On the eve of the landmark Life Esidimeni arbitration award this week, Health Minister Aaron Motsoaledi finally gazetted new regulations to keep nongovernmental organisations (NGOs) that look after mental health patients in check.Now there are policy guidelines for the licensing of residential and daycare facilities for mental health patients.The 208-page policy document has been the long-held cry of mental health rights groups. The previous gaps in legislation meant many mental health NGOs went unregulated, with no set standards for facilities to house these patients.The Esidimeni arbitration hearings exposed how former Gauteng health directorate head Makgoba Manamela forced her subordinates to license NGOs illegally. It was at many of these ill-equipped facilities that 144 of the province’s mental health patients died from starvation, dehydration and neglect.Chair of the arbitration hearings, retired deputy chief justice Dikgang Moseneke, awarded 135 claimants who lost loved ones or survived the tragedy R1.2m each, in compensation for government’s “unjustifiable and reckless” breach of six sections of the Constitution and multiple contraventions of the National Health Act.Cassey Chambers, operations director at the SA Depression and Anxiety Group (Sadag), was surprised the guidelines were gazetted. She said they and other organisations hadn’t received word of them.Civil society group Section27 said they only recently received them and were still studying them.Chambers said: “Ideally these guidelines should have been revised and updated before the patients were sent to the 27-plus unlicensed and ill-equipped NGOs.”Not only would the guidelines have helped the NGOs, they would have been a valuable resource for patients’ families, helping them measure what services should have been in place and what reporting processes to follow when laying complaints. “But I don’t know if it would have changed a heck of lot, since it was very apparent that the NGOs were not equipped to take on the type of Esidimeni patients who needed high-level care,” she said.Nicole Breen, information and awareness manager at the SA Federation for Mental Health (SAFMH), said the NGOs would have had to be licensed and forced to improve patient care if they wanted to receive their subsidies. Instead, they received licences illegally, without anyone inspecting them.Health ombud Professor Malegapuru Makgoba found that one of these irregularly licensed NGOs was Takalani Home in Soweto. It ran under the licence of another NGO, Mosego. At the arbitration hearings, it emerged that a 36-year-old patient was raped after her transfer there, and contracted HIV. There was a typhoid outbreak at the home because of a lack of hygiene. One of the first patients to die after being moved to Takalani, Deborah Phehla, had plastic and brown paper in her stomach.In March last year, Motsoaledi appointed an independent tribunal to process appeals against Makgoba’s findings.The tribunal’s chair, Judge Bernard Ngoepe, overturned the ombud’s rulings on Takalani and Mosego, and both are still operating today.Takalani’s new manager, who identified himself only as Judgment, said this week: “We weren’t part of the Life Esidimeni situation when it happened. We are new management, so it would be awkward and difficult for us to comment on previous management. We are busy with the licensing process with the department.”Gauteng acting mental health director Kobie Marais said the department held workshops with the management of provincial NGOs in July, and they undertook to comply with the proposed guidelines. The department began auditing the NGOs, a process that is still ongoing.Marais said the amendments to the regulations are intended to improve conditions in mental health NGOs. “These guidelines provide more detailed criteria that NGOs have to comply with to be licensed,” he said.More workshops would be held with NGOs and officials to prepare them for implementing the guidelines.Marais said the department would conduct unannounced visits to NGOs to ensure compliance.Both Sadag and the SAFMH welcomed the gazetting.Breen said they would regularise these residential centres and established criteria that had to be met for an NGO to be licensed. This would ensure better service for people with psychosocial and intellectual disabilities.“Non-registration will preclude the NGOs from receiving subsidies, which will significantly affect their operations.”However, Breen said there was little help for NGOs to ensure they made the grade.“Many NGOs simply do not have the resources to become compliant, or do not have knowledge of the registration process. Government should have included an illustration of what they will do to assist NGOs in becoming compliant.“It makes no sense to simply implement guidelines and regulations without a plan,” she said.