Submission for Reforming Unfair Systems in Psychiatry
The South African Society of Psychiatrists (SASOP) challenges the authoritarian and discriminatory nature of forensic investigations by medical schemes. Highlighting racial bias, stigma against psychiatry, and unethical treatment, SASOP advocates for an independent and transparent system. Join the call for fair practices in mental healthcare.
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CMS Section 59 Investigation: Submission by the South African Society of Psychiatrists Dr Mvuyiso Talatala CMS 29 August 2019
Introduction Dr Mvuyiso Talatala: Director PsychMg, Past President of SASOP, Past Chair of PsychMg Dr Sebolelo Seape: President Elect of SASOP, Chair of PsychMg Prof Bonginkosi Chiliza: President of SASOP Dr Eugene Allers: Past President of SASOP, Past Chair of PsychMg
South African Society of Psychiatrists SASOP PsychMg Pubsec SASOP about 700 members PsychMg 284 members
Objective for SASOP Submission The system of forensic investigations by medical schemes authoritarian, unfair and lacks transparency (and this is by design). The lack of transparency is the hallmark of discriminatory systems throughout the world.
Objective for SASOP Submission Colonisation, apartheid and Nazi Germany have similar designs Designed to lack transparency to achieve discrimination Authoritarian In these systems the police and the prosecutors, the judges and the executive were one resulting in unfair adjudication of cases Once the design is made it functions automatically without the need for the participants to rethink the system
Objective for SASOP Submission SASOP therefore submits that the system needs a total overhaul into an independent, transparent fair system.
SASOP Submits that the system is unfair for the following reasons Our data shows that there is a racial bias against Black and Indian Psychiatrists (racism within the design of the system). Psychiatry is targeted by the medical schemes when compared to other Specialist Disciplines (stigma against mental health care and people living with mental illness).
SASOP Submits that the system is unfair for the following reasons The process followed by the schemes when investigating is unethical (Stigma/and lack of care). There is bullying as medical schemes withhold payments if a psychiatrist raises objections about the investigation.
SASOP Submission should be taken into context It is based on SASOP s experience with these investigations by medical schemes. It is not an invitation to the medical schemes to investigate the White Psychiatrists or to investigate other disciplines so that they also suffer as psychiatry does.
SASOP Submission should be taken into context It is not a denial that fraud may occur in the mental health care space It is a call for the overhaul of the system.
SASOP submits that there is racial bias against Black and Indian Psychiatrists (Deliberate or by system design)
PsychMg/SASOP Member Demographics Black Coloured Indian White Total Eastern Cape 4 1 12 17 Free State 4 17 21 Gauteng 35 2 27 63 127 Kwazulu-Natal 8 3 24 4 39 Limpopo 3 3 6 Mpumalanga 2 1 3 North West 3 1 4 8 Northern Cape 2 2 4 Western Cape 3 2 13 41 59 Total 64 7 66 147 284
PsychMg/SASOP Member Demographics (Total:284) Total number of White Psychiatrists: 147 (52%) Total number of Black/Indian/Coloured Psychiatrists: 137 (48%)
PsychMg/SASOP Investigation Demographics Black 1 6 28 4 5 1 Coloured Indian White Total 1 16 57 26 7 1 12 120 Eastern Cape Free State Gauteng Kwazulu-Natal North West Northern Cape Western Cape Total 10 15 2 1 14 19 1 1 6 40 6 45 1 34
Demographic analysis of PsychMg/SASOP: Membership vs Forensic Investigations Black Coloured Indian White Total 64 6 66 147 284 # of Members per race category 45 1 40 34 120 # of Investigations per race category 23 1 25 25 74 # of Members Investigated (Actual bodies) 22.5% 2.1% 23.2% 51.8% % of Membership per race category 37.5% 0.8% 33.3% 28.3% % of investigations per race category 31.1% 1.4% 33.8% 33.8% % of Individual Members investigated (actual bodies) 35.9% 16.7% 37.9% 17.0% 26.1% % of Individual Members investigated per Race (i.e % of investigations within a race)
