Health
With respect to psychiatric hospitals in the Western Cape:
(1) Whether there is any national legislation that has an impact on the capacity pressures at these institutions; if so, what are the relevant details;
(2) whether there are any state patients from other national departments who are absorbed by the Department of Health; if so, what is their contribution towards these patients?
1. The Mental health Care Act 2002 is in its 17th year of implementation.
- This has required an extension of mental health treatment and assessment capacity at district and regional health service level and over the past 17 years there has been a significant investment in this by the Provincial Department of Health.
- This has allowed for specialist psychiatric hospitals to focus on what they are most skilled to do – the treatment of acute and severe mental health disorders.
- The challenge has been the significant increase in health problems and particularly mental health problems. Poor lifestyle choices, social and economic stressors have increased dramatically and related to this an increase in poor coping choices such as substance use and mental health symptoms and disorders.
- The legislation does not cause capacity pressures, it ensures that people can access the health care and mental health care that they need, it is the underlying precipitants of acute mental health conditions that cause capacity problems at all health services, including psychiatric hospitals, [as noted above, e.g., substance induced psychosis account for up to 30% of admissions at district/regional hospitals and 23% of admissions at psychiatric hospitals]
- The Legislation also supports treatment closest to home and with the least restrictions – so it does not result in extended treatment in a psychiatric hospital unless this is necessary, and a number of legal criteria are met.
The legislative framework that determines how those services are accessed, the issue of burden is due to the myriad of issues including socio-economic difficulties and/or consequent substance abuse.
2. The courts always admit state patients to specific forensic units within their jurisdiction, state patients from other provinces are not sent to the Western Cape, unless a patient’s family has relocated to the Western Cape or the patient is originally from the Western Cape. This only occurs when the family/support system has shown convincing motivation to become the patient’s custodian. Very occasionally, state patients are admitted if they have absconded from other provinces, but this is only temporarily, until they are returned to their own province. All the above happens so infrequently that it can’t be held responsible for the lack of capacity in our service.
