Community mental health services in Southern Gauteng: An audit using Gauteng District Health Information Systems data.

BACKGROUND: Community mental health services (CMHS) are a central objective of the National Mental Health Policy Framework and Strategic Plan. Three core components are described: residential facilities, day care and outpatient services. Primary mental health care with specialist support is required according to an intervention pyramid. Staffing norms provide for a minimum mental health service coverage of 2.7% of the population for adults and 1.5% for children and adolescents. AIM: The aim of this study was to describe the existing CMHS in Southern Gauteng in terms of the National Mental Health Policy. METHODS: The CMHS of the City of Johannesburg, Ekurhuleni, Sedibeng and West Rand districts were studied. Information regarding service organisation and staffing was obtained via the Gauteng Directorate of Mental Health. Routinely collected District Health Information Systems data for the 2014/2015 year were analysed. RESULTS: The organisation of services was not consistent with that recommended by the Mental Health Policy, and specialist CMHS were inappropriately situated within primary care. Only 2.23% of clinic visits were for mental health, and 80% of these were at specialist CMHS. Overall mental health coverage was approximately 0.3% of the population for adults and 0.02% for children and adolescents. Staffing, residential facilities and day care were far below the cited norms for minimal cover. CONCLUSION: Our audit revealed that the CMHS in Southern Gauteng did not meet any of the norms cited by the Mental Health Policy. Barriers to implementation of this aspect of the Mental Health Policy need to be explored.

Disparate plasma cortisol concentrations in sexually abused female children from Johannesburg, South Africa.

A growing body of research indicates that a bidirectional response to a stressor may occur in maltreated children and may be associated with later life psychopathology. However, few studies have investigated stress reactivity in children when they first present to a sexual abuse clinic. Thus, in order to evaluate whether HPA axis dysregulation would be evident at first presentation to a sexual abuse clinic in young girls (n = 26), between the ages of 6-12 years old, blood samples were obtained immediately following examination at a forensic sexual abuse clinic and from the matched control group of children (n = 14; 10.1 ± 0.8) immediately following a bone density scan. Stratification of the sexually abused group into those children who were reportedly abused by a stranger and had no other family stressors (n = 15, 10.4 ± 1.8) and those children whose parents reported abuse of the child by a stranger and other family stressors (n = 11; 9.5 ± 1.8) revealed differences in stress reactivity. Plasma concentrations, of the children from the forensic clinic, were significantly increased in children who reported abuse by a stranger only (322.3 ± 117.4 nmol/l) and significantly decreased in children whose histories indicated sexual abuse by a stranger and other family stressors (149.6 ± 39.7 nmol/l) when compared to the control group (225.5 ± 47.5 nmol/l). In conclusion, following sexual abuse and a secondary stressor, the forensic examination, there is evidence of divergent cortisol responses in the stratified clinical group of children.

A model for the role of defined spirituality in South African specialist psychiatric practice and training.

The current bio-psycho-social approach in South African psychiatry refers to Engel's extended model of health care. It forms the basis of the existing collaboration between medicine, nursing, psychology, occupational therapy and social work. Psychiatry also has to bridge the multi-cultural, multi-religious and spiritual diverse reality of everyday practice. It has become important to establish how, within accepted boundaries, spirituality should be incorporated into the model for practice. Referring to methods described for nursing theory development, a defined core concept was used to construct a model. It may contribute to the discourse on spirituality in local psychiatry, health and mental health.

Competence of medical students and residents in psychiatry regarding spirituality, at a South African school of clinical medicine.

OBJECTIVE: Elsewhere, curricula for undergraduate and postgraduate psychiatry have been extended to include the role of spirituality. It has also become important to establish how, within accepted professional boundaries, spirituality should be incorporated appropriately into the current model for South African practice and training. The objectives included exploring, analyzing, and describing the views and experience of local academic psychiatrists on this topic. METHODS: This study was designed as an explorative, descriptive, phenomenological qualitative investigation. In-depth, semi-structured interviews were conducted with individual academic specialist psychiatrists as the primary data source. RESULTS: Data saturation was achieved after 13 interviews. "Training of spirituality in psychiatry" emerged as one of six main themes from the integrated interview and literature content. All participants proposed that spirituality must be included in undergraduate medical and specialist psychiatric training. They have suggested that a mentorship model should be considered, which implies the reorientation of the teachers of psychiatry in this regard. CONCLUSIONS: This view concurred with the international medical literature, recommending that spirituality has to be incorporated into specialist psychiatric practice and training, but within professional boundaries and with all faith traditions and belief systems considered equally.

