Abstract
BackgroundThe World Health Organization’s action plan for 2020 has identified the need for service-based data to motivate for more appropriate community-based services. To date, there is no published data from step-up or step-down facilities in South Africa.AimTo describe the demographic and clinical profile of all patients admitted to New Beginnings between 01 January 2011 and 31 December 2015.SettingNew Beginnings is an intermediary care facility focused on psychosocial rehabilitation and accommodates 40 patients in a step-up or step-down setting.MethodsIn this retrospective audit, we reviewed the medical records of all patients (N = 730) admitted to New Beginnings between 01 January 2011 and 31 December 2015.ResultsMost admissions were male (n = 600; 82.2%), unmarried (92.1%) and unemployed (92.7%) patients with a mean age of 28 years. Only 20.7% had completed their schooling and 37.9% were receiving a disability grant. Most patients lived in the Cape Town Metro area (89%) with their families (94.7%), and 75.6% had no children. Schizophrenia (53.7%) was the most common primary psychiatric diagnosis, and most patients were on a combination of oral and depot treatment (46.8%). Illicit substances were used by 75.9% of patients with 30% using both cannabis and methamphetamine. Most patients (74.9%) had only one admission to New Beginnings.ConclusionsThese baseline data could inform improved service delivery. Further research is needed to evaluate the success of New Beginnings and highlight the need for more of these facilities in the Western Cape and across South Africa.
Highlights
Deinstitutionalisation in South Africa started in the early 1990s but has not been accompanied by the development of community-based multidisciplinary mental healthcare.[1,2,3,4]
It is an intermediary care facility focused on psychosocial rehabilitation and accommodates 40 patients in a step-up or step-down setting
New Beginnings is regarded as a ward of Stikland Psychiatric Hospital from a management perspective and is funded by the Department of Health
Summary
Deinstitutionalisation in South Africa started in the early 1990s but has not been accompanied by the development of community-based multidisciplinary mental healthcare.[1,2,3,4] The reason for this is multifactorial and includes mental healthcare budget challenges, especially at community level, lack of adequate information systems, lack of development of communitybased services appropriate to the severity of the mental health condition, lack of facilities providing psychosocial rehabilitation and lack of engagement with users and families.[5] the decreased number of inpatient psychiatric beds has put increased pressure on available beds.[6]. Premature discharges are necessary to ensure that more severely, ill patients can be accommodated. This has resulted in high readmission rates, revolving door patterns of care and high-frequency users.[7] These consequences have placed much emphasis on the recovery model and how it can be optimised. There is no published data from step-up or step-down facilities in South Africa
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