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

2. 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)

3. 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

4. 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)

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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)

11. State Patients
Initially West End Hospital had no beds for State Patients
In 2011/12 we opened 12 beds – resulting in 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

12. New Northern Cape Mental Health Hospital
Construction is anticipate to be complete end 2017/early 2018
Value of Current contract is R (R    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)

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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
1.7
100.0
109.0
1.2
25.7
97.8
May
1.9
98.0
101.0
1.1
29.7
95.8
June
1.8
98.9
95.0
1.0
24.2
95.7
July
2.0
108.0
25.9
August
97.9
144.0
1.6
25.0
94.9
September
83.0
0.9
13.3
95.1
October
97.1
102.0
24.5
95.2
November
98.5
133.0
1.4
24.8
96.7
December
138.0
94.1
January
99.1
1.5
27.8
90.8
February
97.0
19.6
93.9

20. Thank you