Short­age of beds at men­tal hos­pi­tals

There might be one for Shrien De­wani

Weekend Argus (Saturday Edition) - - NEWS - SIBONGAKONKE MAMA

AL­THOUGH hon­ey­moon mur­der ac­cused Shrien De­wani is likely to tie up his re­turn to Cape Town for trial in lengthy ap­peals, the provin­cial health depart­ment says Valken­berg Hos­pi­tal will be “more than pre­pared” to ac­com­mo­date him should he be sent here.

Spokes­woman Faiza Steyn was re­spond­ing to ques­tions af­ter the Cape Men­tal Health So­ci­ety said bed short­ages were a prob­lem not only at Valken­berg, but also at “ev­ery men­tal health fa­cil­ity” through­out the coun­try.

De­wani had been di­ag­nosed in the UK with post- trau­matic stress dis­or­der and de­pres­sion

The so­ci­ety’s com­ments fol­lowed news from ear­lier this month when the Cape Town Mag­is­trate’s Court heard that a man ac­cused of stran­gling his girl­friend to death had not yet un­der­gone men­tal eval­u­a­tion be­cause he was wait­ing for a bed to be­come avail­able be­fore the process could be­gin.

Steyn said it was, how­ever, “sim­plis­tic” to say that there were not enough beds in the prov­ince’s men­tal health fa­cil­i­ties for peo­ple who needed treat­ment. Given Valken­berg Hos­pi­tal’s con­text and re­sources, she said, treat­ment lev­els there fared “rea­son­ably well” when com­pared to those of in­ter­na­tional in­sti­tu­tions.

On the pro­posed De­wani ex­tra­di­tion, Steyn added: “We are proud of the ser­vice we pro­vide, and feel more than pre­pared to ad­dress most sit­u­a­tions.”

She ex­plained that the hospi- tal was di­vided into an acute and foren­sic sec­tion, which com­pleted the ob­ser­va­tions re­ferred from the courts. “Once pa­tients are clas­si­fied as state pa­tients, we pro­vide care and ser­vices. The acute sec­tion is di­vided into an adult acute ad­mis­sions unit and an adult in-pa­tient ther­a­peu­tic unit. The acute ad­mis­sion unit treats adult pa­tients (aged 18-59) with se­ri­ous men­tal ill­nesses.

“This group of pa­tients with se­ri­ous men­tal ill­ness con­sti­tutes mainly pa­tients with schizophre­nia and bipo­lar dis­or­der, but also other con­di­tions such as se­vere de­pres­sive dis­or­ders, anx­i­ety dis­or­der and neu­ropsy­chi­atric dis­or­ders such as de­men­tia,” Steyn said.

Beds at Valken­berg Hos­pi­tal had been “re­con­fig­ured” since 2011 to ac­com­mo­date more acute pa­tients.

“The cur­rent num­ber of acute beds to­tals 215, and there are 125 beds in the foren­sic ser­vice. The to­tal num­ber of beds for Valken­berg will in­crease to 432 beds, with the gain pri­mar­ily in foren­sics,” she said.

Th­ese would be added in terms of the Hos­pi­tal Re­vi­tal­i­sa­tion Pro­ject, for which there were not yet any firm dates.

Mean­while, Cape Men­tal Health So­ci­ety di­rec­tor In­grid Daniels has la­belled lim­i­ta­tions in the pub­lic health-care sys­tem a vi­o­la­tion of hu­man rights.

Re­fer­ring to the case of one 31-year-old schiz­o­phrenic man, who was ad­mit­ted to a gen­eral hos­pi­tal five times be­fore re­ceiv­ing at­ten­tion at a spe­cial­ist hos­pi­tal, she said he was among the 75 per­cent of South Africans with men­tal dis­abil­i­ties with­out ac­cess to men­tal health ser­vices.

“Dur­ing one of th­ese ad­mis­sions, he was given a chair to sleep on. An­other time he waited a week be­fore be­ing ad­mit­ted, sim­ply be­cause there weren’t beds avail­able,” Daniels said.

She said the con­se­quences of bed short­ages meant peo­ple of­ten went un­treated, plac­ing an enor­mous bur­den on fam­i­lies and com­mu­ni­ties who were ex­pected to care for peo­ple in need of hos­pi­tal­i­sa­tion.

The bed short­ages, Daniels charged, cre­ated a “re­volv­ing door” in psy­chi­atric care.

“Be­cause of pres­sure on beds in dis­trict hos­pi­tals and psy­chi­atric hos­pi­tals, some pa­tients are dis­charged be­fore they are com­pletely well. They re­turn home where there is ex­tremely limited com­mu­nity psy­chi­atric ser­vices and sup­port. As a re­sult, they end up be­ing read­mit­ted to hos­pi­tal again,” she said.

Drug abuse and lack­ing of fund­ing for men­tal health ser­vices were partly to blame for the chal­lenges.

“About 4 per­cent of the to­tal health bud­get goes to­wards men­tal health. This is sim­ply not ad­e­quate when men­tal ill­ness ac­counts for the third-high­est bur­den of dis­ease in South Africa. Tik and other drugs can cause drug- in­duced psy­chosis. HIV/ Aids can cause de­pres­sion and even de­men­tia, in some cases,” Daniels said.

Steyn agreed that sub­stance abuse put pres­sure on hos­pi­tals, but said it would be “sim­plis­tic” to say that there were not enough beds.

With ad­di­tional beds, which are be­ing planned, there would be in­creased ca­pac­ity for as­sess­ments (45 beds), while the max­i­mum se­cure unit (for pa­tients in need of con­tain­ment, and those sent by a court) in­creased from 35 to 50 beds.

For medium se­cure (for pa­tients al­lowed out for a cer­tain pe­riod), low se­cure (for pa­tients al­lowed freedom of move­ment) and long stay (for pa­tients in need of longer re­ha­bil­i­ta­tion), there would be a to­tal 110 beds.

“What we ex­pe­ri­ence is a per­ceived lack of beds with a small per­cent­age of peo­ple with very se­ri­ous men­tal ill­nesses, who are read­mit­ted to hos­pi­tal due to the lack of suf­fi­cient com­mu­ni­ty­based, al­ter­na­tive, su­per­vised res­i­den­tial place­ments,” Steyn ex­plained.

But Daniels said she would like to see an ur­gent au­dit of the avail­abil­ity of men­tal health beds coun­try­wide, with the aim of pro­vid­ing more.

“We also need in­creased com­mu­nity psy­cho- so­cial men­tal health ser­vices to as­sist and sup­port peo­ple liv­ing with men­tal dis­abil­ity on their jour­ney to re­cov­ery. There is suf­fi­cient ev­i­dence to high­light that peo­ple liv­ing with men­tal ill­ness who re­ceive such ser­vices have fewer re­lapses and sig­nif­i­cantly re­duced ad­mis­sions,” she said.

PIC­TURE: THOMAS HOLDER

WEL­COME: Valken­berg Hos­pi­tal says it is well-pre­pared to ac­com­mo­date hon­ey­moon mur­der ac­cused Shrien De­wani. \

PA­TIENT: Shrien De­wani is said to have post-trau­matic dis­or­der.

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