Briefing to the Portfolio Committee on Health, Parliament The State of Mental Health Services in the Northern Cape June 7th 2017

Contents Overview (slides 1 & 2) Primary health care (5) 72-hour assessments (6, 7 & 8) Psychiatric hospital (9 & 10) State Patients (11) New Northern Cape Mental Health Hospital (12) MHRB (13) Advocacy groups (14) Human resources (15 & 16) Challenges (17 & 18) Patient utilisation statistics (19)

Overview (1) Mental health services mainly provided by government There is one licenced private psychiatric hospital and a large NGO provides limited intellectual disability services (Yonder) Decentralization of inpatient services from West End Hospital in Kimberley is a challenge - inadequate infrastructure and staffing in general hospitals Non-complicated mental illness is managed by primary health care Government has no community based accommodation for clients with mental illness or profound intellectual disability

Overview (2) A Provincial Mental Health Coordinator provides oversight and coordination for all hospital and primary health care services District mental health coordinators are responsible at district level The psychiatric hospital in Kimberley (WEH) provides a limited outreach service to the districts. WEH provides the main source of support and referral for acute mental illness. WEH is also the only referral resource for State Patients, Forensic Patients and Child & Adolescent Mental Health Services (CAMHS)

Primary Health Care (Clinics and CHCs) Screening for mental health disorders Treatment for mental health disorders Screening for substance abuse There is also a specialist outreach service from WEH for: Psychiatry Psychology

Assessment in General Hospitals Involuntary and voluntary 72-hour mental health assessment aims to eliminate any underlying medical condition such as urinary tract infection) This should be provided across a range of general hospitals (district, regional and tertiary) Most hospitals are not meeting the requirements for 72-hour assessment as set out in the NDOH policy The province has allocated capital funds for the refurbishment of key facilities this financial year

Hospitals providing 72-hour assessments DISTRICT HOSPITALS Frances Baard Kimberley Hospital Prof ZK Matthews Hartswater John Taolo Gaetsewe Kuruman Hospital Tshwaragano Hospital Namakwa Calvinia Hospital Springbok Hospital Pixley Ka Seme De Aar Hospital Maane Dipico Hospital Prieska Hospital ZF Mgcawu Dr Harry Surtie Hospital Postmansburg Hospital Kakamas Hospital

Hospitals for Refurbishment for 72-Hour Assessment Number of Beds Kimberley hospital 20 beds Upington (Old Gordonia hospital) 32 beds Tshwaragano hospital 10 beds De Aar hospital 4 beds Hartswater hospital Springbok hospital Calvinia hospital Postmansburg hospital

Specialised Psychiatric Hospital (West End) General Adult Psychiatry (Voluntary and Involuntary – acute and chronic) State Patients Child and Adolescent Psychiatry (outpatients only) Intellectual Disability Services (outpatients only) Forensic observations – day case only

Adult Psychiatry Services (WEH) Voluntary care male: 13 beds unit Voluntary care female:8 beds unit Involuntary care male: 36 beds unit Involuntary care female:10 beds unit Long term care female: 19 beds unit Long term care males: 17 beds unit State Patients: 31 beds (separate male and female)

State Patients Initially West End Hospital had no beds for State Patients In 2011/12 we opened 12 beds – resulting in 18-26 State Patients having to be held in correctional services over many years (in March/April this was 26 people) The refurbishment of a an old ward created space to transfer all state patients from Kimberley and Upington Correctional Services to West End Hospital during May 2017 The is the first time that the Northern Cape has ever been in this position

New Northern Cape Mental Health Hospital Construction is anticipate to be complete end 2017/early 2018 Value of Current contract is R680 305 062 (R560 417 147   has been spent to date) Administration block, and Blocks A, B & C have reached 95% completion and will be inspected in July 2017 A budget of R136 million is allocated in this financial year for the project. Upon practical completion the department will require six months period for equipping and commissioning (initially 199 beds)

Mental Health Review Board The overarching role of the MHRB is the protection of the human rights of the mentally ill people There is one Review Board in the province – based at WEH Board members are five: Two mental health practitioners One legal practitioner Two community members All board members are appointed by the Member of Executive Committee and are remunerated at an hourly rate

Mental Health Advocacy Groups Through the help of the South African Mental Health Federation of South Africa based in Pretoria, patient driven advocacy groups were established in four towns: Kimberley Douglas Prieska Upington

Human Resources in District Level CATEGORIES OF STAFF Frances Baard John Taolo Gaetsewe Namakwa Pixley Ka Seme ZF Mgcawu Psychiatrist Psychologists 3 1 Occupational therapist 6 2 Community Service 3 Permanent 3 Community Service Social workers 4 2 7 Mental Health Coordinators 1 Advanced Psychiatric Nurse

Human Resources at Tertiary & Specialized Hospitals Categories Tertiary Hospital Specialized Hospital Private Sector Psychiatrist 3 1 Psychologists 2 Permanent 2 Community Service 2 Interns 12 Occupational therapist 10 3 Permanent 6 Social workers 5 2 Psychiatric Nurses 14 2Advanced Psychiatric qualification

Mental Health Challenges (1) SOLUTIONS/INTERVENTIONS District Specialist Mental Health Team Capacity in mental health Shortage of psychiatrists Appoint the District Mental Health Specialist Team in phases Shortage and capacity in mental health will be address through registrar programme with the University of Free State Rotating the medical officers from the district to West End Hospital for in-service training

Mental Health Challenges (2) SOLUTIONS/ INTERVENTIONS Lack of proper infrastructure and staffing for mental health at all levels of care Attaching mental health units in general hospital Refurbishing facilities to accommodate mental health services Additional staffing budget

Mental health service utilisation 2016/17 Month clients total Case load Admission >17 years Admissions total Admission rate (per 10,000) Involuntary admission rate Visit rate >17 years April 4 362.0 1.7 100.0 109.0 1.2 25.7 97.8 May 5 107.0 1.9 98.0 101.0 1.1 29.7 95.8 June 4 692.0 1.8 98.9 95.0 1.0 24.2 95.7 July 4 711.0 2.0 108.0 25.9 August 5 358.0 97.9 144.0 1.6 25.0 94.9 September 4 894.0 83.0 0.9 13.3 95.1 October 4 349.0 97.1 102.0 24.5 95.2 November 4 809.0 98.5 133.0 1.4 24.8 96.7 December 3 320.0 138.0 94.1 January 3 354.0 99.1 1.5 27.8 90.8 February 3 763.0 97.0 19.6 93.9

Thank you