South African Psychiatric Hospital Research Articles

“They are not even called by name.”: Security guards in a South African Psychiatric Hospital.

BackgroundSecurity guards (SGs) play a significant role in health care and are an integral part of many psychiatric institutions. While their main duty is to ensure service users’ (SUs) and staff's safety and protect the premises, they are also called upon for other tasks, often ones for which they are not adequately trained. This study aimed to explore the roles, formal and informal tasks performed, working conditions and well-being of SGs working in psychiatric services. MethodsGuided interviews were conducted with n = 12 SGs and n = 18 mental healthcare providers (MHCPs) at a psychiatric hospital in the Western Cape of South Africa. All interviews were audio recorded, transcribed verbatim and analyzed using a thematic analysis approach. ResultsIn addition to ensuring safety, SGs take on numerous informal tasks, often for which they are not adequately trained and which formally fall under the purview of other MHCPs, mostly nurses, including talking with SUs about their mental health issues, dressing, showering, feeding, and administering medication. SGs also serve informally as interpreters, raising ethical concerns regarding accuracy and confidentiality. SGs lack formal training for working in psychiatric services and handling aggressive SUs, which may lead to increased violence instead of de-escalation and, in the worst case, injuries. SGs work under precarious working conditions (i.e. low salary, outsourced employment, absence of labour rights and job insecurity) and lack professional recognition, potentially leading to lower job satisfaction and increased emotional distress. ConclusionAddressing the challenges outlined in the study requires collaborative efforts between government, psychiatric institutions, private security companies, SGs and MHCPs. The establishment of clear roles, implementation of comprehensive formal training, psychosocial support and improved working conditions, particularly in-house employment, higher pay, increased employee rights and job security, are needed.

Patients' voices from music therapy at a South African psychiatric hospital.

BackgroundIn the Life Esidimeni tragedy, crucial voices of mental healthcare users and practitioners were silenced, captured in the Ombud’s report as a ‘failure to listen’. Working against this kind of failure, various therapeutic interventions listen deliberately and uncover the voice of the patient, that is, what matters from his or her subjective perspective in his or her particular circumstances. Amongst these interventions, music therapy provides for this sensitive listening by expanding the scope and means of expression from the verbal to the musical.AimThis article reports on a qualitative exploration of patients’ lived experiences both during and after their course of individual music therapy, expressed both verbally and in the language of active music-making.SettingA tertiary public psychiatric hospital in South Africa.MethodsAudio-video recordings of 131 music therapy sessions and 15 post-therapy interviews were analysed thematically. From three sets of themes accounting for patients’ verbal contents, musical participation and verbal post-therapy reflections, 11 salient voices were identified.ResultsThe 11 voices that emerged were (1) the voice of struggle, (2) the voice of disturbance, (3) the voice that feels, (4) the voice of isolation, (5) the powerless voice, (6) the voice that desires, (7) the voice of flow and connection, (8) the reflecting voice, (9) the symbolic voice, (10) the resilient voice and (11) the voice of liberation.ConclusionAlthough mental health practitioners may recognise these voices from their clinical experience, space and opportunity for hearing the voice of each patient should be generated deliberately.

Illicit drug use and violence in acute psychosis among acute adult admissions at a South African psychiatric hospital

The prevalence of mental illness and illicit substance use has increased markedly in South Africa's Western Cape Province, over the last 2 decades; potentially increasing demand for psychiatric care. This paper describes the demographic and substance use profile of patients admitted to Lentegeur (LGH), the largest of the four psychiatric hospitals in the Province. Medical records, patient interviews and other clinical notes were used to collect data on demographics, illicit substance use, violent behaviour and utilization of rehabilitative services for patients (n=535) admitted to LGH between 1 August 2012 and 31 January 2013. Majority of admissions were male (65.6%) and younger (69.8% < 35 years) compared to females (62.6% >35 years). Overall, 255 (49%) used an illicit substance, (24% females and 63% males). Majority of substance users were youth (18-35 years) in both males (83.1%) and females (73.8%). Cannabis and methamphetamine were the most popular drugs in males (56.3% and 34.9%) and females (17.9% and 16.2%) with the highest rates being among the youth. Violence was common among both men (60.7%) and women (40.8%); among the violent, 67% of males and 35.6% of female used substances. Only 5.5% of drug users utilized formal drug rehabilitation services. Substance use and violence were high, yet only a small proportion of the patients utilised available drug rehabilitation services. This may have implications on psychotic relapses, morbidity and subsequent pressure on financial resources within the health care system. Efforts are needed to maximise utilisation of existing rehabilitative resources for these patients.

