The care, treatment, rehabilitation and legal outcomes of referrals to a tertiary psychiatric hospital according to the Mental Health Care Act No. 17 of 2002

BACKGROUND : The Mental Health Care Act No. 17 of 2002 (MHCA) was introduced to combat poor care received by mentally ill persons. OBJECTIVE : The objective of this study was to evaluate diagnostic and treatment accuracy as well as compliance with procedural matters related to the MHCA, using a sample in the northern region of Gauteng Province, South Africa. METHOD : Files of 200 patients admitted to Weskoppies Hospital between June and December 2009 were evaluated for admission procedures, and care, treatment and rehabilitation (CTR). RESULTS : From referring hospitals, 174 (87%) persons had appropriate signs and symptoms documented in the referral note or MHCA forms. All of these were appropriately diagnosed. Although about one-third of the patients’ treatment was not documented, more than 50% (n=163) received the correct treatment. In two-thirds of patients, correction of detected abnormalities was not documented. Approximately 50% of the admissions had documents that did not adhere to MHCA provisions. At Weskoppies Hospital, CTR was considered appropriate for 92% of the patients. The legal status of the majority of patients was involuntary at discharge point. The majority of persons stayed for <3 months but for longer than what medical aid schemes allow in the private sector. CONCLUSIONS : The study highlighted both improvements and gaps in CTR given to mentally ill persons in the northern Gauteng region, which might apply to the rest of the country. Medicolegal requirements stipulated by the MHCA are still a challenge a decade post enactment, but there may be a move in the right direction.http://www.sajp.org.za/index.php/sajphb201

The care, treatment, rehabilitation and legal outcomes of referrals to a tertiary psychiatric hospital according to the Mental Health Care Act No. 17 of 2002

Background. The Mental Health Care Act No. 17 of 2002 (MHCA) was introduced to combat poor care received by mentally ill persons.  Objective. The objective of this study was to evaluate diagnostic and treatment accuracy as well as compliance with procedural matters related to the MHCA, using a sample in the northern region of Gauteng Province, South Africa.  Method. Files of 200 patients admitted to Weskoppies Hospital between June and December 2009 were evaluated for admission procedures, and care, treatment and rehabilitation (CTR).  Results. From referring hospitals, 174 (87%) persons had appropriate signs and symptoms documented in the referral note or MHCA forms. All of these were appropriately diagnosed. Although about one-third of the patients’ treatment was not documented, more than 50% (n=163) received the correct treatment. In two-thirds of patients, correction of detected abnormalities was not documented. Approximately 50% of the admissions had documents that did not adhere to MHCA provisions. At Weskoppies Hospital, CTR was considered appropriate for 92% of the patients. The legal status of the majority of patients was involuntary at discharge point. The majority of persons stayed for <3 months but for longer than what medical aid schemes allow in the private sector.  Conclusions. The study highlighted both improvements and gaps in CTR given to mentally ill persons in the northern Gauteng region, which might apply to the rest of the country. Medicolegal requirements stipulated by the MHCA are still a challenge a decade post enactment, but there may be a move in the right direction

Dissociation - a preliminary contextual model

Background. The Diagnostic and Statistical Manual of Mental Disorders (DSM) system has certain limitations when applied to two South African examples of dissociation, because it is descriptive (non-explanatory) and focuses on intrapsychic (non-communal) processes. Even the existing Western explanatory models of dissociation fail to accommodate fully the communal aspects of dissociation in our South African context. Objectives and methods. The aim was to explore an expanded perspective on dissociation that does not limit it to an intrapsychic phenomenon, but that accounts for the interrelatedness of individuals within their social context. Auto-ethnography was used. In this article a collective, socially orientated, contextual hermeneutic was applied to two local examples of dissociation. Three existing Western models were expanded along multicontextual, collective lines, for them to be more useful in the pluralistic South African context. Results. This preliminary contextual model of dissociation includes a person’s interpersonal, socio-cultural, and spiritual contexts, in addition to the intrapsychic context. Dissociation is considered to be a normal information-processing tool that maintains balanced, coherent selves-in-society, i.e. individuals connected to each other. In the South African context dissociation appears mostly as a normal phenomenon and seldom as a sign of mental illness. Dissociation is pivotal for the normal construction of individual and communal identities in the face of conflicting sets of information from various contexts. Dissociation may help individuals or communities to survive in a world of conflicting messages, where conflict is often interpersonal/cultural/societal in nature, rather than primarily intrapsychic. Conclusions. This model should be developed and evaluated further. Such evaluation would require suitable new local terminology