Following on from the Life Esidimeni incident – access to care for people living with severe mental disability, according to national policy

Following the release in February 2017 of the health ombudsman’s report on the deaths of psychiatric patients in Gauteng Province, South Africa (SA) (the Life Esidimeni incident), the South African Society of Psychiatrists (SASOP) has called for a complete overhaul of the mentalhealthcare system in terms of the principles of existing mental-health policy, in particular the National Mental Health Policy Framework and Strategic Plan 2013 - 2020 (NMHPF and SP). Overhauling the mental-healthcare system according to the NMHPF and SP will include the identification and costing of the required facility and staffing interventions that must be put into place to ensure capacity and integration on the different service levels, namely: residential and day-care community-based facilities and programmes, providing a range of care, treatment and rehabilitation services with a fulltime multidisciplinary team available; primary mental-healthcare services at district level; a specialist community-psychiatry service; acute psychiatric units in secondary, tertiary and central general hospitals; and specialised psychiatric beds

Clinical profile of acutely ill psychiatric patients admitted to a general hospital psychiatric unit

Objectives: Helen Joseph Hospital in southern Gauteng Province is one of five specialist hospitals on the academic circuit of the University of theWitwatersrand. Against a background of new mental health legislation, implemented in South Africa during December 2004 with no formal mechanisms in place to monitor mental health services on different levels of care or in regions, a study with three objectives was undertaken, namely: (I) to provide a baseline on psychiatric morbidity and treatment outcome; (II) to establish the state of affairs analysis for mental health care and (III) to establish a framework for cost centre management. The current study focuses on objective one. Method: A retrospective clinical audit was undertaken of mental health service delivery, teaching and research at Helen Joseph Hospital over a one-year period from September 2003 to August 2004. This article reports on the two service delivery datasets identified: the “Inpatient Discharge Summary Report” and the “Consultation/Liaison Report”. Results: A total number of 438 service users were admitted and a monthly average of 80 consultation/liaison assessments was conducted during the study period. Persistent unfavourable nursing staff ratios continued, while the number of service users from other African countries was generally underrated. Non-compliance and substance abuse contributed significantly to the admission of service users. Schizophrenia was indicated as the most likely diagnosis in almost a quarter of cases. Conclusion: Morbidity and treatment outcome at Helen Joseph Hospital will only be contextualized after the implementation of a regular clinical audit process in all the facilities of its referral network. Keywords: Psychiatric morbidity; Treatment outcome; Referral network; Clinical profile; Service delivery; Clinical audit African Journal of Psychiatry Vol. 10 (3) 2007: pp. 159-16

A framework for current public mental health care practice in South Africa

One of the main aims of the new Mental Health Care Act, Act No. 17 of 2002 (MHCA) is to promote the human rights of people with mental disabilities in South Africa. However, the upholding of these rights seems to be subject to the availability of resources. Chapter 2 of the MHCA clarifies the responsibility of the State to provide infrastructure and systems. Chapters 5, 6 and 7 of the Act define and regulate the different categories of mental health care users, clarify the procedures around these categories and spell out mental health practitioners' roles and responsibilities in this regard. Also according to the National Health Act No. 61 of 2003, the State remains the key role player in mental health care provision, being responsible for adequate mental health infrastructure and resource allocation. Due to “limited resources” practitioners however often work in environments where staff ratios may be fractional of what should be expected and in units of which the physical structure and security is totally inadequate. The interface between professional responsibility of clinical workers versus the inadequacy of clinical interventions resulting from infrastructure and staffing constraints needs to be defined. This paper considered recent legislation currently relevant to mental health care practice in order to delineate the legal, ethical and labour framework in which public sector mental health practitioners operate as state employees. These included the Mental Health Care Act, No.17 of 2002; the National Health Act, No. 61 of 2003 and the proposed Traditional Health Practitioners Act, No. 35 of 2004. Formal legal review of and advice on this legislation as it pertains to public sector mental health practitioners as state employees, is necessary and should form the basis of the principles and standards for care endorsed by organized mental health care practitioner groups such as the South African Society of Psychiatrists (SASOP).African Journal of Psychiatry Vol. 10 (4) 2007: pp. 205-20

Acute psychiatric in-patients tested for HIV status: a clinical profile

No Abstract.South African Psychiatry Review Vol. 10 (2) 2007: pp.83-8

Psychiatric consultations and the management of associated comorbid medical conditions in a regional referral hospital

