Burnout among community service doctors in South Africa.

BACKGROUND:  Burnout in doctors is an important issue with far-reaching consequences. Community service doctors may be particularly vulnerable because of their specific roles (rural settings, junior positions and reduced supervision). AIM:  This study aimed to determine the prevalence of burnout among community service doctors in South Africa (SA), the potential contributory and protective factors and the consequences thereof. SETTING:  This was a national study of community service doctors in SA. METHODS:  A quantitative, descriptive cross-sectional study was performed. The Maslach Burnout Inventory was used to measure burnout. The online questionnaire also included demographic data, workplace and individual characteristics. RESULTS:  Of the 208 community service doctors analysed, 89% and 94% had high emotional exhaustion and depersonalisation, respectively, while 97% had a low personal accomplishment. Mental illness, financial difficulties, unmanageable volume of patients and female gender were found to be potential contributory factors. Having manageable patient volumes, satisfaction with their decision to study medicine, talking to colleagues and feeling supported by healthcare facility management were among the significant potential protective factors. Significant potential consequences of burnout included: leaving the government sector, ever being diagnosed with a mental illness, using alcohol as a coping mechanism and possible current major depression. CONCLUSION:  Burnout among community service doctors in SA is highly prevalent with significant potential consequences. There are a number of modifiable possible contributory and protective factors identified that may be targets for mental health interventions.Contribution: Healthcare burnout research is lacking in the African and specifically SA context. This void includes community service doctors.

Is mental health in South Africa moving forward?

A landmark South African Mental Health Conference took place in April 2023, marking the first national collaborative conference between government and mental health professionals. The theme was Join the Movement, and a 'whole of society' approach was emphasised, imploring various sectors to collaborate in relieving the country's burden of mental illness. Challenges in mental health were raised and possible solutions presented. This article discusses the conference, aspects of psychiatric care in South Africa, South Africa's health system issues and the importance of moving forward measurably.

A case of schizophrenia refuting mind-body dualism.

Introduction: The case report depicts the complex interplay between mental and physical illness and contests the notion of mind-body dualism in medicine. It emphasises the importance of holistic management of patients and the misnomer of schizophrenia as a purely mental illness. Patient presentation: Mr S is a 35-year-old male who presented to a South African specialist psychiatric hospital via the forensic system. He had multiple physical symptoms involving the abdominal, haematological, dermatological and neurological systems, in addition to an eight year duration of untreated psychosis with a marked decline in cognition and functioning. Management and outcome: An extensive medical examination during his admission excluded conditions such as early onset dementia, Huntington's disease, pellagra, Wilson's disease, autoimmune encephalitis and substance-related complications. A definitive diagnosis of schizophrenia was made, and both physical and psychiatric symptoms responded well to the administration of an antipsychotic resulting in an eventual discharge from the hospital. Conclusion: Mind-body dualism can result in a delayed diagnosis of schizophrenia and subsequent increased duration of untreated psychosis and other complications. Contribution: This case emphasises the flaws of mind-body dualism, and the interplay of mental and physical illness.

Smoking cessation among people with mental illness: A South African perspective.

Tobacco use is recognised as a serious, worldwide public health concern. Smoking cessation is of great interest across a wide range of medical specialities, including family medicine. However, smoking cessation among people with mental illness (PWMI) has attracted scant attention in South African literature. This is despite PWMI suffering disproportionately from the damages of tobacco. The harms of smoking are not limited to physical health but extend to mental health. This article discusses the need for multifaceted smoking cessation treatments for PWMI in the public health sector, taking into consideration the prevalence and unique drivers of smoking in this population. A brief overview of patterns of tobacco use, associated harms and smoking cessation interventions in South Africa is given; all within the context of mental illness.

Exploring burnout among psychiatric trainees at a South African university.

Background: The mental health of doctors is increasingly topical, internationally and locally. Of importance is the phenomenon of burnout, a far-reaching repercussion of chronic work-related stress. Psychiatrists are more vulnerable to stress, burnout and suicide in comparison with other medical specialities. There is a void in published research relating to South African psychiatric trainees. Aim: The study aimed to investigate burnout and associated factors among psychiatric registrars at a South African university. Setting: Department of Psychiatry at the University of the Witwatersrand. Methods: This was a cross-sectional study via an anonymous self-administered questionnaire. The questionnaire comprised three sections: demographics; the Maslach Burnout Inventory Human Services Survey (MBI-HSS) and questions relating to contributing factors, protective factors and consequences of burnout. The MBI-HSS is recognised as the leading measure of burnout, consisting of three subscales: emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). Results: The questionnaire was completed by 33 out of 55 psychiatric registrars (60.0% response rate). Data from 31 registrars were used in the analyses, as two registrars did not provide informed consent. Among participants, EE was the most commonly affected, followed by DP and lastly PA. The majority (67.8% or n = 21) had scores in the high category for any one of the three subscales (EE/DP/PA). Significant factors associated with burnout included poor work and non-professional life balance (p = 0.017), utilising annual leave days for work-related tasks (p < 0.001), irregular holidays (p = 0.003) and financial debt (p = 0.026). A possible protective factor was an amicable relationship with fellow psychiatric registrars. Conclusion: There is evidence of some degree of burnout in more than two-thirds of participants. Associated factors lie largely at an organisational level, and while optimising individual resilience is important, systemic support plays a key role.