RESUMO
Background: People living with mental illness (PWMI) have significantly reduced life expectancy compared to the general population, yet mental healthcare providers (MHCPs) do not regularly prescribe exercise, despite its proven health benefits. Aim: This study aimed to evaluate South African MHCPs' views regarding exercise for PWMI. Setting: A cross-sectional descriptive study conducted across five public sector specialised psychiatric units in Gauteng. Methods: Mental healthcare providers were surveyed using the Exercise in Mental Illness Questionnaire - Health Professionals Version. Results: Most participants were nurses (49.1%) and doctors (26.2%) and reported no prior formal training in exercise prescription (79.4%). The vast majority (up to 89.7%) agreed regarding the physical benefits of exercise, particularly cardiometabolic benefits. The most common barriers, as perceived by MHCPs, to exercise participation for PWMI were: stigma (56.5%) and medication side effects (56.5%). The majority (76.2%) reported prescribing exercise for PWMI at least 'occasionally'. The method most frequently used was personal discussion (77.3%) and aerobic exercise was most frequently recommended (81.0%). Specific instructions regarding physical activity recommendations however were often not provided. Regarding MHCPs personal exercise habits, only a third (34%) met physical activity guidelines. Most MHCPs (92.1%) indicated an interest in further training regarding exercise for PWMI. Conclusion: Mental healthcare providers were supportive of exercise for PWMI. Strategies to address the stigma around mental illness and medication side-effects, to improve training regarding exercise prescription, as well as the exercise habits of MHCPs themselves, and collaboration with exercise professionals and organisations are recommended. Contribution: This study provides insight into the views of South African MHCPs regarding exercise for PWMI.
RESUMO
Background: Patients with schizophrenia and schizoaffective disorder often require longer admissions. Aim: To explore length of stay (LOS) and associated factors of patients with schizophrenia and schizoaffective disorder, admitted to a public sector specialised psychiatric hospital, over a 4-year period. Setting: The study was conducted at Tara Hospital in Johannesburg. Methods: A retrospective record review of 367 adult schizophrenia and schizoaffective disorder patients admitted between 01 January 2015 and 31 December 2018. Average LOS was calculated and the proportion of short-stay (< 30 days), medium-stay (31-90 days) and long-stay (> 90 days) admissions determined. Sociodemographic, clinical and admission outcome data were collected and analysed from a randomly selected subset of patients in each LOS category. Results: Mean LOS was 128 days (median 87, interquartile range [IQR] 49-164, range 0-755 days). A significantly greater proportion had long-stay admissions (p < 0.001). Male gender (p = 0.018), being unmarried (p = 0.006), treatment resistant (p < 0.001) and on clozapine (p = 0.009) were factors found to have a significant association with long-stay admissions. Rates of unemployment (> 80%), comorbid substance use disorders (> 40%), medical illnesses (> 40%), antipsychotic polypharmacy (> 40%) and readmissions (> 80%) were high. Most (> 80%) were discharged. Conclusion: Long-stay admissions were frequently required for patients with schizophrenia and schizoaffective disorder admitted to Tara Hospital. Contribution: This study highlights factors associated with long-stay admissions in patients with schizophrenia and schizoaffective disorder. More research is needed into whether increased access to community-based services, such as residential and daycare facilities, outpatient substance rehabilitation programmes and dual diagnosis clinics, could translate into shorter admissions, less frequent relapses and improved outcomes in this population.
