Regional aspects of long-term public sector psychiatric care in the Eastern Cape

Abstract

ObjectivesThe objective of this research was to determine regional aspects (such as clinical, geographic and socio-demographic) influencing the use of public sector long-term psychiatric services in the Eastern Cape. This is important in improving service delivery, to assist policy developers with evidence-based research and in providing equitable and efficient resource utilisation.MethodologyA situational analysis of Tower Psychiatric Hospital and Psychosocial Rehabilitation Centre (TPHPRC) in the Eastern Cape was conducted. Patient administrative data were utilised to determine geographic origin, date and age at admission, gender and diagnosis as of December 2015. The number of admissions from each region for the years 2010–2015 was also extracted from these data.ResultsAs of December 2015, there were a total of 390 patients at TPHPRC. Of these, 87% were male patients. The average age at admission for male and female patients was 36 years and 44 years, respectively. Of the patients, 53% originated from the western regions and 57% of female patients presented with a dual diagnosis. The highest number of admissions was in 2015, with the majority originating from Port Elizabeth.ConclusionDespite higher access to public psychiatric care in the western region, the majority of patients originated from there. Contributing factors to this include diagnoses, insufficient bed numbers and the absence of admission criteria and referral pathways. It is recommended that the provincial Department of Health set up a task team to determine a standardised working framework for all public sector psychiatric institutions. This should be informed by national policies, legislation and provincial norms and indicators.

Schizophrenia and schizoaffective disorder: Length of stay and associated factors

“… 24 While deinstitutionalisation may reduce costs by reducing hospital stay, other costs, such as that of developing efficient community-based services, and consequences must be considered. 25 , 26 Failure to couple deinstitutionalisation with improved community care has been shown to lead to further problems, namely increased relapses and readmissions, incarcerations, homelessness, increased suicide and mortality rates. 25 , 27 In the South African context, attempts at deinstitutionalisation occurred but without adequate development of community psychiatric services and psychosocial rehabilitation facilities.…”

“… 25 , 26 Failure to couple deinstitutionalisation with improved community care has been shown to lead to further problems, namely increased relapses and readmissions, incarcerations, homelessness, increased suicide and mortality rates. 25 , 27 In the South African context, attempts at deinstitutionalisation occurred but without adequate development of community psychiatric services and psychosocial rehabilitation facilities. 28 , 29 This discrepancy was noted in the National Mental Health Policy Framework and Strategic Plan 2013–2020, and the Life Esidimeni tragedy of 2016 further demonstrated the consequences of a failed and poorly planned attempt at deinstitutionalisation.…”

The experiences and perceptions of mental health service provision at a primary health centre in the Eastern Cape

“…The provision of mental healthcare in sub-Saharan African countries remains sparse, whilst the impact of mental and substance use disorders continues to add to the burden of disease in African countries. 1 In the case of South Africa, and lower resourced provinces such as the Eastern Cape, the provision of mental health services are still limited by various factors such as socio-economics status, early detection of mental disorders and limited access to mental healthcare in low-resource communities. 2 Considering the persistent issues of financial and systemic limitation, exploring the nature and experience of mental health service provision in low-resource communities remain to an important indicator to assess the state of mental health service provision.…”

“…For example, in 2018 the state of psychiatric hospitals in the Eastern Cape, such as Tower Hospital in Fort Beaufort, concerningly had only one psychiatrist whilst it serves a large portion of the entire province of the Eastern Cape, with an estimated population of 6.9 million, having only 400 beds for 344 males and 56 females. 1 …”

“…For example, in 2018 the state of psychiatric hospitals in the Eastern Cape, such as Tower Hospital in Fort Beaufort, concerningly had only one psychiatrist whilst it serves a large portion of the entire province of the Eastern Cape, with an estimated population of 6.9 million, having only 400 beds for 344 males and 56 females. 1 Considering the precarious state of mental healthcare in South Africa and with the recent findings of the South African Human Rights Commission (SAHRC) 6 report, the commission found several shortcomings, namely a lack of policy implementation, underinvestment in mental health by government and access to mental health is still focussed at a tertiary level and not at primary care level, amongst others. 6 Considering the precarious state of mental healthcare in South Africa, it was deemed necessary to explore the experiences and perceptions of mental health service provision at a primary care level in the Eastern Cape.…”