COVID-19 infection at a psychiatric hospital in KwaZulu-Natal, South Africa: Clinical service planning and challenges

Background: South Africa had over 4 million cases of coronavirus disease 2019 (COVID-19) infections and more than 1 million COVID-19-related deaths. Despite the devastating psychological impact of the COVID-19 pandemic, there is little qualitative, critical evaluation of government mental health services in this resource-limited setting. Aim: The authors describe the clinical service plan and response to the COVID-19 pandemic at a government psychiatric hospital. Setting: KwaZulu-Natal, South Africa. Methods: A descriptive narrative overview of the specialised psychiatric hospital's clinical response (April 2020 ­ March 2021) to the COVID-19 pandemic was undertaken in the following domains: screening policy; testing and swabbing policy; staff training and monitoring; and restructuring the wards to accommodate mental health care users (MHCUs) with suspected cases of COVID-19. Results: The in-depth narrative reviews led to the introduction of staff training, routine COVID-19 reverse transcription polymerase chain reaction (RT-PCR) testing of all MHCUs, the creation of designated quarantine and isolation facilities and screening of physical health status of patients with COVID-19 prior to transfer being implemented to prevent an outbreak or increased morbidity or mortality. Conclusion: Implementing a service plan early which included staff training, screening and routine COVID-19 testing services for psychiatric admissions in a rapidly evolving environment with few additional resources was challenging. The absence of guidelines early in the pandemic that addressed the unique needs of a clinical psychiatric inpatient population is a noteworthy learning point. Contribution: The article highlights that the inpatient infrastructural requirements and clinical management protocols of acutely psychiatrically ill inpatients, in the context of infectious outbreaks, require dedicated task teams and bespoke policies.

A practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into primary health care in KwaZulu-Natal province

Background: Mental health care at primary health care (PHC) still remains a challenge despite the Policy on Integration of Mental Health Care into PHC which was developed in 1997 at the time when the White Paper for the Transformation of the Health System in South Africa was published. The White Paper made provision for a new health care system based on the principles of the PHC approach to care. This was followed by the promulgation of the Mental Health Care Act No. 17 of 2002 which is based on the principle that mental health care should be integrated into PHC; however, there have been challenges with regard to the implementation of this policy. Aim: This study aimed to analyse the implementation of Policy on Integration of Mental Health Care into PHC with the ultimate aim of developing a practice framework for PHC nurses to enhance such implementation in KwaZulu-Natal (KZN). Setting: The study took place in selected health districts in KZN, namely, Ugu, eThekwini, iLembe and uMgungundlovu. Methods: A qualitative approach using grounded theory design was used to develop a practice framework to enhance the implementation of Policy on Integration of Mental Health Care into PHC. A theoretical sampling method was used to select the sample from PHC managers, operational managers and professional nurses for the collection of data. The sample consisted of 42 participants. Data were collected by means of one-on-one interviews and focus group interviews. Strauss and Corbin's approach of data analysis was used for analysing data. The paradigm model was used as a guide to develop a practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into PHC in KZN. Results: This study found that integration of mental health care into PHC is understood as a provision of comprehensive care to mental health care users using either a supermarket approach or a one-stop-shop approach at PHC clinics. Strategies that are used at PHC clinics in KZN ensure that the integration of mental health care into PHC is implemented, includes the screening of all patients that come to the PHC clinic for mental illness, fast tracking of mental health care users once they have been assessed, and found to be mentally ill and management of all mental health care users as patients with chronic diseases. Conclusion: The practice framework developed identifies comprehensive mental health care being offered to mental health care users using either a supermarket approach or a one-stop-shop approach, depending on the availability of staff with a qualification in psychiatric nursing science

Mental health care - a public health priority in South Africa

Mental health is an integral part of health and it includes an individual's emotional, psychological and social well-being. Mental illness remains underreported and underdiagnosed, particularly in low- and middle-income countries, including South Africa. South Africa carries a huge burden of mental illnesses with the most prevalent being anxiety disorders, substance abuse disorders, mood disorders and depression. People with mental health conditions often face neglect in the health system as well as stigma and discrimination. This has resulted in poor health outcomes, isolation and high suicide rates, including amongst adolescents. The South African National Mental Health Policy Framework and Strategic Plan (2013­2020) aims to integrate mental health into the health system to provide quality mental health services that are accessible, equitable and comprehensive, particularly for community-based mental health. This article provides an overview of mental health care in South Africa, highlighting its public health importance

Prevalence and correlates of alcohol use disorders among bipolar patients at Amanuel Mental Specialized Hospital, Addis Ababa (Ethiopia): A cross-sectional institution based study

