South African Society Of Psychiatrists Research Articles

Cultural formulation interview: Awareness and attitudes of South African psychiatrists and psychiatry registrars.

BackgroundThe Cultural Formulation Interview (CFI) includes a set of 16 questions formulated for clinicians to obtain information about cultural influences on an individual’s clinical presentation during a mental health assessment. The CFI is a newly formulated interview that has been evaluated in various localities, but not in South Africa.AimWe assessed the awareness and attitudes of South African psychiatrists and psychiatrists in training towards the CFI and its use in their patient care.SettingParticipants were recruited via the South African Society of Psychiatrists (SASOP) database and were invited to complete an online questionnaire.MethodsCertain demographic aspects of psychiatrists and psychiatrists in training were compared with regard to their awareness of and attitudes towards the CFI.ResultsOf the 75 participants who completed the questionnaire, only 46.7% (n = 35) were aware of the CFI, and of these, only 5.3% (n = 4) used the CFI. There was generally a positive attitude towards the CFI with the majority of the participants agreeing that the CFI is easy to understand and relevant in clinical practice; however, none of the results showed statistical significance. Most participants who were aware of the CFI (89%, n = 31) were of the opinion that the CFI would prolong their patient assessment time.ConclusionMost participants had a positive attitude towards the CFI. The negative response regarding the CFI prolonging patient assessment time could be a potential barrier in its clinical application. This study is an essential first step for further research into the CFI and its use in SA and contributed towards improving awareness of the CFI.

Following on from the Life Esidimeni incident – access to care for people living with severe mental disability, according to national policy

Following the release in February 2017 of the health ombudsman’s report on the deaths of psychiatric patients in Gauteng Province, South Africa (SA) (the Life Esidimeni incident), the South African Society of Psychiatrists (SASOP) has called for a complete overhaul of the mentalhealthcare system in terms of the principles of existing mental-health policy, in particular the National Mental Health Policy Framework and Strategic Plan 2013 - 2020 (NMHPF and SP). Overhauling the mental-healthcare system according to the NMHPF and SP will include the identification and costing of the required facility and staffing interventions that must be put into place to ensure capacity and integration on the different service levels, namely: residential and day-care community-based facilities and programmes, providing a range of care, treatment and rehabilitation services with a fulltime multidisciplinary team available; primary mental-healthcare services at district level;a specialist community-psychiatry service; acute psychiatric units in secondary, tertiary and central general hospitals; and specialised psychiatric beds.

The South African Society of Psychiatrists/Psychiatry Management Group management guidelines for adult attention-deficit/hyperactivity disorder.

DisclaimerThese guidelines do not aim to provide a comprehensive review of all the pertinent literature comprising the evidence base and, as such, should be utilised in conjunction with other guidelines as well as the responsibility of practitioners to maintain a high level of personal knowledge and expertise. Despite the known efficacy of treatment and the substantial costs of untreated attention-deficit/hyperactivity disorder (ADHD), access to healthcare and treatment is not a given for many patients in South Africa (SA). In SA, there is poor identification and treatment of common mental disorders at primary healthcare level and limited access to specialist resources with a service delivery and treatment gap of up to 75%. Medication options are also often limited in emerging markets and in SA psychiatrists, and patients do not have access to the medication armamentarium available in established markets. Furthermore, the majority of South Africans currently utilise the public healthcare sector and may not have access to treatment options referred to in these guidelines. These guidelines should therefore not be seen as a policy document.The processThe South African Society of Psychiatrists’ Special Interest Group (SIG) for adult ADHD was launched on 25 September 2015, with doctors Rykie Liebenberg and Renata Schoeman as convenor and co-convenor, respectively. The overall objective of the ADHD SIG is to improve the basket of care available to patients with ADHD. This is only possible through a combined and concerted effort of individuals with a special interest in and passion for ADHD to improve knowledge about and funding for the care of individuals with the disorder. One of the specific aims of the ADHD SIG was to develop South African guidelines for the diagnosis and treatment of adult ADHD specifically and update guidelines for the treatment of child, adolescent and adult ADHD. Dr Schoeman has recently completed her MBA at the University of Stellenbosch Business School with a thesis entitled ‘A funding model proposal for private health insurance for adult attention-deficit/hyperactivity disorder in the South African context’. This is first South African study exploring the situation with regard to the prevalence and treatment of adult ADHD. Dr Schoeman was tasked by the SIG with the drafting of guidelines. Dr Liebenberg provided valuable input. The guidelines were then circulated to the SIG members, as well as the Chair of the Public Sector SIG, for written feedback and evidence-based suggestions which were then incorporated into the guidelines. The final guidelines were circulated for written approval by the SIG members, followed by formal approval at a SIG meeting held on 14 August 2016, after which it was submitted to the South African Society of Psychiatrists (SASOP) and Psychiatry Management Group (PsychMG) boards for recommendation and ratification.

