Men­tal health­care in spot­light

Com­mu­nity psy­chi­a­trist says more needs to be done to en­sure men­tally ill pa­tients are not left be­hind and are given the care they need

The New Age (Northern Cape) - - NEWS - LER­ATO DIALE ler­a­tod@the­newage.co.za

CHAL­LENGES af­fect­ing the de­liv­ery of men­tal health­care in the coun­try yes­ter­day came un­der the fo­cus at the na­tional hear­ing on the sta­tus of men­tal health­care in South Africa.

The two-day hear­ing comes as the Life Esidi­meni Ar­bi­tra­tion hear­ings are presently un­der way in Park Town, Jo­han­nes­burg.

This fol­low­ing the deaths of more than 100 men­tally ill pa­tients un­der the watch of the Gaut­eng de­part­ment of health.

The pa­tients died af­ter they were moved from Life Esidi­meni fa­cil­i­ties into il­le­gal and ill equipped NGOs across the prov­ince.

This af­ter the de­part­ment ter­mi­nated its long run­ning con­tract with Esidi­meni cit­ing de-in­sti­tu­tion­al­i­sa­tion and cost cut­ting.

Dr Les­ley Robert­son a com­mu­nity psy­chi­a­trist tes­ti­fied at the hear­ing that de-in­sti­tu­tion­al­i­sa­tion was not a new pol­icy and that pa­tients have been de­in­sti­tu­tion­alised for years.

Robert­son said what the coun­try wit­nessed with the Esidi­meni tragedy was the ter­mi­na­tion of a con­tract and not the be­gin­ning of de-in­sti­tu­tion­al­is­ing.

She said there is a mis­con­cep­tion that com­mu­nity based care is cheaper than in­sti­tu­tion­alised care.

Robert­son said there’s been no devel­op­ment of com­mu­nity based metal health­care par­al­lel to de-in­sti­tu­tion­al­i­sa­tion.

She said for ex­am­ple there is one psy­chi­a­trist for ev­ery 8000 peo­ple in Ekurhu­leni.

Robert­son said there is con­fu­sion with re­gards to the Men­tal Health Act.

She said while the Men­tal Health Act pro­motes com­mu­nity based care, in re­al­ity it’s dif­fer­ent.

“We have a mis­match where we have pa­tients sit­ting in com­mu­ni­ties and we have our spe­cial­ists sit­ting in spe­cialised hos­pi­tals that are re­mote and dif­fi­cult to ac­cess, if the pa­tient doesn’t fit the hos­pi­tal re­quire­ment then they don’t get care,” she said.

She said the ac­cess to care suit­able to the pa­tient sim­ply isn’t there.

To make mat­ters worse, Robert­son said the lack of men­tal health pro­gramme guide­lines like those for TB, HIV and other ill­nesses is prob­lem­atic.

“There is noth­ing in de­tail to tell us what to do with men­tal health pa­tients.

The lack of na­tional pro­gramme guide­lines in­hibits the im­ple­men­ta­tion of the pol­icy and the de­liv­ery of men­tal health­care in the coun­try,” she said.

She said the fact that psy­chi­atric nurses can­not pre­scribe medicines also neg­a­tively im­pacts on the pro­vi­sion of men­tal health­care.

She said in­fra­struc­ture is also a prob­lem.

“Con­sul­ta­tion rooms are not big enough and cor­ri­dors are not con­fi­den­tial enough,” she said.

Robert­son said there is a ten­dency to ad­dress men­tal health when it dis­rupts or pre­sents in an un­ac­cept­able be­hav­iour and that more needs to be done to en­sure that men­tally ill pa­tients are not left be­hind and are given the care they need.

The South African So­ci­ety of Psy­chi­a­trists’ Prof Janse van Rens­burg also tes­ti­fied about the short­age of psy­chi­a­trists and spe­cial­ists, say­ing the coun­try is not train­ing nearly enough of what is re­quired.

He said for the so­lu­tion the state might need to look at the aca­demic part of it.

He also spoke about the freez­ing and fil­ing of posts and how it im­pacts men­tal health­care.

Van Rens­burg said mul­ti­ple ar­eas need to be strength­ened to im­prove the de­liv­ery of men­tal health­care ser­vices in­clud­ing in­creas­ing re­sources for men­tal health­care.

Un­der the ac­cess to ru­ral men­tal health cam­paign, chair­per­son of the RuRESA Shan­non Mor­gan said there was lit­tle or no ac­cess to men­tal health­care for those in ru­ral ar­eas where peo­ple are of­ten forced to travel long dis­tances to ac­cess care.

Mor­gan also called for the in­clu­sion of men­tal health users in chang­ing the sit­u­a­tion.

PIC­TURE: ANN 7

TRAGEDY: Dr Les­ley Robert­son, a com­mu­nity psy­chi­a­trist tes­ti­fy­ing at the Life Esidi­meni ar­bi­tra­tion hear­ings said there’s been no devel­op­ment of com­mu­nity based metal health­care par­al­lel to de-in­sti­tu­tion­al­i­sa­tion.

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