Overcrowding as a possible risk factor for inpatient suicide in a South African psychiatric hospital

About 4% of all suicides are estimated to occur while being an inpatient in a psychiatric facility. Staff generally assume that an inpatient suicide reflects a failure on their part to recognise the patient’s suicidal intent and whether it could have been prevented in any way. Inpatients who commit suicide do not seem to be a homogenous group, but some risk factors have been identified, including being young, single, male, unemployed, abusing substances, schizophrenia and personality- and affective disorders. Number of admissions in the previous month also appears to be a risk factor. When the numbers of inpatients are high, more violent incidents occu. Although literature presently do not suggest an association, overcrowding in psychiatric inpatient wards should be considered a risk factor for inpatient suicide.

Overcrowding as a possible risk factor for inpatient suicide in a South African psychiatric hospital

&lt;p&gt;About 4% of all suicides are estimated to occur while being an inpatient in a psychiatric facility. Staff generally assume that an inpatient suicide reflects a failure on their part to recognise the patient’s suicidal intent and whether it could have been prevented in any way.&lt;/p&gt;&lt;p&gt;Inpatients who commit suicide do not seem to be a homogenous group, but some risk factors have been identified, including being young, single, male, unemployed, abusing substances, schizophrenia and personality- and affective disorders. Number of admissions in the previous month also appears to be a risk factor.&lt;/p&gt;&lt;p&gt;When the numbers of inpatients are high, more violent incidents occu. Although literature presently do not suggest an association, overcrowding in psychiatric inpatient wards should be considered a risk factor for inpatient suicide.&lt;/p&gt;

The potential consequences of informal interpreting practices for assessment of patients in a South African psychiatric hospital

In South Africa health care practitioners are commonly professionals who speak only one, or at most two, of the languages spoken by their patients. This provides for language provision challenges, since many patients are not proficient in English or Afrikaans and ad hoc and haphazard arrangements are made for interpreting by untrained personnel. As part of a larger study (conducted in 2010) in a public psychiatric hospital, we report here on the potential consequences for diagnostic assessments of 13 psychiatric evaluations mediated by ad hoc interpreters who were employed as health care workers and household aides. The psychiatric evaluations were recorded and transcribed verbatim. The first author checked for accuracy of transcription and translations, and the two members of the author team who are both senior African language academics rechecked transcription and translation. We used the typology developed by Vasquez and Javier (1991) to study interpreter errors (i.e. omissions, additions and substitutions). All errors were independently rated by a senior psychiatrist and a senior clinical psychologist to determine whether the errors were likely to have a bearing on clinical decisions concerning the patient and to rate whether errors deemed clinically significant contributed to making the patient appear more ill psychiatrically, or less ill. Of the 57 errors recorded, 46% were rated as likely to have an impact on the goal of the clinical session. Raters concurred that the clinically significant errors contributed towards potentially making the patient look more psychiatrically ill. Detailed analyses of evaluations demonstrate the complexity of informal interpreter positioning regarding issues of diagnosis and cultural factors in illness. Evaluations conducted where clinicians and interpreters are not trained in language and interpreting issues may create a distorted picture of the patients' mental health conditions.

The accuracy of interpreting key psychiatric terms by ad hoc interpreters at a South African psychiatric hospital

This study examined the competence and accuracy of ad hoc interpreters in interpreting key psychiatric terms at a South African psychiatric hospital Nine individuals were asked to translate key psychiatric terms from English to Xhosa. These translations were then back-translated by independent translators, who do not have knowledge of psychiatric terminology. These back-translations were then compared with the original English. It was clear that not all the participants were fully competent in English. None had formal training in interpreting or psychiatric terminology. Not all of the participants were familiar with the psychiatric concepts that clinicians use and they often made mistakes while interpreting. The competency levels of interpreters are unsatisfactory to ensure the optimal delivery of mental health care. It is clear that there is a need for trained interpreters in South Africa, as the continuous use of untrained interpreters compromises the effectiveness of mental health care and could lead to adverse health outcomes.

Recollected experiences of first hospitalisation for acute psychosis among persons diagnosed with schizophrenia in South Africa

&lt;p&gt;First-time admission to a psychiatric hospital for acute psychosis has been reported to be extremely traumatic, and this has not been adequately researched in the South African context. This study approached persons diagnosed with schizophrenia and explores their recollected, subjective experiences of their first admission to a South African psychiatric hospital ward for acute psychosis. Semi-structured individual interviews were conducted with seven participants diagnosed with schizophrenia. These were analysed using thematic content analysis. While some participants had positive experiences, the majority reported frightening, distressing, emotionally painful or traumatic experiences during their first hospitalisation. The first hospital admission was also described as having serious long-term implications for the person’s wellbeing, particularly as the diagnosis of schizophrenia made them feel isolated and stigmatised, which further hinders them from recovering from their symptoms and reintegrating into society. This study therefore draws attention to aspects of the process of first admission to psychiatric wards in South Africa, which may benefit from proactive intervention and closer research attention.&lt;/p&gt;