Reconciliation and psychiatry in South Africa.

Although psychiatrists did not form part of the structures of the South African Truth and Reconciliation Commission (TRC), the Society of Psychiatrists of South Africa (SPSA) at the time did make a submission. Since then, the local association of psychiatrists has been reconstituted as the South African Society of Psychiatrists (SASOP). Psychiatry and psychiatrists may have to extend their activities beyond rehabilitation and restoration, to include endeavours to prevent future violations of human rights.

South African Society of Psychiatrists guidelines for the integration of spirituality in the approach to psychiatric practice

<p><strong>Background. </strong>It was important to develop South African guidelines in view of the extent of local and worldwide religious affiliation, rapid growth of academic investigation, guidelines provided by other associations (e.g. Royal College of Psychiatrists), the South African Society of Psychiatrists (SASOP)’s own position statements on culture, mental health and psychiatry, the appropriate definition of spirituality, the need for an evolutionary and anthropological approach, the <em>Diagnostic and Statistical Manual of Mental Disorders</em>, 5th edition (DSM-V)’s cultural formulation, local legislation, ongoing research, and teaching requirements. </p><p><span><strong>Objective.</strong> To report on the outcome of the peer-reviewed process that was followed to draft local guidelines for psychiatric training and practice. </span></p><p><strong>Methods.</strong> During 2013, comments by members of the SASOP on a framework for guidelines on the role of spirituality in psychiatry practice and training were collated and subsequently submitted to the SASOP board for approval. </p><p><strong>Results.</strong> Guidelines were compiled in terms of: (<em>i</em>) integrating spirituality in clinical care and service provision; (<em>ii</em>) integrating spirituality in psychiatric training; (<em>iii</em>) ethically integrating spirituality within the professional scope of practice; and (<em>iv</em>) appropriate referral between psychiatrists and spiritual advisors. </p><p><strong>Conclusions.</strong> Integrating spirituality in the approach to practice and training cannot be ignored by local psychiatrists in the multicultural, multireligious and spiritually diverse South African context.</p>

Does religious identification of South African psychiatrists matter in their approach to religious matters in clinical practice?

<p><strong>Background.</strong> It is not known whether psychiatrists’ approach to religious matters in clinical practice reflects their own identification or non-identification with religion or their being active in religious activities. </p><p><strong>Objective. </strong>This question was investigated among South African (SA) psychiatrists and psychiatry registrars, including the importance they attach to the religious beliefs of patients for diagnostic and therapeutic purposes.</p><p><strong>Methods.</strong> Respondents from the SA Society of Psychiatrists (SASOP) completed a purpose-designed questionnaire anonymously online. Respondents were compared statistically with regard to whether they identified with a religion, and the regularity of their participation in religious activities. Further comparisons were made based on gender and years of clinical experience.</p><p><strong>Results. </strong>Participants who identified with a religion showed no statistical differences in comparison with those who did not, regarding: how they viewed the importance of a patient’s religious beliefs for purposes of diagnosis, general management, psychotherapy, pharmacotherapy, recovery from an acute episode, maintenance of recovery or remission, time to be spent on religious education, referral for religious/spiritual counselling according to patient’s own beliefs; referral when patient and participant are of different religions; and whether referral is considered harmful when a patient’s religious beliefs are similar to or different from the participant’s. Statistically significant differences were found where participants who did not identify with a religion were more likely to indicate religion had ‘little importance’ for the purpose of understanding the patient and to indicate ‘no’ when asked if they would refer a patient for religious/spiritual counselling. When comparing regularity of participation in religious gatherings, participants who indicated their participation as ‘no/never’ were more likely to answer ‘no’ when asked if they would refer a patient for religious/spiritual counselling, even when of a similar religion to that of their patient. In comparing genders, males were more likely to answer ‘yes’ than females when asked if they considered religious/spiritual counselling (in accordance with the patient’s own religious beliefs) potentially harmful when the patient’s religion was different from the participant’s.</p><p><strong>Conclusion. </strong>It appears that SA psychiatrists’ identification with religion and regularity of participation in religious gatherings do not influence their approach to religious matters of their patients in most respects. The exception seems to be for those psychiatrists who do not identify with a religion (~16%), who tend to respond that they do not refer for religious counselling and that they consider the patient’s religious identification to be of little importance in understanding the patient.</p>

