The Care, Treatment, Rehabilitation and Legal Outcomes of Referrals to a Tertiary Psychiatric Hospital According to the Mental Health Care Act No. 17 of 2002

By Madlala, D. P.; Sokudela, F. B. | South African Journal of Psychiatry, November 2014 | Go to article overview

The Care, Treatment, Rehabilitation and Legal Outcomes of Referrals to a Tertiary Psychiatric Hospital According to the Mental Health Care Act No. 17 of 2002


Madlala, D. P., Sokudela, F. B., South African Journal of Psychiatry


When psychiatry burgeoned as a medical discipline in the 19th century, the quality of care and treatment given to mentally ill persons worldwide was unsatisfactory. The mentally ill were confined in asylums, and the living conditions therein were characterised by overcrowding, shortage of human resources and lack of treatment. Stigma, discrimination and isolation were also prevalent. [1-3] In the 20th century there was, however, a slight paradigm shift from strictly ostracised and isolated inpatient care to a more decentralised form of care based at community level, which sought to empower affected individuals. Despite this move, neuropsychiatric disorders still comprise 13% of the global disease burden. [4] Research continues to reveal poor-quality care given to mentally ill persons globally. [5] In many facilities, inpatient care has been subjected to criticism, [5-10] and care has been described as lacking containment and management in some settings. [11] Attitudes of healthcare practitioners (HCPs) towards mentally ill persons largely contribute to this poor care, and research shows that mental HCPs (MHCPs) perpetuate the stigma attached to mental illness through negative attitudes. [12,13] These negative attitudes translate to poor clinical management of patients. Some patients are denied proper physical work-up, including history taking, physical examination and laboratory investigations, on the basis of being mentally ill. [14-16] The poor levels of care result in lack of detection of natural diseases and non-treatment. This in turn leads to a high rate of mortality from natural diseases in mentally ill people compared with the general population. [17]

South Africa (SA) is not exempt from these findings regarding poor treatment given to mentally ill persons. Williams et al. [18] found that 75% of people living with mental disorders in SA do not receive the care they need. After adopting its new Constitution in 1996, SA also needed to incorporate the care of mentally ill persons within the required principles of the protection of human rights and human dignity. [19] The Mental Health Care Act No. 17 of 2002 (MHCA) [20] was promulgated in 2004 and contains provisions that are based on these principles. The MHCA seeks to ensure that appropriate care, treatment and rehabilitation (CTR) are provided, and promotes the rights and interests of mentally ill persons. It also promotes provision of community-based care. In terms of admission procedures, the emphasis is on full assessment of a mentally ill person both physically and psychologically. The MHCA also allows for treatment to be initiated as soon as possible and referral of persons still in need of inpatient care after 72 hours to psychiatric facilities.

Although the MHCA has good intentions, whether its objectives can be fully applied in clinical settings is questionable. Research done in SA has pointed to problems with infrastructure and human resources as impediments to the accomplishment of these objectives. [21-23] There are scant data in the country regarding the effect of the MHCA since its promulgation, in improving the care given to mentally ill persons. Nonetheless, a survey carried out in KwaZulu-Natal has shown some degree of improvement in care. [24]

The current study measured the effect of the MHCA by selecting a sample in a specific region of northern Gauteng and focusing on the following aspects of care: the way diagnoses were formulated; the appropriateness of the treatment provided; the correction of abnormal results of investigations; the quality of record-keeping; and compliance with the procedural matters of the MHCA. All of the above were evaluated at Weskoppies Hospital, as well as length of stay and the legal status at discharge point.

The study received approval from the Research Ethics Committee of the Faculty of Health Sciences, University of Pretoria. A waiver of informed consent was obtained from Weskoppies Hospital authorities. …

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