Empilweni:
Who are we?

Who and what is Empilweni?

Empilweni is a community-based Mental Health Project situated in Khayelitsha, and provides essential care for its clients through a comprehensive range of programmes. The Empilweni Project was established in 1994 as a direct response to research undertaken by the University of Cape Town’s Department of Mental Health and Psychiatry. The initial study showed that of 1 000 children interviewed in Khayelitsha, about a quarter displayed signs of Post Traumatic Stress Disorder (PTSD). Follow-up research showed that of 504 youths sampled with a mean age of 14, 61% reported personal exposure to taxi violence, 8% that a family member had been wounded when travelling in a taxi, 6% that a family member had been killed while travelling in a taxi, 10% reported personal experience of attempted rape, 6% that they had been raped and 98% manifested the presence of distress symptoms consequent to exposure to violence. Each and every one of the 504 young people interviewed had experienced some form of violence.

These initial studies quickly showed the desperate need for child intervention and therapy in an informal settlement such as Khayelitsha. Established in the decades prior to 1994 in response to the former apartheid government’s attempts to control the movement of the black population, Khayelitsha lies about 32 kilometres from central Cape Town, and may be considered a de facto black suburb of the city. Many of its members were relocated from the Crossroads settlement, which had a history of political violence between militant anti-apartheid groups and more moderate organisations supported by the apartheid government. The violence and poverty permeating Crossroads were effectively transferred wholesale to the largely unplanned settlement of Khayelitsha, where it persists. Although census data is sparse and unreliable, Khayelitsha’s population is estimated to be in excess of
600 000 and is expected to double within 10 years. A substantial proportion of the population still resides in corrugated iron shacks, approximately 33% of which are without basic amenities such as running water, flushing toilets and electricity.

An estimated 38% of the Khayelitsha community are below the age of 15 years.
Two-thirds of the adult population are estimated to be unemployed and a large number of households are headed by single mothers. There is a high rate of violence, child abuse and poverty and children are often the most drastically impacted. Without adequate support and intervention, many abused and traumatised children develop scholastic and social problems. It is highly likely that many of these children are being lost to crime, alcohol and drug abuse. Many children are in advanced stages of depression and substance abuse and some have attempted suicide by throwing themselves in front of trains.

Caring for children who are most at-risk

The high levels of social and economic, cultural and spiritual deprivation which permeate the settlement impact most upon those least able to protect themselves. Consequently, a very high percentage of children are routinely exposed to the crime and violence which are endemic in the settlement, both at home and in the street, and it is this which lies behind the emotional disturbance and psychosocial disorder experienced by children and adolescents. In 2000 Zissis and Robertson conducted a study under the auspices of the University of Cape Town’s Department of Psychiatry and Mental Health, entitled “The Empilweni Project: The Effectiveness of this Community-Based Mental Health Project Situated in Khayelitsha, South Africa”. The study showed that in addition to a 14% prevalence rate of psychiatric disorder with impairment, 64% of children presented at least one psychosocial problem, 23% needed assistance with multiple psychosocial problems and 10% of families required urgent interventions for severe emotional disturbance.

It is generally acknowledged that early intervention with children and adolescents at risk is a prerequisite for mental health in adults. However, children and adolescents tend to be marginalised, and their distress is often not identified. In a marginalised environment such as Khayelitsha, Mental Health is not well understood, and very little exists in terms of intervention, specifically for children, through local clinics. Parents often do not have the time or the means to take their children to the nearest child facility centre, which is at The Child and Family Unit, at Red Cross Children’s Hospital in Claremont, Cape Town. Most parents simply do not have the money to pay for a minibus taxi or train fare to reach other services lying outside of Khayelitsha.

Empilweni is the only project in Khayelitsha
with specialised services for children

Services and facilities for mental health care for children are scarce in the extreme. Khayelitsha contains three day-hospitals (only one can accommodate patients overnight), a number of specialized community health clinics (such as maternity and child health), and two community psychiatric clinics which provide assessment, medication and hospitalisation as required. There are neither psychiatric hospitals nor any therapeutic services whatsoever aside from those offered by traditional healers and Empilweni in the Khayelitsha community. Even in greater Cape Town, most services are inaccessible to Xhosa-speaking children as few professionals are competent in this language, which is the predominant tongue of Khayelitsha. Moreover, there is a scarcity of translators and carrying out therapy through a translator can be awkward and counter-productive. The children who are hospitalised often find themselves in frightening situations where they only occasionally have contact with someone with whom they can communicate.

Empilweni is providing an essential ongoing service for children who would otherwise fall through the cracks of crisis intervention facilities and basic health care organisations. Empilweni offers longer-term intervention through its specialised counselling and group therapy programmes. In these ways Empilweni works closely with the local government’s Department of Social Services as well as with other NGOs including: Child Welfare, Child Line. Wola Nani, Nonceba Counselling Centre, Ilitha Labantu, Simamalene, RAPCAN. Various Primary and High Schools in the Khayelitsha area refer specific children identified as being at-risk to Empilweni. Clinical support for Empilweni is provided by two psychologists from the Child and Family Unit at Red Cross Children’s Hospital, and two psychiatrists at Lentegeur Hospital.

Back to top