South African Society of Psychiatrists guidelines for the integration of spirituality in the approach to psychiatric practice

Background. It was important to develop South African guidelines in view of the extent of local and worldwide religious affiliation, rapid growth of academic investigation, guidelines provided by other associations (e.g. Royal College of Psychiatrists), the South African Society of Psychiatrists (SASOP)’s own position statements on culture, mental health and psychiatry, the appropriate definition of spirituality, the need for an evolutionary and anthropological approach, the Diagnostic and Statistical Manual of Mental Disorders , 5th edition (DSM-V)’s cultural formulation, local legislation, ongoing research, and teaching requirements. Objective. To report on the outcome of the peer-reviewed process that was followed to draft local guidelines for psychiatric training and practice. Methods. During 2013, comments by members of the SASOP on a framework for guidelines on the role of spirituality in psychiatry practice and training were collated and subsequently submitted to the SASOP board for approval. Results. Guidelines were compiled in terms of: ( i ) integrating spirituality in clinical care and service provision; ( ii ) integrating spirituality in psychiatric training; ( iii ) ethically integrating spirituality within the professional scope of practice; and ( iv ) appropriate referral between psychiatrists and spiritual advisors. Conclusions. Integrating spirituality in the approach to practice and training cannot be ignored by local psychiatrists in the multicultural, multireligious and spiritually diverse South African context.

Integrating spirituality in the approach to psychiatric practice

Interest in spirituality and psychiatry has grown significantly over the past two decades. Since the 1990s, interest groups have been formed by several professional associations in the USA, Canada, the UK, the Netherlands, Brazil and Australia. Interest in spirituality, religion and culture has, however, always existed in Africa and has recently in a South African (SA) context also emerged more publicly in secular areas such as health and mental health, where the need to be ‘culturally competent’ has extended to competence regarding the multireligious and spiritually diverse contexts of local medical practice. Locally, in SA, a Spirituality and Psychiatry Special Interest Group (S&PSIG) of the South African Society of Psychiatrists (SASOP) was established with the objectives, among others, to promote, maintain and protect the discipline of psychiatry as a medical speciality as far as it relates to spirituality as an additional dimension to the biopsychosocial model, and to provide a forum to clarify concepts and professional boundaries. It also became important to develop local guidelines, which was initiated by the S&PSIG, undertaken in view of the extent of local and worldwide religious affiliation, rapid growth of academic

Does religious identification of South African psychiatrists matter in their approach to religious matters in clinical practice?