At this time, alcohol use is increasing in African countries. The prevalence of alcohol use disorders (AUDs) remains unknown in patients with psychiatric disorders. This study aimed to assess the prevalence of AUDs among individuals with bipolar disorder in the outpatient department at Amanuel Mental Specialized Hospital. An institution-based cross sectional study was conducted among 412 bipolar patients attending the outpatient department at Amanuel Mental Specialized Hospital from May ­ July 2015.Participants were selected using a systematic random sampling technique. Semi-structured questionnaires were used to collect socio-demographic and clinical data. Alcohol use disorder was measured using the Alcohol Use Disorders Identification Test (AUDIT-10). Binary logistic regression analysis was performed. The prevalence of alcohol use disorder was found to be 24.5%. Those affected were predominantly female (58.5%). Being18-29 years of age(AOR=3.86, 95% CI: 1.34, 11.29), being 30-44 years of age (AOR=4.99, 95%CI: 1.85, 13.46), being unable to read and write (AOR=5.58, 95%CI: 2.026, 13.650), having a secondary education (AOR=3.198, 95%CI: 1.149, 8.906), being a farmer (AOR=4.54, 95%CI: 1.67, 12.32), being employed by the government (AOR=3.53, 95%CI: 1.36, 4.15), being a day labourer (AOR=3.5, 95%CI: 1.14, 10.77), use of other substances during past 12 months (AOR=2.06, 95%CI: 1.06, 3.99), having a family history of alcohol use (AOR=2.18, 95%CI: 1.29, 3.68), having discontinued medication (AOR=2.78, 95%CI: 1.52, 5.07), having suicidal thoughts (AOR=4.56, 95%CI: 2.43, 8.54), and having attempted suicide (AOR=5.67, 95%CI: 3.27, 9.81) were statistically significant to alcohol use disorder using multivariate logistic analysis. The prevalence of co-morbid alcohol use disorder was high. This finding suggests that screening for risky alcohol use should be integrated into routine hospital outpatient care. Further, preventive measures against alcohol use disorder should be established

A four-year review of geriatric mental health services in a Lagos based hospital, Nigeria

Background: There is a growing global concern about the public health implications of the increasing population of the elderly. One main issue of concern is centered on how to address their mental health needs using home-grown interventions and services. We expect that important lessons on geriatric mental health issues would be brought to fore in this report.Methods: This is a four-year (2007-2011) retrospective report on the mental health services rendered to 938 clients aged 60 years and above at a Lagos based mental health treatment facility in Nigeria. Designed questionnaires were filled with socio-demographic and clinical data obtained from patients' case notes based on the objectives of the study.Results: The mean (standard deviation) age of elders was 69.6 (±7.93) years, and 65.5% were females. Majority were married, self-employed and belonged to low socio-economic status (73.1%, 63.1% and 63.2%, respectively). Close to two-thirds (62.4%) commute for at least one hour to get treatment. The commonest diagnosis was psychotic disorders (34.8%), while 5.5% had Alzheimer's dementia. Some 96.5% of the elders were solely on medications. About a quarter had past history of mental illness and 48.5% reported co-morbid medical conditions, with cardiovascular problems (53.0%) being the commonest physical comorbidity. The middle old along with very old elders (aged ≥70years), and those with at least tertiary education, were more likely to present with dementia. Elders with dementia were more likely to present with index episode of mental illness and receive outpatient care.Conclusion: The elders were managed for a wide range of treatable mental illnesses and other comorbidities and commute for hours to access care. Pharmacotherapy was the preponderant sole treatment modality. There is need for sustained development of expertise to enhance multimodal care and scaling up of comprehensive geriatric mental health services. Further research is needed on how to appropriately link and/or integrate geriatric care with services at all-tiers of health care delivery

Pathways to psychiatric care for children and adolescents at tertiary facility in northern Nigeria

There is limited availability of mental health services in Nigeria; and indeed most of Africa. Available services are also often under-utilized because of widespread ignorance and supernatural beliefs about the etiology of mental illnesses. The consequence; therefore; is a long and tedious pathway to care for the mentally ill; especially children and adolescents. This was a study of all new patients; aged 18 years and below; presenting over a 6 month period in 2009 (January - June) at the outpatient clinic of a tertiary psychiatric facility in northern Nigeria. A socio-demographic questionnaire was utilized; along with a record of the clinician's assessment of diagnosis for 242 patients. Subjects who had been withdrawn from school; or any previously engaged-in activity for longer than 4 weeks on account of the illness; were recorded as having disability from the illness. The children were aged 1-18 years (mean=12.3; SD=5.2) with males accounting for 51.7 (125) while 14.5 of the females (n=117) were married. Two thirds (64.5) of the patients had been ill for longer than 6 months prior to presentation. One hundred and forty four subjects (59.5) had received no care at all; while 36.4 had received treatment from traditional/religious healers prior to presentation. The most disabling conditions were ADHD (80); mental retardation (77.8); epilepsy (64.1) and psychotic disorders (50). There is urgent need for extending mental health services into the community in order to improve access to care and increase awareness about effective and affordable treatments