Gender assignment surgery on children with disorders of sex development: a case report and discussion from South Africa.

This case report highlights the dilemma faced by staff with regard to the timing of surgery on a child with a disorder of sex development living in a large, lower socio-economic class, South African, urban township. In this community, children with disorders of sex development can sometimes become an object of interest and ridicule or are thought to be bewitched. Many parents of children with such disorders find it difficult to protect their offspring from the marginalization and rejection that is the consequence of such curiosity and transparency. Current research and theory pertaining to the biological and social bases of gender identity and behaviour are reviewed and their capacity to guide decisions is explored. The absence of a support group to assist these children and their parents, and the paucity of information available in the public domain, compounds an already challenging problem.

Why do individuals with anorexia die? A case of sudden death.

OBJECTIVE: The mechanism of death in anorexia nervosa (AN) is unclear. METHOD: We present a case of sudden death in AN with unexpected autopsy findings. A 36-year-old woman with long-standing AN presented to the eating disorders unit. She was severely underweight with a body mass index of 12.5. Ten days after admission, she went into coma with no obvious precipitant. RESULTS: Clinical examination and investigations failed to reveal its cause. Despite attempts at resuscitation, she died the following morning. A postmortem examination revealed multiple bilateral pulmonary thromboemboli and bilateral calf vein thrombosis. CONCLUSION: This case illustrates that in AN, pathology may not manifest with obvious clinical features. A high level of clinical vigilance is required. The cause of death in AN cannot reliably be established from antemortem clinical features. We recommend that any AN death be reported and that, where possible, an autopsy be performed. This may lead to advances in knowledge and treatment practices.

Race and psychiatric services in post-apartheid South Africa: a preliminary study of psychiatrists' perceptions.

OBJECTIVES: The primary objective of this study was to examine the perception of the quality of psychiatric services five years after apartheid, and specifically whether care for black patients had improved. DESIGN: A survey was distributed to South African psychiatrists during a national congress and by mail. The questionnaire focused on the quality of psychiatric care in general, for black and white patients, the racial composition of each respondent's psychiatric practice currently, and the racial composition of the psychiatric practice during apartheid. RESULTS: Psychiatric services in South Africa were viewed as deteriorating. The end of apartheid has done little to improve the quality of psychiatric care for both black and white patients. Although less pronounced, racial inequality in psychiatric care continues to exist. Psychiatric practices continue to be overrepresented with white patients. CONCLUSION: There remains a differential in quality of psychiatric care and further monitoring should continue. Continued efforts to improve racial equality and the need for greater awareness of cultural issues need to be addressed. Limitations of this study included possible social desirability bias, use of subjective rather than objective measures, and a survey that was limited in scope.

A pilot randomized, double-blind, placebo-controlled study of granisetron in the treatment of sexual dysfunction in women associated with antidepressant use.

A pilot study was conducted to evaluate the usefulness of granisetron for the treatment of antidepressant induced sexual dysfunction in women. Twelve women with antidepressant induced sexual dysfunction (AISD) were assigned granisetron (n=5) or placebo (n=7) in a 14-day randomized, double-blind, placebo-controlled study. One participant in the granisetron group did not complete the study. Participants were assessed at baseline, day 7 and day 14 using the Feiger Sexual Function and Satisfaction Questionnaire and the Arizona Sexual Experience Scale. No statistical differences were measured at baseline or at endpoint between the granisetron or placebo group. This study did not produce evidence supporting the usefulness of granisetron in AISD.

Application of the Eating Attitudes Test (EAT-26) in a rural, Zulu speaking, adolescent population in South Africa.

This study was undertaken as part of an exploration of the potential risk for future eating disorders in the black female population of South Africa. Previous research has documented eating attitudes suggesting that such a risk exists in urban populations. A translated version of the Eating Attitudes Test (EAT-26) was applied in a Zulu speaking, rural population (n=361). A prevalence of 3% for abnormal eating attitudes was established. In keeping with the hypothesis, the findings suggest that the risk for developing an eating disorder in a rural population is somewhat lower. In this regard, there does appear to be an urban-rural divide, which may have implications for the prevention of the emergence of eating disorders in black, South African adolescents. However, the validity of the EAT-26 in this population is a consideration in interpreting the data.