Background. It is not known whether psychiatrists’ approach to religious matters in clinical practice reflects their own identification or non-identification with religion or their being active in religious activities. Objective. This question was investigated among South African (SA) psychiatrists and psychiatry registrars, including the importance they attach to the religious beliefs of patients for diagnostic and therapeutic purposes. Methods. Respondents from the SA Society of Psychiatrists (SASOP) completed a purpose-designed questionnaire anonymously online. Respondents were compared statistically with regard to whether they identified with a religion, and the regularity of their participation in religious activities. Further comparisons were made based on gender and years of clinical experience. Results. Participants who identified with a religion showed no statistical differences in comparison with those who did not, regarding: how they viewed the importance of a patient’s religious beliefs for purposes of diagnosis, general management, psychotherapy, pharmacotherapy, recovery from an acute episode, maintenance of recovery or remission, time to be spent on religious education, referral for religious/spiritual counselling according to patient’s own beliefs; referral when patient and participant are of different religions; and whether referral is considered harmful when a patient’s religious beliefs are similar to or different from the participant’s. Statistically significant differences were found where participants who did not identify with a religion were more likely to indicate religion had ‘little importance’ for the purpose of understanding the patient and to indicate ‘no’ when asked if they would refer a patient for religious/spiritual counselling. When comparing regularity of participation in religious gatherings, participants who indicated their participation as ‘no/never’ were more likely to answer ‘no’ when asked if they would refer a patient for religious/spiritual counselling, even when of a similar religion to that of their patient. In comparing genders, males were more likely to answer ‘yes’ than females when asked if they considered religious/spiritual counselling (in accordance with the patient’s own religious beliefs) potentially harmful when the patient’s religion was different from the participant’s. Conclusion. It appears that SA psychiatrists’ identification with religion and regularity of participation in religious gatherings do not influence their approach to religious matters of their patients in most respects. The exception seems to be for those psychiatrists who do not identify with a religion (~16%), who tend to respond that they do not refer for religious counselling and that they consider the patient’s religious identification to be of little importance in understanding the patient.

SASOP treatment guidelines for psychiatric disorders: Eminence or evidence based?

In August 2013, the South African (SA) Society of Psychiatrists (SASOP) published their treatment guidelines for psychiatric disorders. We commend the authors and editors for completing such a huge undertaking. In the spirit of ongoing peer review, we would like to point out a few issues that may warrant consideration for future guideline updates.

The South African Society of Psychiatrists is speaking up for good reasons

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Contributions from the South African Society of Psychiatrists (SASOP) to the National Mental Health Action Plan

<p>The national Mental Health Action Plan (MHAP) flowed from the Ekurhuleni Declaration, adopted at the National Mental Health Summit (NMHS) in April 2012. The final draft of the MHAP included eight national objectives, with key activities which were believed to be ‘catalytic.’ These objectives include: district-based mental health service; institutional capacity; surveillance, research and innovation; infrastructure and capacity; mental health technology, equipment and medicines; inter-sectoral collaboration; human resources; and advocacy, mental health promotion and prevention of illness. A representative group of regional State Employed Special Interest Group (SESIG) delegates met during April 2013, to: operationalise the 12 South African Society of Psychiatrists (SASOP)/SESIG position statements of the previous year; review SASOP’s position statements in the context of the proposed national MHAP; and to identify SASOP’s role and responsibilities accordingly. This paper describes the contextual events in the drafting of the MHAP, as well as the appraisal of the MHAP during the 2013 SASOP/SESIG meeting, and SASOP’S envisaged role and responsibilities according to the national MHAP. </p>

Contributions from the South African Society of Psychiatrists (SASOP) to the National Mental Health Action Plan

The national Mental Health Action Plan (MHAP) flowed from the Ekurhuleni Declaration, adopted at the National Mental Health Summit (NMHS) in April 2012. The final draft of the MHAP included eight national objectives, with key activities which were believed to be ‘catalytic.’ These objectives include: district-based mental health service; institutional capacity; surveillance, research and innovation; infrastructure and capacity; mental health technology, equipment and medicines; inter-sectoral collaboration; human resources; and advocacy, mental health promotion and prevention of illness. A representative group of regional State Employed Special Interest Group (SESIG) delegates met during April 2013, to: operationalise the 12 South African Society of Psychiatrists (SASOP)/SESIG position statements of the previous year; review SASOP’s position statements in the context of the proposed national MHAP; and to identify SASOP’s role and responsibilities accordingly. This paper describes the contextual events in the drafting of the MHAP, as well as the appraisal of the MHAP during the 2013 SASOP/SESIG meeting, and SASOP’S envisaged role and responsibilities according to the national MHAP.

The South African Society of Psychiatrists is speaking up for good reasons

The South African Society of Psychiatrists is speaking up for good reasons

The South African Society of Psychiatrists (SASOP) Treatment Guidlelines for Psychiatric Disorders

The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders have been developed in order to address the local need for guidelines in our unique clinical setting.

The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders

The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders have been developed in order to address the local need for guidelines in our unique clinical setting.

