What is Psychiatry?
Psychiatry is a medical speciality that deals with the assessment, prevention, diagnosis and treatment of mental health related symptoms and complaints. Mental illness is the cornerstone of the practice of psychiatry, and the clinical symptomatology may include psychological, emotional, behavioural , somatic and cognitive symptoms that may present with distress, disability or loss of personal independence. The field of psychiatry deals with people across the age spectrum, from as early as pregnancy, infancy, childhood, adolescence, adulthood and old age.
Who is a psychiatrist?
A psychiatrist is a medical doctor who has specialized in the field of psychiatry. A psychiatrist is a specialist who is registered with the Health Professions Council of South Africa and is skilled to assess and treat mental health related symptoms and disorders with a range of treatment interventions including prescription medication.
When do I need to see a psychiatrist?
A psychiatrist can be consulted at any time once symptoms related to mental health and illness arise. In South Africa people can consult a psychiatrist in private practice (which is paid for by a medical aid or in cash by the patient) or in public services.
What is the referral pathway in the Public Sector to see a psychiatrist?
Public services differ according to the various provincial department of health resources and clinic allocations. The referral pathway to see a psychiatrist in the public sector is usually via a primary health care screening assessment. This is done by a nurse practitioner, a medical officer or an advanced psychiatric nurse at a local clinic. They will then refer the patient to a district psychiatrist who visits the clinic, or make a referral to a psychiatric service in a district or regional hospital for further consultation. The referral to public sector psychiatrists can also be made by a private General Practitioner, however the same pathway via the local clinic applies.
How can I get admitted to a psychiatric hospital in the state service?
South African regional and district hospitals may have a limited number of beds available for psychiatric admissions. This depends on the province and the availability of specialist psychiatric hospitals in the province.
Admission to hospital for a psychiatric condition is assessed according to risk to the patient and the community, and this is assessed by the primary health care clinic who can then refer to the next level of specialist care.
Risk is determined by a clinical assessment performed by a nurse, a medical doctor or specialist.
The options available for admission to state services are determined by the MENTAL HEALTH CARE ACT (MHCA)of 2003 – where patients can be admitted as Voluntary, Assisted or Involuntary Users according to their level of risk.
The same rule applies to the admission of children over the age of 13 under the MHCA. Children under the age of 12 can only be admitted for psychiatric reasons to a designated child facility which depends on the province that the child resides in.
A member of the public cannot attend a psychiatric hospital without a referral from the appropriate referral pathway as explained in the previous section.
Any request for emergency or involuntary care must be done via the referral pathway, but also can be expedited by requesting the SAPS to assist in dangerous or risky situations.
How can I help someone in crisis?
Psychiatric emergencies can be distressing and traumatic both for those in crisis and those close to them. If the patient is already known to a psychiatrist, contact the treating doctor directly. If you are unsure of their contact details, click here.
Patients who are known to state hospitals will normally need to follow the same process for the state services referral pathway as explained in the previous section.
If the patient is not known to a psychiatrist, but wants help, then the best way to help them is to take them to your local clinic or a GP who can then refer them to a hospital or specialist psychiatrist who will assess what treatment they need and whether they should be admitted. Psychiatrists will usually only see a new patient in an emergency on referral from another doctor.
What if they don't want help?
Unlike other medical emergencies, there are extreme cases where the person in crisis does not want help. This can either be because they are severely suicidal or are unable to make a reasonable decision regarding their care.
If you are concerned about risk to the person or to others and they refuse to comply with a visit to an emergency unit, you can contact the South African Police Service (SAPS) to assist with getting the patient to a local clinic to be assessed by the medical staff.
Depending on the level of risk, the patient will then be assessed for an admission or appropriate care depending on the Mental Health Care Act status. If the patient is assessed as high risk and refuses treatment, and that treatment is determined to be necessary for their safety or the safety of others, they may be admitted via the Involuntary status of the MHCA. Involuntary care can only occur under the MHCA in a state hospital, and this will require your treating doctor to follow the local referral pathway for psychiatric state care in your province.
If they are not violent or aggressive, you can take them directly to a local emergency unit. You may need a referral from a local doctor or clinic to get admitted to an observation unit.
What other options are there for me to get help for mental health problems other than seeing a psychiatrist?
There are many avenues for a person in South Africa to access care related to mental health issues. These may include consulting with counsellors, support groups, NGOs that offer mental health counselling, and psychologists.
A list of resources of these agencies are:
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SADAG Mental Health Line: 011 234 4837
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Suicide Crisis Line: 0800 567 567
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SAPS Emergency: 1011