The mental health industry has grown exponentially in South Africa over the last decade. Experts have described mental health problems as reaching epidemic levels. The only national representative survey of mental illness was conducted between 2002 and 2004 (over a decade ago) which interviewed a representative sample of 4 351 adults across the country. The South African Stress and Health (Sash) study showed that 16.5% of respondents suffered from some or other form of mental disorder in the 12 months it covered.
If one considers the increase not only in professional practitioners, but also in medical wellness facilities, this indeed signifies a phenomenal increase in the need for treatment. The Life Esidimeni matter may have highlighted the State’s shortcomings on improving the care, treatment and facilities available to mental health patients; however, the private sector has also recognised the dire state of care and taken progressive steps in addressing the challenge. With over forty licensed private mental health treatment hospitals or clinics in South Africa, the medical industry has stood up and taken note, but are we in danger of taking a very delicate treatment offering that requires expert skills and turning it into a mega-industry?
Warren Pezaro, hospital manager at Palm Tree Clinic, a Cape-Town based psychological and emotional wellness clinic specialising in a number of conditions including anxiety, depression and personality disorders, says that admitting patients into the care of a mental health facility should not be a “cut and paste” process. According to Pezaro, a patient is an individual to be cared for and not a medical condition to be treated. Each patient is a unique person with needs and therefore factors such as nurse-to-patient ratio, therapist-to-patient ratio, the setting and environment of the facility, the existing patient population and their conditions should be considered before choosing a facility for psychiatric admission.
Psychiatrist Dr Kirsten Reid says that when admitting a patient into a facility, certain factors should be considered for maximum benefit. “Each person requires an individualised treatment plan with consideration given to holistic, in-hospital care, a multi-disciplinary team approach and the availability of facilities that are required for the care of that patient’s specific needs.”
Staff-to-patient ratio
According to Pezaro, hospitals and health systems often establish acuity systems as a valuable tool to allocate nursing resources based on patient care needs. However, these organizations don’t always use their acuity systems to their full capability. In many cases, at least one of what we call “the five rights of staffing” is absent.
According to “the five rights of staffing,” an acuity system should give hospitals:
1) The right number of staff
2) With the right skills
3) At the right location
4) At the right time
5) With the right assignment.
The maximum benefits from an acuity system can be achieved when these five aspects are used together to efficiently leverage existing nursing resources, preventing the need to rely on expensive options such as outside staffing agencies.
Reid outlines the benefits of a lower patient-to-staff ratio not only to the patient, but equally important to the medical practitioner. “When the staff-to-patient ratio is high, the nursing staff are able to observe each patient more closely and can get to know each person as an individual. This helps doctors and care-givers too as feedback from the nursing staff is more detailed and relevant and assists us in our goal for effective, individualised care.”
Therapeutic environment
Reid says that the surrounding environment in mental health care is of paramount importance. “The positive therapeutic effect of a place that feels homely and comforting rather than institutional is a reality. Also, the more appealing the environment, the more likely a patient will be open to admission.” Surroundings should be geared to promote healing by being a supportive, therapeutic and caring environment; preparing patients to return to the community; providing a place of safety from external hazards; and being a home where people live as well as work and visit. It is increasingly acknowledged that the physical environment of healthcare facilities has a considerable role to play in addressing such needs.
The program
Overall experience of treatment is a particularly under-researched area. Evidence-based treatment methods are being used but the clinical and professional team who are facilitating these programs must be appropriately trained and skilled and act within their scope of practice. Before admitting a patient, research should include the program offering, the content and time-table, facilitators and presentation. The content of the program and the way it is presented are very important to the patient care. Outcomes and results must also be captured and assessed in order to measure effectiveness.
Patient peer group
The cohort of patients is of utmost importance. When admission into a facility is being considered, one should investigate the make-up of the patients who are in-house and who will be receiving treatment, undergoing group therapy, sharing breakfast and meals or a room with their new admission.
Reid agrees that certain clinics are more suited to certain individuals and a large aspect of that decision is around the patient cohort and the community at the clinic.
Team of collaborators
Consideration to other practitioners who are consulting to patients in a facility can also be a deciding factor. Doctors and specialist care-givers rely on collaboration and this is often easier in a smaller facility. Larger facilities will offer a greater variation of specialised treatment and access to specialists, but large teams and a high ratio of patient-to-nursing staff can dilute effective collaboration. Interaction between patient, staff and medical practitioners in a smaller ward or facility can be more flexible and individualised. Effective co-operation via team meetings, information handover and team co-ordination can be more streamlined in a smaller facility.
Licensing and Lawfulness
Legitimacy of the facilitation and staff should also be confirmed by checking various license requirements. Facilities must be registered and compliant with The Department of Health, The Department of Social Development and staff must be licensed and registered with the Health Professional Council of South Africa.
Success of mental health treatment is extremely difficult to measure and statistics can prove unreliable. Patient experience and patient satisfaction are terms that are interchangeably used as important measures of efficiency and effectiveness of the services being provided in the healthcare environment. In modern-day healthcare, there is a constant push to improve quality in healthcare delivery. The shift to individualised care and in mental health treatment is a big one.
Patients who are admitted to mental health facilities are there because one-on-one treatment and all other interventions have failed. Summing up, Pezaro says: “Thankfully we have come a long way from the days of straitjackets and sanatoriums and the necessity for careful placement and mindful admissions has never been more profound.”