Better attitudes and mental health for our future

Two issues of the South African Journal of Psychiatry applaud a future in which South Africa pursues both better mental health and better attitudes towards psychiatric difficulties and illnesses. The first, a Special Issue of the SAJP, features the Treatment Guidelines of the South African Society of Psychiatrists, [1] which is published by the SAJP without being subsidised by advertisements from the pharmaceutical industry. This is the first publication of its kind in South Africa, resulting from peer consultation and refinement by psychiatrists and carefully compiled and edited by Professors Soraya Seedat and Robin Emsley. It aims to cater to both the public and private sectors of psychiatric practice. Our 'ordinary' issue of the SAJP, the third of 2013 (Vol. 19), has similar concerns to the Special Issue, i.e. advocating better mental health. But it is not 'ordinary' for at least two reasons: it contains the abstracts of the Biological Psychiatry Conference; and the papers published within collectively call for better attitudes towards, and understanding of mental health difficulties. Moosa and Jeenah [2] consider the ethics of provider-initiated HIV counselling and testing among people with mental illness, working against the double stigmatisation attached to both mental illness and HIV status. Also working against stigmatisation, Vijayalakshmi et al. [3] and Pretorius and Broodryk [4] consider misconceptions about mental illness and traumatic brain injuries, respectively, held in educational settings. Both papers propose educational interventions that foster more accurate understanding of, and better attitudes towards mental health difficulties. In their paper on recollected experiences of first hospitalisation for acute psychosis, Zubi and Connolly [5] have found a profound growth point for the furtherance of better attitudes, as well as better mental health practice: progressive efforts to account for the experiences of people who are mentally ill. The paper explores the qualitative properties of these experiences, which may inform how services and practices may be improved for people who are admitted for the first time for an acute psychotic episode. It is noteworthy that the subjects' experience is being taken seriously in spite of their psychiatric illness --psychiatric illness, even of a psychotic kind, does not necessarily preclude a potentially worthy contribution to the improvement of services and practices. This contribution remains modest, however, considering how much scope and need there is for developing ways in which the experiences of people suffering from psychosis and other mental illnesses may be incorporated into mental health service, practice and research. The emerging byword of this growth point is 'co-production. [6] Co-production brings together experts-by-training and experts-by-experience in efforts to construct jointly not only personalised treatment plans, but also diagnostic processes, as well as an approach to mental health research that extends from conceptualisation to publication. …

Is your prescribing serving a hidden addiction?

Addiction to prescription and over-the-counter (OTC) medicines is a hidden, little-researched chronic illness – which could be significantly countered by destigmatisation, ‘up-scheduling’ certain medications, creating a single electronic database across dispensaries and boosting doctor awareness regarding long-term or repeat prescriptions. This is according to Dr Volker Hitzeroth, President of the South African Addiction Medicine Society and convenor of the addictions sub-group of the South African Society of Psychiatrists.

Are we training our psychiatrists adequately as public mental health practitioners?

No abstract available.

The Mental Health Care Act No 17 – South Africa. Trials and triumphs: 2002-2012

The Mental Health Care Act 17 of 2002 (MHCA) was promulgated in 2004. It has been hailed as one of the most progressive pieces of mental health legislation. A true measure of its merit is the degree to which it has transformed mental health services and in particular improved the quality of care. This paper will describe the impact of the Act on mental health care service delivery in the country. Literature pertaining to the MHCA published from 2006-2012, a report compiled by the South African Society of Psychiatrists and the results of a national survey conducted among Heads of Departments of Psychiatry, Mental Health Review Boards and Provincial Directors of Mental Health was reviewed. The MHCA has been successful in shifting the emphasis of care from psychiatric institutions to general hospitals. However, the integration of services has been hampered by infrastructure constraints and shortages of mental health personnel. It has been less successful in integrating mental health care into primary health services where the focus remains largely on the pharmacological maintenance treatment of the chronically mentally ill. Little attention has been given to the health promotion, disease prevention and rehabilitation aspects of care. Mental health review boards contend with limited resources, administrative challenges and limited political support. Isolated pockets of success characterised the implementation of the MHCA across the country. Greater investment of resources is needed to ensure the comprehensive implementation of the Act.