Recollected experiences of first hospitalisation for acute psychosis among persons diagnosed with schizophrenia in South Africa

First-time admission to a psychiatric hospital for acute psychosis has been reported to be extremely traumatic, and this has not been adequately researched in the South African context. This study approached persons diagnosed with schizophrenia and explores their recollected, subjective experiences of their first admission to a South African psychiatric hospital ward for acute psychosis. Semi-structured individual interviews were conducted with seven participants diagnosed with schizophrenia. These were analysed using thematic content analysis. While some participants had positive experiences, the majority reported frightening, distressing, emotionally painful or traumatic experiences during their first hospitalisation. The first hospital admission was also described as having serious long-term implications for the person’s wellbeing, particularly as the diagnosis of schizophrenia made them feel isolated and stigmatised, which further hinders them from recovering from their symptoms and reintegrating into society. This study therefore draws attention to aspects of the process of first admission to psychiatric wards in South Africa, which may benefit from proactive intervention and closer research attention.

The ‘revolving door’: a profile of acute admissions at a South African psychiatric hospital

This paper reports admission rates within the acute service at a major South African tertiary psychiatric facility, Lentegeur Psychiatric Hospital (LPH) in Cape Town.

The ‘revolving door’: a profile of acute admissions at a South African psychiatric hospital

This paper reports admission rates within the acute service at a major South African tertiary psychiatric facility, Lentegeur Psychiatric Hospital (LPH) in Cape Town.

Competence of Interpreters in a South African Psychiatric Hospital in Translating Key Psychiatric Terms

Provision of good-quality interpreting services in mental health practice is essential, but little is known about interpreting psychiatric terms in low-and middle-income countries. This study examined the basic translation competencies of interpreters in a South African psychiatric hospital. In the context of a larger study, six individuals who interpreted from English into Xhosa were asked to translate key psychiatric terms into Xhosa. These translations were back-translated by translators unfamiliar with psychiatric terminology, and back-translations were compared with the original English. Some interpreters had a very limited command of English. None had formal training in interpreting. Not all were familiar with core psychiatric concepts. Incorrect translations were often made. The competence level of the interpreters was not conducive to optimal care. The lack of formally trained interpreters in South Africa's public health services could lead to misdiagnosis and could compromise interventions.

Competence of Interpreters in a South African Psychiatric Hospital in Translating Key Psychiatric Terms

Competence of Interpreters in a South African Psychiatric Hospital in Translating Key Psychiatric Terms

Linguistic Competence of Interpreters

Linguistic Competence of Interpreters

Perspectives and Practices of Xhosa‐speaking African Traditional Healers when Managing Psychosis

The aim of this study was to investigate perspectives and practices of Xhosa‐speaking African traditional healers, known as “amagqirha”, in managing psychosis. Four traditional healers, 3 male and one female, were chosen to take part in the study through their association with psychosis patients undergoing treatment at a South African psychiatric hospital in Cape Town. In‐depth interviews were used to collect data. The interviews were conducted in Xhosa and were tape‐recorded. Following translation, the verbatim transcripts were analysed using thematic content analysis. The main themes that emerged from the analysis were grouped under the following 3 main issues: diagnosis, aetiology, and treatment. In terms of diagnosis, the African traditional healers identified symptoms of psychosis, which are consistent with the Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) criteria for schizophrenia. With regards to aetiology, supernatural powers such as witchcraft, spirit possession, angered ancestors, and genetic predisposition were articulated. Regarding treatment of psychosis, cleansing the patient and his or her family of evil spirits through washing, steaming, and induced vomiting were of major importance, followed by a group of traditional healers evocating evil spirits at the patient's home through singing and dancing. Implications of the findings for the continued co‐existence and cooperation between traditional and western healing systems are discussed.

The politics of black patients' identity: Ward-rounds on the ?black side? of a South African psychiatric hospital

There are many macrosocial studies of the political organisation of health and mental health care in South Africa, and the maldistribution of resources by race is well known. Little attention, however, has been given to the minutiae of the negotiation of power in the clinical setting. This article, which reports on part of a larger study of aspects of culture in South African psychiatry, focuses on interactions in ward-rounds on the 'Black side' of a South African psychiatric hospital. Through analysis of cases, the complexity of interpreting what transpires in such a setting and the central role that the concept of culture has in debates amongst staff members are demonstrated. Close analysis demonstrates the inadequacy of models which seek to locate the institutional racism of apartheid psychiatry in the motives of individual clinicians. Clinicians may simultaneously reproduce and subvert aspects of apartheid practice. A consideration of the social positioning of the clinician both as a South African and as a practitioner of psychiatry is central to the development of psychiatry in a post-apartheid South Africa.