Global lessons for deinstitutionalisation from the ill-fated transfer of mental health-care users in Gauteng, South Africa

South Africa witnessed a national tragedy between October, 2015, and June, 2016, when the Department of Health in Gauteng province moved 1711 mental health-care users with severe mental illness or severe and profound intellectual disability out of facilities managed by a private company, Life Esidimeni, mainly into the care of non-governmental organisations. The plan was called the Gauteng Mental Health Marathon Project. In a rushed and flawed process, 144 people died, and the whereabouts of another 44 remain unknown. The report of an extensive arbitration process, released in March, 2018, raises important ethical, moral, political, legal, governance, accountability, and clinical issues. The events from the tragedy and findings that were made also serve as lessons for future deinstitutionalisation globally.