Psychiatric education in Africa-a South African perspective.

Psychiatry is an under-resourced discipline, specifically in terms of personnel, not least of all in developing world settings. The capacity for training specialists does not seem to meet the requirements of an increasing disease burden. Notwithstanding the status quo, countries in such settings continue to train and graduate specialists. The current paper provides an overview of specialist training in South Africa, specifically noting the exposure to Psychiatry at undergraduate level, within the context of Psychiatric education in an African setting. An important issue is raised-if a country is not able to meet the personnel requirements at specialist level, is it time to reconsider such training within the broader context of psychiatric education based on country-specific needs. Further, the need for an assertive specialist psychiatrist discipline as well as one that is knowledgeable and respectful of indigenous practice is highlighted.

Psychiatric services for preschoolers: an emerging need.

OBJECTIVE: To describe clinical presentation and service requirements for those under six years of age referred to a specialised child and adolescent psychiatry unit. METHOD: This study used a retrospective review of preschoolers, six years and younger, assessed at a child, family and adolescent psychiatric unit (January 2006 to 31 December 2010). Data analysis established predominant diagnoses (prevalence percentages) and correlations and associations (diagnoses and a range of clinical variables - Fischer's exact test and chi-square test). RESULTS: The sample comprised 149 subjects. Males predominated (77.2%; N = 115). Mean age of presentation was 54 months (SD=12.59). Children were referred predominantly by health professionals (36.9%; N = 55) and schools (20.8%; N = 31). Attention-deficit hyperactivity disorder (ADHD) was the most common diagnosis (52.8%; N = 70), and was not over-represented amongst boys. Girls mostly presented with anxiety disorders (44.1%; 15/34) and reactive attachment disorder (RAD) (35.3%; 12/34), and boys mostly with pervasive developmental disorders (PDD) (26%; 30/115). Psychometric testing was frequent (68.5%; N = 102). Pharmacological intervention was common (46.3%; N = 69). The defaulting rate after initial assessment was high (42.1%; 48/114). CONCLUSION: The study demonstrates the existence of psychiatric illness in this sample, highlighting service needs. Vulnerability of this age group and limited sub-specialist resources emphasise the need for the development of community services leading to early recognition and intervention.

Mental health and the law: a South African perspective.

Mental health law in South Africa has been dominated in recent times by the Mental Health Care Act 2002. This paper provides selective insights into specific aspects of that Act and highlights its impact on clinical practice within a broad clinical setting and in so doing suggests areas for review and revision.

Mental health leadership and patient access to care: a public-private initiative in South Africa.

BACKGROUND: Mental health leadership is a critical component of patient access to care. More specifically, the ability of mental health professionals to articulate the needs of patients, formulate strategies and engage meaningfully at the appropriate level in pursuit of resources. This is not a skill set routinely taught to mental health professionals. METHODS: A public-private mental health leadership initiative, emanating from a patient access to care programme, was developed with the aim of building leadership capacity within the South African public mental health sector. The express aim was to equip health care professionals with the requisite skills to more effectively advocate for their patients. The initiative involved participants from various sites within South Africa. Inclusion was based on the proposal of an ongoing "project", i.e. a clinician-initiated service development with a multidisciplinary focus. The projects were varied in nature but all involved identification of and a plan for addressing an aspect of the participants' daily professional work which negatively impacted on patient care due to unmet needs. Six such projects were included and involved 15 participants, comprising personnel from psychiatry, psychology, occupational therapy and nursing. Each project group was formally mentored as part of the initiative, with mentors being senior professionals with expertise in psychiatry, public health and nursing. The programme design thus provided a unique practical dimension in which skills and learnings were applied to the projects with numerous and diverse outcomes. RESULTS: Benefits were noted by participants but extended beyond the individuals to the health institutions in which they worked and the patients that they served. Participants acquired both the skills and the confidence which enabled them to sustain the changes that they themselves had initiated in their institutions. The initiative gave impetus to the inclusion of public mental health as part of the curriculum for specialist training. CONCLUSIONS: Despite the significant adverse social and economic costs of mental illness, psychiatric and related services receive a low level of priority within the health care system. Ensuring that mental health receives the recognition and the resources it deserves requires that mental health care professionals become effective advocates through mental health leadership.

Child and adolescent electroconvulsive therapy: a case report.

Electroconvulsive therapy (ECT) is a controversial treatment modality that is only rarely performed on children and adolescents. There is a marked paucity of published data relating to the indications, use, clinical outcome and complications of ECT in this age group. The ethical and moral issues surrounding the use and in particular the research of ECT in this group of patients makes controlled data very difficult to come by. The following case report and review of the literature will address some of these issues.

Body figure preference in South African adolescent females: a cross cultural study.

BACKGROUND: Eating disorders have traditionally been associated with the white community in South Africa. The emergence of eating disorders among blacks in the mid 1990's appeared to signal a demographic shift. Subsequent data suggested that eating disorders would increase in prevalence amongst black South Africans. OBJECTIVE: The current study sought to explore body figure preference in a cross cultural South African sample, given the established relationship between body dissatisfaction and eating disorders. METHODS: The sample comprised a community based, multi-racial adolescent population in both urban (n=1353) and rural (n=361) areas. The Body Figure Preference Test [BFPT] was administered. RESULTS: Most urban respondents had a desire to be smaller (white=72%; black=61%), whereas rural black respondents were more evenly divided amongst those who were content (31%), desiring to be larger (29%) and desiring to be smaller (40%) [Chi square value=105.309, df=4, p=0.001]. CONCLUSIONS: The findings of the study demonstrate that racial homogenization exists regarding body figure preference within the urban setting. Data from the rural area suggests milieu specific factors in this regard with fewer respondents desiring to be smaller. This may have implications for the emergence of eating disorders in black South African populations, more specifically those in urban areas.

A cross-cultural study of eating attitudes in adolescent South African females.

Eating disorders were first described in black females in South Africa in 1995. A subsequent community based study of eating attitudes amongst adolescent females in an urban setting suggested that there would be increasing numbers of sufferers from within the black community. The current study sought to extend these findings using a larger, more representative urban sample. The results support those of the preliminary study. The underlying basis for the emerging phenomenon is discussed.