Roe vs. Wade conundrum: Africa must increase commitment to sexual and reproductive health and rights

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Is the Seclusion Policy of Mental Health Care Users a Necessary Evil?

Background. Seclusion in the psychiatric context is the involuntary confinement of an agitated; unstable person alone in a contained; controlled environment. Differing views on seclusion presents clinicians with an ethical dilemma.Significant morbidity and mortality have been associated with seclusion. No data exist in South Africa on rates of seclusion for psychiatric purposes. Consequently neither the need for seclusion nor alternatives to seclusion have been explored. Objective. To determine the number of patients secluded over six months; provide a profile of patients that were secluded; and to ascertain the reasons for seclusion.Methods. A retrospective record review of patients secluded at Sterkfontein Hospital; over a six-month period.Results. A total of 112 patients were secluded over the six-month period. Users were secluded for a total of 59 415.5 hours and on 4 814 separate occasions. A total of 84.8% of the users secluded were male. The mean age of users secluded was 29 years. Just under half the users (49.1%) were secluded for their own safety and 40% of users were secluded for aggression (either physical or verbal). The most common diagnosis was schizophrenia (31.4%) followed by cognitive impairment (20.6%) and bipolar mood disorder (13.7%). The most commonly used medication was sodium valproate (17%); followed by haloperidol (11%) and risperidone (11%).Conclusion. Younger male patients with psychosis were most likely to be secluded. More research should be conducted locally to compare seclusion rates and patient profiles so that we may improve seclusion practices

The regulation of informed consent to participation in clinical research by mentally ill persons in South Africa: an overview

The article examines the legal requirements relating to the informed consent of mentally ill persons to participation in clinical research in South Africa. First; the juridical basis of informed consent in South African law is outlined; and second; the requirements for lawful consent developed in South African common law and case law are presented. Finally; the article deliberates upon the requirements for the participation of mentally ill persons in research as laid down by the Mental Health Care Act and its regulations; the National Health Act and its (draft) regulations; and the South African Constitution

Psychiatric In-Patients' Experience of Being Secluded in a Specific Hospital in Lesotho

This qualitative; explorative; descriptive and contextual study was undertaken to explore and describe the experiences of psychiatric in-patients who are secluded in a specific hospital in Lesotho. Evidence about the rationale and appropriate use of seclusion as well as promotion of mental health in secluded patients has been expressed and docu- mented in the literature. The mental health legislation of Lesotho does not specifically address seclusion of psychiatric in-patients. This research is crucial because it has not been conducted before and information pertaining to it is limited. Purposive sampling was used. Data were generated through eleven (11) individual semi-structured phenome- nological interviews. One central open question was posed to the participants. Patients were interviewed until saturation was reached. Field notes were taken. All interviews were audio taped and transcribed verbatim. Tesch's (in Creswell; 1994:142) method of open coding was used to analyse data. Results where described; pertaining to the categories identified. The main categories were: (1) the experience of being in a prison; (2) seclusion experienced as a punishment; which created an environment where human rights violations were experienced; (3) personnel factors leading to an experience of not being supported and cared for; and (4) emotional responses to the seclusion experience. A literature control followed the description of the results