Sociocultural factors affecting mental health service delivery in neuropsychiatric hospital, Port Harcourt, Rivers State, Nigeria

The study was conducted to find out the socio-cultural factors affecting the delivery of mental health services in Neuropsychiatric Hospital; Port Harcourt. Mental health care providers encounter in everyday practice a diversity in socio-cultural beliefs and practices of their consumers which quite often serve as barriers to their effective and efficient service delivery. 50 mental health care roviders participated in the study; five hypotheses were tested using chi-square measure at the significance level of 0.05. The results showed that all the variables were significant indicating that socio-cultural factors affect the service delivery of mental health care providers. Hence; it is hereby recommended that clinicians must be well vast in the cultural diversities; to be culturally responsive to the needs of their consumers and be aware of their own cultures in order to provide culturally relevant services to their clients/patients and their relations

Acute mental health care according to recent mental health legislation Part II. Activity-based costing

Objective: This is the second of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). Objectives for the review were to provide realistic estimates of cost for unit activities and to establish a quality assurance cycle that may facilitate cost centre management. Method: The study described and used activity-based costing (ABC) as an approach to analyse the recurrent cost of acute in-patient care for the financial year 2007-08. Fixed (e.g. goods and services; staff salaries) and variable recurrent costs (including laboratory'; 'pharmacy') were calculated. Cost per day; per user and per diagnostic group was calculated. Results: While the unit accounted for 4.6of the hospital's total clinical activity (patient days); the cost of R8.12 million incurred represented only 2.4of the total hospital expenditure (R341.36 million). Fixed costs constituted 90of the total cost. For the total number of 520 users that stayed on average 15.4 days; the average cost was R1;023.00 per day and R15748.00 per user. Users with schizophrenia accounted for the most (35) of the cost; while the care of users with dementia was the most expensive (R23;360.68 per user). Costing of the application of World Health Organization norms for acute care staffing for the unit; projected an average increase of 103in recurrent costs (R5.1 million); with the bulk (a 267increase) for nursing. Conclusion: In the absence of other guidelines; aligning clinical activity with the proportion of the hospital's total budget may be an approach to determine what amount should be afforded to acute mental health in-patient care activities in a general regional hospital such as HJH. Despite the potential benefits of ABC; its continued application will require time; infrastructure and staff investment to establish the capacity to maintain routine annual cost analyses for different cost centres

Pattern of Psychiatric Inpatient Admission in Ibadan: Implications for Service Organisation and Planning

Introduction: Reports from different parts of the world has shown a seasonal pattern in psychiatric admission. Seasonal changes in climatic and social situations have been attributed. Such audit of psychiatric services is not a popular research venture in Nigeria. Objectives: The study aims to describe the pattern of old psychiatric admissions in a tertiary health facility and the socio-cultural and environmental factors that may influence the pattern. Methods: Data on monthly admissions over a 5-year period were extracted from the admission and discharge records kept by the nursing services unit. The data was processed using Microsoft excel and the pattern over the 5-year period was examined using graphical representations. Results: There were 2140 admissions during the review period; comprising 1138 ( 53.2) females and 1002 males. The mean new admission per month was 34.55 (M:16.7; F:18.96) with a standard deviation of 7.49 for all admissions. There was a seasonal pattern in admission. Some socio-cultural and environmental factors that may explain the pattern were examined. Conclusion: This study suggests a seasonal pattern of psychiatric admission in a tertiary health facility in Ibadan. Recommendations were made on how to make use of the knowledge of the seasonal pattern of admission to mitigate disruptions in workload that may be occasioned by the observed pattern

A situation analysis of mental health services and legislation in Ghana: challenges for transformation

Objective: To conduct a situation analysis of the status of mental health care in Ghana and to propose options for scaling up the provision of mental health care. Method: A survey of the existing mental health system in Ghana was conducted using the WHO Assessment Instrument for Mental Health Systems. Documentary analysis was undertaken of mental health legislation; utilizing the WHO Legislation checklists. Semi-structured interviews and focus group discussions were conducted with a broad range of mental health stakeholders (n=122) at the national; regional and district levels. Results: There are shortfalls in the provision of mental health care including insufficient numbers of mental health professionals; aging infrastructure; widespread stigma; inadequate funding and an inequitable geographical distribution of services. Conclusion: Community-based services need to be delivered in the primary care setting to provide accessible and humane mental health care. There is an urgent need for legislation reform; to improve mental health care delivery and protect human rights