Black, Indian, Coloured Psychiatrists vs White Psychiatrists Total Percentage of Black, Indian, Coloured Investigations:72% Total Percentage of White Investigations: 38% Total Membership by race: Black, Indian, Coloured (48%): White (52%)
SASOP Submits that there stigma and discrimination of Psychiatry and Mental Health 120 psychiatrists have been investigated 20% of all psychiatrists (Private or State employed) 42% of PsychMg members
Distribution of Investigations per Discipline Black Coloured Indian Unknown White Total PsychMg 45 1 40 34 120 GMG 15 3 15 13 46 CPF 17 2 5 24 Surgicom 3 6 15 24 FCPSA 6 9 7 22 ENT 3 7 9 19 GP 1 12 13 Paeds 2 2 5 9 OMG 6 3 9 NASA 7 1 8 SAAA 1 1 4 6
Distribution of Investigations per Discipline ( Continue) Black Coloured Indian Unknown White Total RADMG 3 3 6 ADSA 5 5 SNSA 1 1 1 3 Urology 2 2 Derm 1 1 Ocularist 1 1 OT 1 1 Plastic 1 1 Optom 1 1 Total 95 4 97 2 122 320
Outcome of all PsychMg/SASOP Investigations In Summary: Outcome 28,33 % In 34 audit cases and 28,33% of total cases, anomalies were found and the doctors had to refund the medical schemes. 34 In 66 audit cases and 55% of total cases, no anomalies were found and the medical schemes accepted the feedback and explanations from the doctor. 55,00 % 66 In 13 cases and 10,83% of the total cases, the doctors referred their audits to lawyers and PsychMg did not receive feedback on the outcome. 10,83 % 13 5,83 % A number of doctors' audits have not been completed as yet and are still pending. 7 120 Total number of investigations
Humans behind the numbers For the actuaries who design these systems it is all about the numbers For SASOP, there are human beings behind the numbers the psychiatrist, the patient and the family The medical schemes are insensitive and reckless about the lives of mental health care users (MHCUs)
Further evidence of Stigma against Psychiatry Many schemes do not pay dietitians when they treat Mental Health Care Users (MHCUs). Many schemes stopped paying for physiotherapy when a Mental Health Care User is admitted in a Psychiatric ward even if the indication for Physiotherapy is due to another medical condition.
Further evidence of Stigma against Psychiatry Psychiatrists have extreme difficulty to get assistance from physicians for MHCUs admitted in psychiatric wards despite the well established evidence of co-occurrence of psychiatric conditions and other medical conditions
SASOP submits that the process followed by the medical schemes when investigating Psychiatrists is unethical (Stigma/and lack of care).
Unfair and Unethical Process The medical schemes/administrators make the rules regarding investigations. They determine who should be investigated. They carry out the investigation themselves. They employ their own methodology. They do not share the data to verify that a healthcare professional is an outlier. They then make a finding of who is guilty or not. They then impose the sanctions.
Unfair and unethical Process Calling of patients to verify services Demand of psychotherapy notes to be shared with the scheme despite objections from PsychMg/SASOP Termination of payments to the psychiatrist should he/she objects
Unfair and unethical Process:Non- representative samples The sample methodology is incorrect and unfair in so far as: The sampling is biased The sample size is too small It is not random It is unscientific to generalize and base recoveries on a biased, non-random sample.
Other Problems that exacerbate the situation Ambiguous and outdated coding Increasing utilisation of mental health services Vulnerability of mental health care to fraud
SASOP respectfully request that the following recommendations be implemented Review of psychiatric coding Establishment of an independent body to audit psychiatric private practice coding, services and utilisation/psychotherapy Re-organisation of mental health services to be value- based, less hospicentric and with outcome measurements determined and monitored by the practitioners
