Mental Health in Eden
25 July 2017
Juanita Nel suffered with the ‘blues’ during her years at college. She started hearing voices after the birth of her first baby, and it was dismissed as postnatal stress. She became delusional after her second child and only then received the help she desperately needed.
July is annually acknowledged as Mental Illness Awareness Month, now referred to as Psychosocial Disability Awareness Month. The Western Cape Government Health has identified mental health as one of its priority programmes and is working towards improving access to mental health services by integrating mental healthcare with general healthcare. The Eden District acknowledge that access to mental healthcare should start at a primary healthcare level and have therefore implemented projects to train generalist health providers to deliver mental health services.
According to the Diagnostic and Statistical Manual of Mental Disorders, a mental illness or a mental disorder is a major disturbance in an individual’s thinking, feelings and behaviour that causes distress and a reduced ability to function as expected. “Such a major disturbance reflects that the brain or parts of the brain is no longer working well or working in the wrong way,” explained Dr Lynnie Boon, the Head of Psychiatry at George Hospital.
The World Health Organization (WHO) defines mental health as a state of well-being in which an individual realises 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.
Mental Health in Eden
• Eden has the highest suicide rate in South Africa
• Eden has the highest rate of incidents of driving under the influence and the second highest rate of drug-related crimes in the Western Cape
• In South Africa, only 25% of people with any mental disorder receive treatment. This is due to people not seeking help, disorders not being adequately identified and limited available resources to deal with the need
• In the Western Cape, 1 in 3 people suffer from a common mental disorder during their lifetime. The most frequent disorders include anxiety, depression and substance abuse. These are also the top three mental disorders seen in the Eden District outpatient services
• Psychotic disorders like schizophrenia and bipolar disorder occur in 1% of the population. Psychosis is a set of symptoms that make it very hard or impossible for a person to know what is real, to think and communicate clearly and relate with others, and to feel normal emotions. Although psychosis is rare, it is a severe condition and the top reason for inpatient admissions
• Common mental disorders (depression and anxiety) frequently occur together with other chronic diseases. “Recent research showed that as many as 50% patients with diabetes, hypertension or HIV in Eden may have co-morbid depression.
The following mental health services are available for the Eden District
1. Community-based Mental Health Services: Screening for common mental disorders and offering referrals to Primary Healthcare (PHC) facilities.
2. Primary mental health services: The majority of mental disorders can be managed by Primary Healthcare providers.
a. Clinics and District Hospital Outpatient Departments: Screening, assessment, diagnosis, medication, counselling and psychotherapy.
b. District Hospitals: Inpatient admission for uncomplicated, but more severely ill disorders.
3. Specialist Mental Health Services:
a. Outreach and support: Specialists (mental health nurses, psychiatrists and psychologists) visit Clinics and District Hospitals on a regular basis to consult complex cases and support Primary Health Practitioners.
b. George Hospital Psychiatric Unit (GPU):
i. The 10-bed inpatient unit receives referrals from District Hospitals of patients who have been certified under the Mental Health Care Act of 2002 or have complex mental illness. It is an acute Admission Unit offering inpatient care for limited periods. Transfers can be accepted within a week from referral.
ii. Specialist outpatient clinics: consult and manage complex cases
c. Nelspoort Psychiatric Unit:
i. Nelspoort is situated 60 km outside Beaufort West. Ten beds are available for medium-term (3-6 months) care. Wailing list for admission is 4-12 weeks, and referrals are only accepted from other specialist services.
d. Tertiary Psychiatric Hospitals: Only about 20%- 30% of cases need to be managed specifically by Specialists or in Psychiatric Hospitals.
i. Valkenberg Hospital: Accepts referrals from GPU for adults requiring a longer period of inpatient care. Transfers are accepted within a week of referral.
ii. Stikland Hospital: Accepts referrals from GPU for elderly patients requiring a longer period of inpatient care. Wailing list for admission is long and transfers can often only be accepted within 3-4 weeks.
iii. Tygerberg Hospital: Accepts referrals from GPU for adolescents requiring a longer period of inpatient care. Wailing list for admission is long and transfers can often only be accepted within 3-4 weeks.
iv. Super-specialist programs E.g. for children, eating disorders or forensic problems have long waiting lists of 3-6 months, but provide telephonic support readily to general specialists to assist in managing patients during the waiting period.
How the community can gain access to these services:
• If there is a suspicion of a possible mental illness, the person, family or friend should report his or her concerns to a Primary Healthcare provider (nurse or general medical doctor) at their nearest clinic
• If a person behaves in a manner that could harm themselves or someone else and there is a suspicion that the behaviour may be caused by a mental illness, the family or friend of the person should report this to the Emergency Unit at their nearest hospital
• A person who experiences mental health problems due to alcohol or drug use/ abuse, should first seek assistance from a local social worker (available at the Department of Social Development or an organisation like SANCA/ South African National Council on Alcoholism and Drug Dependence). Should detoxification be required, the Social Worker will refer the individual to a local Clinic or hospital
• Specialists can see referrals from Primary Healthcare practitioners within hours or maximum 4 weeks, depending on the urgency of the matter. Telephonic Specialist support for Primary healthcare practitioners is available 24 hours daily
Juanita Nel, as with many other patients, had a difficult time explaining to her family how she felt. She was ultimately diagnosed with major depression. Through the support of her family, community and professional help, Jeanine, who is a mother of three beautiful daughters, is now able to enjoy life. Jeanine, a former health worker at Conville Clinic, does motivational speaking at the clinic with the hope to motivate others to seek help. “I am not ashamed to admit that I have a mental illness. Neither should anyone else,” she said.