A situational analysis of child and adolescent mental health services in Ghana, Uganda, South Africa and Zambia

Objective: Approximately one in five children and adolescents (CA) suffer from mental disorders. This paper reports on the findings of a situational analysis of CA mental health policy and services in Ghana; Uganda; South Africa and Zambia. The findings are part of a 5 year study; the Mental Health and Poverty Project; which aims to provide new knowledge regarding multi-sectoral approaches to breaking the cycle of poverty and mental ill-health in Africa. Method: The World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS) Version 2.2 was used to collect quantitative information on mental health resources. Mental health policies and legislation were analysed using the WHO Policy and Plan; and Legislation Checklists. Qualitative data were collected through focus groups and interviews. Results: Child and adolescent mental health (CAMH) - related legislation; policies; services; programmes and human resources are scarce. Stigma and low priority given to mental health contribute to low investment in CAMH. Lack of attention to the impoverishing impact of mental disorders on CA and their families contribute to the burden. Conclusion: Scaling up child and adolescent mental health services (CAMHS) needs to include anti-stigma initiatives; and a greater investment in CAMH. Clear policy directions; priorities and targets should be set in country-level CAMH policies and plans. CAMHS should be intersectoral and include consideration of the poverty- mental health link. The roles of available mental health specialists should be expanded to include training and support of practitioners in all sectors. Interventions at community level are needed to engage youth; parents and local organizations to promote CAMH

Acute mental health care and South African mental health legislation Part 1- morbidity, treatment and outcome

Objective: This is the first of three reports on a follow-up review of mental health care at Helen Joseph Hospital (HJH). In this first part; qualitative and quantitative descriptions were made of the services and of demographic and clinical data on acute mental health care users managed at HJH; in a retrospective review of clinical records over a four year period. Objectives for this review were to provide information on mental health care outcome; to do a cost analysis and to establish a quality assurance cycle that may facilitate a cost centre management approach. The operational areas identified were service delivery; teaching; and research. Activities within each area were in-patient care; out-patients and consultation/liaison; under- and postgraduate teaching and self initiated or contract research. Method: The study reviewed the existing mental health care program and activities in context of relevant policy and legislation. Results: Norms from a World Health Organization model for acute mental health care showed that significant staff shortages existed; especially for nursing. A total of 520 users were admitted for in-patient mental health care during the financial year 2007/08. The average length of stay was 15.4 days and ranged from 1 to 85 days. Ninety users (17) had an extended period of stay of 25 days and more; while 39 users had multiple admissions during the 12 month period. The most common Axis I diagnoses made were schizophrenia n=138 (29); substance-related conditions n=99 (21) and bipolar mood disorder n=69 (14). After discharge; 139 users (27) were referred back to the HJH out-patient department for follow-up. Conclusion: The information from these reports may be used in the allocation of adequate resources to align this acute unit with its responsibilities according to recent legislation

Telepsychiatry in South Africa ­ present and future

The recent progress in telepsychiatry results from advancing technology and videoconferencing as an effective alternative to classic face-to-face psychiatric interaction, in terms of both results and cost-effectiveness. The wide range of applications of telepsychiatry is outlined - in particular, emergency, forensic, prison and adolescent psychiatry. Attitudes of patients and the providers of psychiatric services are discussed, and a short account is given of the place of tele-education in psychiatric teaching. The advantages of telepsychiatry are outlined and its limitations. Lastly, the limited experience and relevance of telepsychiatry in South Africa (and hence for other developing countries) are presented. The conclusion is that telepsychiatry is well established, its successes documented, and that it should be applied in planning future public health services in South Africa

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

Analyse de la prescription des antidepresseurs au dispensaire d'Hygiene mentale de l'INSP du 1er Janvier 1999 au 31 Decembre 2001

