The real facts of psychiatric services

2009-08-27 00:00

AS regional head of Psychiatric Services in Pietermaritzburg and the midlands area, I would like to respond to the article printed in The Witness entitled “Welcome to ‘Mad Town’” (Aug­ust 25).

While I obviously abhor and regret the very tragic incident that recently occurred on the streets of Pietermaritzburg that led to the death of an innocent young woman, there are several inaccuracies in the article that demand a response. This is in the interests of clarifying for the public the situation regarding the admission of mentally ill individuals to hospital.

The Mental Health Care Act (2002) was implemented during 2004 and stipulates that individuals in the community believed to be mentally ill should be taken to local general hospitals for medical assessment and admission, and treatment if indicated. They may not be admitted directly to psychiatric hospitals, such as Town Hill Hospital. The are certain rationales for this.

• Individuals can receive treatment closer to their homes without having to travel significant distances to access psychiatric instit­utions.

• Individuals can receive treatment within the least restrictive environment possible.

• Individuals who recover quickly (e.g. substance abuse patients) avoid unnecessary protracted admissions in psychiatric hospitals.

• Medical causes of psychiatric disturbance (e.g. head injury, epilepsy or meningitis) can be identified and treated appropriately in the correct setting.

• Individuals can avoid the stigma of unnecessary admission to psychiatric hospitals.

These are all important issues in providing safe, humane and equit­able mental health services to the whole population.

I was shocked to read that local SAPS members are under the impression that a person suspected of being mentally ill and requir­ing medical attention needs to be “certified” by two different district surgeons. This procedure was indeed the case prior to 2004. However, the new legislation that was implemented five years ago did away with that cumbersome process and stipulated that individuals suspected of being mentally ill should be taken directly to the nearest general hospital for clinical assessment. This information has been provided repeatedly to the SAPS over the past five years — both by provincial and district health departments and by individual clinicians. I, for example, gave a three-hour talk to the local SAPS on the Mental Health Care Act (2002) and its procedures, less than a year ago. Approximately 30 to 40 SAPS members were present at that workshop. The national Depart­ment of Health published a training manual on the same topic for the SAPS in February 2003 and one assumes that in-service training has been given on this important issue.

I am also amazed at the apparent sense of helplessness expressed by these SAPS members when confronted by an aggressive mentally ill person. Their only solution appears to be the use of their firearms, about which they understandably feel uncertain. Health workers at clinics and hospitals are confronted with potentially aggressive patients every day — some due to medical and surgical confusional states, and some due to mental illness. These health workers need to be able to cope with such behaviour and, consequently, significant effort is given to training health workers in safe methods of calming and res­traint. It seems that our colleagues within the SAPS are not receiving the same training and preparation.

Finally, I would like to set the record straight concerning the relationship between mental illness and violence. Your article once again sensationalises and overstates the link between the two. Well-replicated and authoritative research shows quite clearly that the vast majority of individuals who are mentally ill are not violent or dangerous. Similarly, the vast majority of violent incidents that occur in society are committed by apparently sane individuals. A small percentage of people with a mental illness become aggressive and violent on occasions. To talk of the “mentally disturbed” and “violence” in the same breath (as is done repeatedly in your article) is to perpetuate public misunderstanding of the issue, generate hysteria against those with mental illness and add to the stigma surrounding mental illness in our society. Furthermore, the use of pejorative and discriminatory terms such as “Mad Town” (in the title), “lunatics” (in the subtitle), “mad people” and “mentally unbalanced” is unacceptable in this age where every individual has a human right to respect and to freedom from discrimination.

This tragic incident highlights the urgent need to educate the public about mental health, train and increase the skills of emergency personnel, such as the SAPS, and to focus more on the development of mental health services in our country. We clinicians are more than happy to assist with all of these tasks (as we already do), and I urge your newspaper to respond to incidents such as this with constructive and responsible reporting that can contribute positively to improving the state of our society.

• Dr J. K. Burns is the chief specialist psychiatrist of area two (western districts).

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