A piece of paper displaying a dishwashing roster hangs on a cupboard in the kitchen of Graham House in Mowbray. The list is a standard method used to maintain order in most households and in this rambling home it is no different.

The house is one of the eight owned by the Comcare Trust. Comcare accommodates up to 70 patients all living with schizophrenia or other manageable psychiatric conditions. Residents pay a minimal fee of R 800 from their monthly grant of R1080 to live in the facilities.

Christina Brooks, the house supervisor at Graham House has been employed by the Comcare Trust for almost two years. For eight hours a day, Brooks ensures that the house is running smoothly

‘€œI see to it that they wake up early and participate in their various daily activities. We believe that they have to lead an active life style,’€ she said.

Brooks spends the day cooking meals for the 11 residents, making   sure they take their medication.

The eleven residents often go to the library, watch movies and volunteer their services at the Welcome Club at Valkenberg Hospital, which serves as a social, knowledge and skills sharing centre for people with psychiatric illnesses. Today all residents have gone to watch a movie except Alexander Smith (30) who is steadfastly working behind his computer. He is a graphic designer and an artist.

Smith was only 22 when he started experiencing hallucinations, but he was not convinced that he may have schizophrenia.

 ‘€œIn most cases, I thought people were out to get me. I had a great start to my career as a graphic designer but then things started going wrong. I started hearing voices and seeing things that were not there,’€ says Smith.

‘€œI thought I needed help and so my sister took to me to a doctor who diagnosed me with schizophrenia and put me on treatment. Although I felt I needed help I still did not take my treatment because I thought it made me feel worse. In certain instances I was convinced that someone was inside me,’€ he said.

Smith was in and out of the hospital for over a year. During one of his hospital stays he decided not to return home and asked to be put in one of the Comcare homes.

‘€œMy dad was also schizophrenic, but he sometimes skipped his medicine and that made him worse. My mom also didn’€™t encourage him to take his medicine. She said she did not believe taking medicine helped. On top of all of that my parents were too old to look after me and so I decided not to stay at home,’€ he said.

Shortly after being diagnosed, Smith got married in an attempt to convince himself that there was nothing wrong with him.

‘€œEven though we were told to wait for a few months because of a waiting list we insisted we wanted to get married as soon as possible. Our marriage lasted only three months. I went back to the doctor and he repeated that I had schizophrenia. He said I needed to take my treatment. This time I believed him.   After I told my wife about my schizophrenia diagnosis she left me,’€ he said.

As his illness progressed Smith’€™s social circle shrunk.  

‘€œMy friends pulled away from me. Most people saw my illness as something that I could control. They expected me to snap out of it and to start living positively. Some said I needed prayer for everything to be alright. They all thought I needed some intervention that would make me alright. But here in the house people are more understanding. I feel safe enough to tell them when I’€™m not feeling well. The people around me often tell me that I need to take my medicine and I’€™ll be alright,’€ said Smith.

Smith recalled his stay at Valkenberg hospital as chaotic and unsafe.

‘€œThis place keeps me sane but the hospital often kept me insane. Some of the wards at the hospital were completely unsafe. At times patients fought among themselves and no one would intervene. Sometimes the nurses themselves were violent towards patients. Nurses forcefully threw patients on the floor if they did not want to take the medicine. I also hit a nurse once because she was hitting another patient,’€ he claimed.

Smith claimed his medicine was forced down his throat in hospital, but in the house he has an understanding that he needs to take his medicine in order to be better.

‘€œIf I skip my medicine in the morning by the time the afternoon comes I do not feel well and sometimes the hallucinations would start,’€ he said.  

Michelle De Goede, director of the Comcare Trust, said society’€™s change of attitude and acceptance of people with mental illnesses had eased the integration of people with mental illnesses into communities.

For over 15 years, the Comcare Trust has provided homes for individuals with psychiatric conditions. But while there is a great need for the services, facilities are scarce.

‘€œWe receive over 120 applications a year but we can normally take about five. This attests to how great the need is for the service but there is a shortage of organisations that offer these services. The few organisations that are there also have long waiting lists,’€ said De Goede

De Goede said methamphetamine (‘€˜Tik’)-induced psychosis placed massive pressure on health facilities, including those that treat mental health illnesses.

 ‘€œIn the past, society assumed that people with psychiatric conditions were violent, but most of the violent conditions of psychosis are those that are Tik induced psychiatric disorders. Tik-induced psychosis patients are in and out of the hospital more often. The more times the person goes in and out of the hospital the more severe their psychosis gets and the longer each stay in the hospital becomes,’€ she said.

She said Tik-induced psychosis patients occupied much of the bed space in hospitals.

‘€œBut over time people realised that many people with psychiatric disorders can function in a general society without resorting to violence,’€ she said.

She said the Comcare service catered for people who desperately needed extra support after being discharged from the hospital.  

‘€œNot all people with psychiatric disorders will need our service. For some their illness is not that severe and they are able to live on their own after being discharged.   Some might stay with their families but there are some that need extra support. Their condition might be more severe and their families might not have the capacity to care for them,’€ she said.

Between 1998 and 2004, 164 people receiving chronic institutional care for psychiatric illnesses in the Western Cape were discharged.