Background. Psychiatrists are often called upon to evaluate patients with a medical condition and psychiatric symptoms, either as a complication thereof or initial presenting symptoms. There are often grey areas with regard to neuropsychiatric disorders in which psychiatrists and specialists from other clinical disciplines would need to co-manage or share ideas on the comprehensive treatment of a presenting patient. Objectives. This study was undertaken to provide a demographic and clinical profile of all patients consulted by the consultation-liaison psychiatry (CLP) service at the Helen Joseph Hospital (HJH) in Johannesburg, and to describe the clinical management of patients admitted with a diagnosis of a mental disorder associated with a comorbid medical condition, including delirium, dementia and a mood or psychotic disorder due to a general medical condition. Methods. A retrospective record review of all patients referred to the HJH CLP team over a 6-month period. Results. A total of 884 routine and emergency consultations were done for 662 patients (males n=305; females n=357) between the ages of 13 and 90 years who were referred from various other clinical departments. The most common documented reason for referral was a request for assessment (n=182; 27.5%), which consisted of mental state assessment, reconsultation and assessing capacity. A total of 63 patients (10.0% of cases consulted) were admitted to either the medical or psychiatric wards with a confirmed diagnosis of delirium, dementia and/or a mood or psychotic disorder due to a general medical condition (although admission wards were identified in 55 files only). The medical wards admitted the majority (n=37; 67.3%) mostly for delirium (n=28; 50.9%). HIV was identified as the most common systemic aetiological factor (n=23; 67.7%). Conclusion. In this study, a female patient between 31 and 45 years of age was slightly more likely to be referred to the HJH CLP service for assessment, and was more likely to be managed in the medical wards for delirium, which was most often associated with HIV/AIDS. The study highlighted the need for development of guidelines to facilitate adequate and effective use of this service for the local practice of CLP in a general specialist referral hospital like HJH, which would cover the following: clinical management; training needs; and administrative procedures

Tricarbon­yl(η6-flavone)chromium(0)

In the title compound, [Cr(C15H10O2)(CO)3], the Cr(CO)3 unit exhibits a three-legged piano-stool conformation. The chromium metal centre is coordinated by the phenyl ring of the flavone ligand [Cr—(phenyl centroid) distance = 1.709 (1) Å]. The ligand is approximately planar, the dihedral angles between the γ-pyrone ring and the phenyl ring and between the γ-pyrone and the phenyl­ene ring being 2.91 (5) and 3.90 (5)°, respectively. The mol­ecular packing shows π–π stacking between the flavone ligands of neighbouring mol­ecules

Collapsing lattice animals and lattice trees in two dimensions

We present high statistics simulations of weighted lattice bond animals and lattice trees on the square lattice, with fugacities for each non-bonded contact and for each bond between two neighbouring monomers. The simulations are performed using a newly developed sequential sampling method with resampling, very similar to the pruned-enriched Rosenbluth method (PERM) used for linear chain polymers. We determine with high precision the line of second order transitions from an extended to a collapsed phase in the resulting 2-dimensional phase diagram. This line includes critical bond percolation as a multicritical point, and we verify that this point divides the line into two different universality classes. One of them corresponds to the collapse driven by contacts and includes the collapse of (weakly embeddable) trees, but the other is {\it not yet} bond driven and does not contain the Derrida-Herrmann model as special point. Instead it ends at a multicritical point $P^*$ where a transition line between two collapsed phases (one bond-driven and the other contact-driven) sparks off. The Derrida-Herrmann model is representative for the bond driven collapse, which then forms the fourth universality class on the transition line (collapsing trees, critical percolation, intermediate regime, and Derrida-Herrmann). We obtain very precise estimates for all critical exponents for collapsing trees. It is already harder to estimate the critical exponents for the intermediate regime. Finally, it is very difficult to obtain with our method good estimates of the critical parameters of the Derrida-Herrmann universality class. As regards the bond-driven to contact-driven transition in the collapsed phase, we have some evidence for its existence and rough location, but no precise estimates of critical exponents.Comment: 11 pages, 16 figures, 1 tabl

Polar decompositions of quaternion matrices in indefinite inner product spaces

Polar decompositions of quaternion matrices with respect to a given indefinite inner product are studied. Necessary and sufficient conditions for the existence of an $H$-polar decomposition are found. In the process an equivalent to Witt's theorem on extending $H$-isometries to $H$-unitary matrices is given for quaternion matrices

Punctured polygons and polyominoes on the square lattice

We use the finite lattice method to count the number of punctured staircase and self-avoiding polygons with up to three holes on the square lattice. New or radically extended series have been derived for both the perimeter and area generating functions. We show that the critical point is unchanged by a finite number of punctures, and that the critical exponent increases by a fixed amount for each puncture. The increase is 1.5 per puncture when enumerating by perimeter and 1.0 when enumerating by area. A refined estimate of the connective constant for polygons by area is given. A similar set of results is obtained for finitely punctured polyominoes. The exponent increase is proved to be 1.0 per puncture for polyominoes.Comment: 36 pages, 11 figure