L'analyse de la prescription des antidepresseurs au Dispensaire d'Hygiene Mentale de l'INSP. du 1er janvier 1999 au 31decembre 2001 a mis en evidence: AU NIVEAU EPIDEMIOLOGIQUE: *61;4pour cent des sujets sont de sexe feminin ; *31;1pour cent ont un age compris entre 26 et 35ans ; *25pour cent exercent dans le secteur public ; *452pour cent sont des celibataires. AU NIVEAU CLINIQUE: *25;3pour cent de cas d'insomnie sont evoques comme motif ; *61;1pour cent des symptomes observes sont somatiques ; *Les diagnostics sont domines par la depression endogene (77;1pour cent) suivi de la psychose maniaco-depressive (7;8pour cent) et des troubles anxieux (4;9pour cent). AU NIVEAU THERAPEUTIQUE: *84;9pour cent des indications sont des troubles de l'humeur. On ne note pas d'indication non psychiatrique ; *La famille des antidepresseurs tricycliques est prescrite dans 97;2pour cent des cas ; *39;9pour cent des posologies journalieres moyennes sont de 25mg ; *36;1pour cent des prescriptions sont associees a d'autres psychotropes ; *57;3pour cent des sujets ne signalent aucun effet secondaire ; *84;6pour cent des patients assidus ont une evolution favorable.Cette etude revele egalement que les antidepresseurs Inhibiteurs des Recepteurs de la Serotonine sont faiblement prescrits (2;1pour cent) dans notre contexte.Au cours du traitement; 62;4pour cent des sujets sont perdus de vue et 8;1pour cent sont irreguliers. Nous estimons qu'il serait souhaitable: *De mettre en place une politique sanitaire afin d'augmenter le nombre de centre pour l'hygiene mentale ; *De favoriser la formation des specialistes en psychiatrie ; *D'elaborer une programme de formation continue pour les praticiens des services d'hygiene mentale

Pratique de la psychothérapie institutionnelle en Côte d'Ivoire : exemple du Centre de Santé Victor Houali de Trinle-Diapleu

La pratique de la Psychotherapie Institutionnelle au centre de sante Victor Houali de Trinle-Diapleu est une experience complexe qui tente d'articuler depuis vingt-deux ans environ; les soins de sante mentale et les soins de sante primaire dans une structure villageoise. Cette experience tres originale s'appuie sur une demarche de recherche action integrant psychotherapie institutionnelle; chimiotherapie et contexte socioculturel africain. Elle peut d'ailleurs servir de reference au developpement de la psychiatrie communautaire et a la necessaire decentralisation des soins psychiatriques en Cote d'Ivoire

Place des pathologies mentales au conseil de sante de la Cote d'Ivoire. Bilan de 10 annees d'activite : de janvier 1989 a decembre 1998

Le Conseil de Sante de la Cote d'Ivoire a ete mis en place le 1er avril 1965 arrete no12 SP. CAB et est charge d'examiner et d'emettre son avis sur : -Les demandes presentees par les fonctionnaires et agents de l'etat au sujet des Conges de maladie; conges de convalescence; conges de longue duree; changements de position administrative pour raison de maladie. -Les demandes d'evacuation sanitaire hors de la Cote d'Ivoire; -Les demandes de cure thermale. Cette etude a pour objet d'apprecier la place qu'occupent les sujets consultant pour des motifs d'ordre psychiatrique. En effet la frequence des pathologies mentales est elevee; c'est ainsi que sur 10 ans (de janvier 1989 a decembre 1998); les services de psychiatrie ont adresse 1342 sur les 5629 demandes repertoriees au Conseil de Sante soit 23;8 pour cent ;les services de Pneumophtisiologie et de Neurologie ayant respectivement 20;2 pour cent et 12;4 pour cent. Les sujets de sexe masculin representent 70;9 pour cent des consultants et les professions d'enseignants (instituteurs; professeurs du secondaire et du superieur) 56;6 pour cent avec un taux de 41;6 pour cent (sur les 5629 demandes) pour les seuls instituteurs. Les sujets de sexe masculin represente 70;9 pour cent des consultants et les professions d'enseignants (instituteur; professeurs du secondaire et du superieur) 56;6 pour cent avec un taux de 41;6 pour cent(sur les 5629 demandes) pour les seuls instituteurs. Les diagnostics de psychiatrie les plus frequents sont les Etats psychotiques chroniques a savoir schizophrenie; paranoia; psychose hallucinatoire chronique avec 37 pour cent suivi de la depression avec 36;5 pour cent. Les decisions finales du conseil de Sante a savoir maintien ou non de l'activite professionnelle sont en faveur du maintien avec 89;7 pour cent des 5629 demandes avec cependant 13;3 pour cent des dossiers non traites. Les sujets de sexe feminin representent les taux les plus eleves de demandes de conge de maladie courte duree(grossesse a risque)et aussi un taux important des patients adresses par les services de cancerologie 96;2 pour cent (contre 30;8) d'hommes sur les 65 cas .Ce travail revele la meconnaissance du statut et des objectifs du Conseil de Sante par les fonctionnaires et aussi leurs superieurs hierarchiques ses limites sont imprecises et ses decisions vont permettre d'eviter des sanctions disciplinaires