The 15th Biannual National Congress of the South African Society of Psychiatrists, 10-14 August 2008, Fancourt, George, W Cape

Abstract

In the past few years, the sustainability of private practice in South Africa has been questioned, due to spiralling cost and a real reduction in the membership of medical schemes. An ever-increasing number of patients are opting out of medical schemes and now prefer to carry the risk of health expenditure themselves. This trend has implications for psychiatrists in private practice in the short, medium and long term.The realities of the past and current economic climates are discussed in relation to these realities.Government has committed itself again in December 2007, at the ANC Polokwane conference, to implementing a National Health Insurance System and to move much faster on the proposals than in the past. A set of amendment bills and regulations are currently before parliament for debate and promulgation. This legislation has profound implications for a sustainable private practice. Government has indicated that a sustainable and healthy private sector needs to be part of a health National Health System and needs to industry to adapt to the new challenges for the future. A critical review of these changes is presented and the impact on private practice.The National Health Reference List is currently under review, and SASOP P3 presented a detailed investigation to the Department of Health about the cost of running and managing a private psychiatric practice. The relevance of a NHRPL in the current economic and political climate is discussed and, due to these changes and challenges, alternative international and other models are discussed. SASOP CLINICAL GUIDELINES, PROTOCOLS AND ALGORITHMS: DEVELOPMENT OF TREATMENT GUIDELINES FOR BIPOLAR MOOD DISORDER AND MAJOR DEPRESSION Eugene Allers, Margaret Nair, Gerhard GroblerThe development of the SASOP clinical guidelines is presented. The specific guidelines on bipolar mood disorder and major depression are then discussed.Currently, the guidelines for major depression and bipolar mood disorder for 2008 are on the SASOP website for review and comment.The algorithms will be presented as they appear on the website, with a discussion on the differences between other international guidelines. THE REVOLVING DOOR PHENOMENON IN PSYCHIATRY: COMPARING LOW-FREQUENCY AND HIGH-FREQUENCY USERS OF PSYCHIATRIC INPATIENT SERVICES IN BACKGROUND:A major obstacle to establishing successful community-based treatment in South Africa has been that the reduction in number of inpatient beds did not coincide with the development of adequate community resources. This fact, in combination with our patients' poor socio-economic circumstances, has contributed to a substantial increase in the so-called 'revolving door' or high-frequency use phenomenon in state psychiatric facilities. In an attempt to address this problem, the APH in the Western Cape appointed three community treatment teams. Although these teams have faced many challenges, overall there has been a very positive response from service users, their families and other staff, leading us to conclude that this initiative seems to be ...