Psychiatric patients overload EC health

Public facilities under strain and bed shortage means families sometimes forced to shoulder burden of care themselves

Inadequate resources at several Eastern Cape public mental health facilities means families often have to shoulder the burden of caring for relatives with mental disorders while healthcare centres are overwhelmed by patients in need of psychiatric services.

The provincial health department admitted this week that it faced challenges, including an increase in substance-induced psychosis cases, but said interventions had already been identified and in some instances, implemented.

However, a shortage of beds for patients, poor distribution of mental health services, as well as infrastructure and staffing challenges continue to affect families who have shared harrowing tales of having to lock up relatives with mental health disorders.

The resource constraints have also negatively affected the legal system. Court cases are frequently postponed pending the availability of “a bed in Fort England” while accused wait for up to two years to be seen by a psychiatrist, the provincial health department has confirmed.

In May this year, the Dispatch recorded 10 cases that were postponed for a psychiatric evaluation in a single day at the Willowvale regional and Mthatha magistrate’s courts.

On Friday, another case was postponed in the Makhanda magistrate’s court pending the availability of a bed at Fort England, which is less than 3km from the court.

NPA regional spokesperson Luxolo Tyali said in some cases an accused was referred to a psychologist for screening to establish whether he or she should be sent for observation. In some instances a relative would tell the court about the accused’s psychiatric history while in others the suspect’s behaviour in court raised questions about his or her fitness to stand trial.

“The delay awaiting the outcome of the 30day observation period results in cases remaining on court rolls for longer than a year in instances where the accused must be observed by a panel — that is two psychiatrists and a psychologist — owing to the violence inherent in the alleged offence,” Tyali said.

“Observations for non-violent crimes are done by a single panel of one psychiatrist and one psychologist, which tend to be quicker.

“If the accused is found unfit to stand trial, he or she will be referred to a psychiatric institution, either as an involuntary mental healthcare user or as a state patient. A trial will not ensue in these circumstances.

“Prejudice for the prosecution can result from the lengthy waiting periods if the accused is found fit to stand trial as the trial itself can start only after the accused has been observed.”

The province’s biggest psychiatric hospital, Fort England, has only one forensic psychiatrist and a sessional doctor to assess the mental state of some of those facing a range of crimes, including murder and rape.

Since January, 232 accused had been admitted to Fort England Hospital for observation, department spokesperson Yonela Dekeda said. Of those, 116 had been found to be mentally unstable.

Families with loved ones in need of mental care sometimes have to make do themselves.

Mncekeleli Qekeleshe, from Ngxakaxa, in Dutywa, has two aunts who have mental health disorders, one of whom had to be taken to a centre in Gqeberha, about 400km away, due to violent behaviour. “It was painful to watch her shouting [at] relatives and other people,” Qekeleshe said.

“At times she would want to break windows of our homes.

“She completely destroyed a house in another village in Dutywa after throwing stones at it.

“That is why we decided to seek help as she was deemed unsafe to be with us and had to be taken to a centre in Gqeberha.”

Qekeleshe stays with his other aunt, who also needs professional help.

“We always make sure that the yard is locked because if we don’t do that she would disappear and go to other villages.

“She has treatment that we periodically take from the Dutywa community health centre but the medication is not helping and we appeal to the government for help.

“I always worry about her condition when I am not around.”

Dr Rolene Wagner, head of the provincial health department, pointed to a growing number of patients with substance-abuse issues, which was putting pressure on facilities.

“There is an increased number of patients admitted with substance-induced psychosis in the facilities. These patients take time to ‘settle’, thus staying longer in an acute mental health facility.”

Dr Lesley-Ann Foster, director of Masimanyane Women’s Rights International, said it was a “travesty of justice not to have adequate resources to deal with such a serious problem in our society”.

“People are suffering with serious mental health issues ... The health department is doing us a great disservice by not employing more specialists in the field of mental health and they need to take the issue very seriously.

“What bothers me is that the department doesn’t seem to take a holistic view of the health requirements of communities at large.

“They do sporadic responses ... I have a deep concern about that, particularly about women who suffer domestic violence or rapes and who need psychiatric services they can’t access.

“It’s not a direct justice issue, but an issue of health and overall wellbeing that is neglected.”

The Democratic Nursing Organisation of SA’s provincial chair, Sivuyile Mange, said a shortage of specialised nurses in the field of psychiatry was of great concern.

“There’s also a shortage of these designated facilities, especially on the eastern side of the province and on the western side.

“The existing ones are not having capacity to deal with the growing population.”

In September last year, the department established a separate directorate for mental health in the province.

Wezile Tshali was appointed in the same month as the provincial director for mental health.