Involuntary First Admissions to a Tertiary Psychiatric Hospital in Cape Town: A Five Year Review of Family Referrals to Psychology

Abstract

Background: Valkenberg Hospital is one of three tertiary psychiatric hospitals in Cape Town – and has a catchment area population of over one million. It is an acute admissions hospital for adults (18-59 years). Objectives: This article aimed to determine the psychosocial history of male patients involuntarily admitted to a high care psychiatric unit for the first time, and the needs and concerns of their families, to allow for the development of more appropriate services. Method: The psychology family clerking interviews (June 2007 – June 2012) of the Male High Care Unit (MHCU) of Valkenberg Psychiatric Hospital’s first admission families (FAF) were reviewed. All of the patients in the chart review were severely psychotic and had not been able to be managed at a secondary hospital level, which had necessitated their referral to Valkenberg. Each clerking interview with the family lasted 1.5 to 2 hours, and was conducted by the Intern Clinical Psychologist placed at Male Admissions. All 225 available folders were reviewed and coded. Results: The majority of the patients were young (mode = 21), still living at home (80%), single (90%) and unemployed (65%).More than 80% of the men were given a working diagnosis of either Substance Induced Psychotic Disorder (SIPD: 46%), Schizophrenia (27%) or Bipolar (11%). There was a strong family history of severe mental illness (SMI: 49 %), psychiatric admissions (30%), depression (26%), suicide (18%), substance use (SUD in parent/s: 45%, siblings: 36%) and domestic violence (30%). Most families suspected that the patient had used drugs and police had had to be involved in at least 40% of the admissions. Despite nearly half of the patients expressing regret at their substance use, more than half the families reported that the patient had become aggressive and that at some stage they had feared them. The families most identified the patients’ admission as their greatest stressor. The second most identified greatest stressor was finances, with 40% of the families being in debt and more than a third of the families being either unable to or financially struggling to visit the patient while he was admitted. Conclusion: For many patients and their families, the times before and during the admission had been long and traumatic. Family intervention was necessary to provide more effective help-seeking methods, and to provide services that simultaneously looked at co-morbid substance use, depression and anxiety, suicidal thinking, social isolation and domestic violence, often in the background of poverty. It was highly recommended that the development of services aimed at treating dual diagnosis (severe mental illness or the risk thereof, and substance use disorder) be developed and prioritised.