Mental Health Conditions
Precepts of the Mental Health Care Act No. 17 of 2002 include: All patients with mental illness and/or severe to profound intellectual disability should receive mental health care as either Voluntary, Assisted or Involuntary Mental Health Care Users. All registered medical practitioners, professional nurses, psychologists, occupational therapists (OTs), and social workers whose training includes
Precepts of the Mental Health Care Act No. 17 of 2002 include:
- All patients with mental illness and/or severe to profound intellectual disability should receive mental health care as either Voluntary, Assisted or Involuntary Mental Health Care Users.
- All registered medical practitioners, professional nurses, psychologists, occupational therapists (OTs), and social workers whose training includes mental health are designated Mental Health Care Practitioners.
- Mental health care practitioners and heads of health establishments at PHC and Hospital Adults level must be familiar with MHCA Forms 01 – 13A, 14, 17, 22, 25, 26, 27, and 48.
- The South African Police Service (SAPS) have an obligation to protect, apprehend, and assist people with mental illness with transfer, to and between health establishments.
Meaning of selected terminology used in this chapter:
Psychoeducation (psychological education) involves informing a patient and their family or support system about their illness and providing problem solving, communication, and assertiveness skills training. The goals are to enable understanding, self-care, crisis management, suicide prevention, and relapse prevention. Information on aetiological factors, signs and symptoms, early signs of relapse, treatment options, need for adherence to treatment, and long-term course and outcome should be provided with consideration of the individual and their family’s culture, beliefs, and coping mechanisms. Myths and misconceptions regarding the illness and its treatment are identified and managed in a person-centred manner. Advice on managing difficult behaviour and emergency situations is provided, and stigma is dispelled.
Psychoeducation may require several individual, family, or group sessions, depending on the complexity of the illness and the understanding of the problem by the individual and their family / support system. Involvement of a registered counsellor, occupational therapist, and/or social worker is advised.
- Risk assessment refers to a clinical judgement of the patient’s potential for:
- suicide or self-harm
- aggression or violence towards others
- being assaulted by others
- high risk sexual behaviour
- severe self-neglect
- being exploited
- reputational damage
- non-adherence to treatment
- causing damage to property
- poor physical health
A risk assessment is performed by collecting information from the patient and relevant stakeholders which may include the person’s family / support system, healthcare providers (including community health workers or social workers who have knowledge of the person’s home), as well as past clinical and forensic history.
Close attention must be given to women in the perinatal period, people who care for others (e.g., parents, grandparents, teachers, and health and social care providers), and those with previous high-risk behaviour.
While the clinical judgement may not always be accurate, it should be justified by the available information. The clinical judgement serves to inform precautionary interventions, e.g. close clinical follow-up after hospital discharge with increased attention by the Ward-Based Outreach Team (WBOT), referral to social welfare / statutory services, advice regarding a protection order, and/or further psychoeducation.
A useful clinical guideline on how to conduct a risk assessment is available at: https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/SESLHDGL%20082%20%20%20Clinical%20Risk%20Assessment%20and%20Management%20- %20Mental%20Health2.pdf
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults_Chapter 15: Mental Health Conditions and Substance Misuse_NEMLC Recommendations for Medicine Amendments 2020-2023