaries, and in bridging governmental and non-governmental resources, new openings for treatment of drug abuse and related mental disorder in the Western Cape are emerging.