Academic journal article South African Journal of Psychiatry

The Mental Health Care Act: Stakeholder Compliance with Section 40 of the Act

Academic journal article South African Journal of Psychiatry

The Mental Health Care Act: Stakeholder Compliance with Section 40 of the Act

Article excerpt

Worldwide, new laws have been enacted concerning the issues and profiles of mental health care users (MHCUs). These laws serve as an advocacy for MHCUs and play an extremely important part in protecting their health and human rights.

Included in these laws are the roles, responsibilities and terms of collaboration between the various stakeholders responsible for the care of MHCUs. (1-3)

In South Africa, the new Mental Health Care Act (MHCA) (4) was promulgated in 2002 and implemented in 2004. Similar to most legislation worldwide, (1-3) this Act defines a collaborative and mutually co-operative relationship between the South African Police Services (SAPS), the mental health care practitioner (MHCP), the judiciary, and emergency medical services (EMS) at a local and national level. The Act serves to preclude the detention of acutely mentally ill users in police cells, and prioritises prompt access to local hospitals. It defines the role of the various stakeholders regarding transportation, hospitalisation and care of a MHCU within the criminal justice system. It also sets out a clear policy and working relationship between SAPS and medical services, especially concerning the humane handling of MHCUs when they are acutely ill. More specifically, Section 40 of the MHCA and its regulations (5) state that if a member of the SAPS has reason to believe, either from personal observation or information obtained from a MHCP, that a person is mentally ill and is likely to inflict harm on himself or others, that member must apprehend the person and cause him to be either: (i) taken to an appropriate health establishment for assessment of his mental health status; or (ii) handed over into the custody of the head of health establishment (HHE) or any designated person to receive such a person. The handing over of custody includes the completion of a Mental Health Care Act (MHCA) form 22 by the HHE, SAPS member and the MHCP.

While the legislation is clear in its requirements, the compliance of various stakeholders in its implementation is still in question. In a study of outcomes of police responses to mental health emergencies, Steadman et al. (6) concluded that current police training is inadequate to prepare police officers to identify and deal with the mentally ill. Police officers did not know how to recognise mental illness, how to deal with psychotic and violent behaviour, or what to do with someone trying to commit suicide. Teplin (7) reported that police officers did not know what community resources were available, how to gain access to them, how to deal with their own emotional issues as a result of an extremely stressful career, or how to engage appropriately with mentally ill people. This lack of knowledge affects proper compliance with legislation.

Teplin (7) also reported that training goals about raising awareness of mental health issues were more successful than goals relating to influencing behavioural change. Furthermore, approaching police officers within their workplace allowed them to consider specific training needs and to create an environment where their attitudes and behaviours could be addressed. Similarly, persons with mental illness may also experience interactions with police officers in numerous ways. (8) The manner in which police officers approach such situations will determine whether the mentally ill person co-operates or whether the situation becomes contentious or violent. Watson and Angell (8) reported that police officers were more likely to arrest and incarcerate individuals with mental illness when: (i) there was evidence of a crime having been committed; (ii) the individual had a criminal history; (iii) they felt that the individual would be inadmissible to a hospital; (iv) public encounters exceeded the community's tolerance for defiant behaviour; and (v) it was likely that the person would continue to be a problem.

It is evident that educational seminars for improving police officers' knowledge of mental illness and training in their roles concerning mental health care legislation should be provided. …

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