MHM Magazine

Issue 61 | 2022 | MENTAL HEALTH MATTERS | 19 MHM such as mentally ill patients. “Poor treatment, abuse and neglect of patients result, not only in a denial of their rights to access health, but also violate their right to be treated with dignity.” Mental health remains unintegrated and misunderstood across the health care sector. For many South Africans, including healthcare professionals, ‘all’ mental health patients look like aggressive Schizophrenics. The nuances, subtleties and everyday suffering from illnesses like depression, anxiety and PTSD often go untreated as a mental health problem or are labelled as ‘stress’. Community education, support, and training across all sectors is crucial. MENTAL HEALTH VS MENTAL ILLNESS A place to start is an understanding of what mental health is. “According to WHO, mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community" says Prof Yusuf Moosa. Mental illness results when health condition alters this state of wellbeing. Currently, there is an inherent constraint within communities for preventative mental health care. However, through good psychoeducation, the public can learn how to positively impact their own mental wellness, and identify the risk factors and enhance the protective factors within their family and community settings. COMMUNITY PSYCHIATRIC CARE Many mental health systems as well as our thinking about mental health care need reform. In South Africa, policy has reformed but that reform needs to be implemented. Interestingly, females tend to access clinics, whereas males tend to more frequently access hospitals. “There must be a de-centralising of mental health services from traditional hospital-based (institutional) care into community-based and the integrating of mental health services into primary care,” says Prof Moosa. This is a particular challenge for poor and vulnerable communities which lack even basic services. The goals of community psychiatric care “The ultimate goal of community psychiatric care, which we don’t have in South Africa, is to improve quality of life and functioning,” says Prof Lesley Robertson. In South Africa, psychiatric nurses conduct the first interview and evaluation of patients. The Brief Psychiatric Rating Scale (BPRS) is a tool designed to be used in a clinical setting to measure psychiatric symptoms. Nurses tend to rate depression more severely than doctors – which instinctively seems more accurate. “It is not about whether the symptom is there or not there,” says Prof Robertson. “Rather how frequent the symptom is, how much distress it causes.” The manual for its use may be downloaded at https://www.researchgate . net/publication/284654397_ Brief_Psychiatric_Rating_Scale_ Expanded_version_40_Scales_ anchor_points_and_administration_ manual THE NUMBERS A SASOP survey done in October 2020 revealed that there are with 783 active psychiatrists (all members of SASOP). Of these, 39% are over age 50. Only 26% of these psychiatrists work in the public sector compared with 74% in the private sector. “The overall ratio of psychiatrists is 1,07 per 100 000 but in the public sector, there’s an average of 0.33 psychiatrists per 100 000 people in SA,” says Prof Rita Thom. In Mpumalanga, there are no psychiatrists. PHC Sector Beds per 100 000 Population Generalised Hospital 2.8 Specialised Hospital 18.0 Community-Based Residential 3.6 TOTAL 24.4 Private Sector Beds per Province Beds Insured population Limpopo 0 936 408 North-West 0 657 411 Mpumalanga 58 748 866 Eastern Cape 111 1 077 440 Kwa-Zulu Natal 230 1 835 070 Gauteng 981 2 478 102 Free State 210 468 624 Western Cape 531 1 120 919 Northern Cape 104 206 846 TOTAL 2 225 9 539 576 THE REVOLVING DOOR According to research conducted by Drs Docrat and Besada, as well as a SASOP survey in October 2020 led by Prof Rita Thom, South Africa’s shortage of mental health professionals and resources is exacerbated by the uneven distribution between the public and private sector. Our hospital stays and re- admission rates are far higher than they should be. “We have a readmission of approximately 25% within 3 months,” says Dr Sumaiyah Docrat. “This accounts for about 18% of mental health expenditure.” Prof Rita Thom’s survey found that readmission rates are too high in both the public and private sector. This clearly shows that community- based mental wellness is lacking. South African mental health care users spend an average 100 days in hospital. “There is no community care and nowhere to be discharged to.” Improved personal functioning Improved quality of life Prevention of relapse/ recurrent episodes