Reinstitutionalization by stealth: The Forensic Mental Health Service is the new chronic system

Kaliski, Sean

doi:10.4314/ajpsy.v16i1.2

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…This constituted an annual admission rate of 50 patients with a discharge rate of only 5 per year. 4 Most South African psychiatric facilities designated for SPs are exceeding their maximum capacity. 5 Prolonged inpatient admission comes at a significant financial and human resources cost.…”

Section: Introductionmentioning

confidence: 99%

Identifying factors associated with the discharge of male State patients from Weskoppies Hospital

Swanepoel

Lippi²

2017

S. Afr. J. Psych.

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BackgroundDesignated psychiatric facilities are responsible for the care, treatment and reintegration of State patients. The necessary long-term care places a considerable strain on health-care resources. Resource use should be optimised while managing the risks that patients pose to themselves and the community. Identifying unique factors associated with earlier discharge may decrease the length of stay. Factors associated with protracted inpatient care without discharge could identify patients who require early and urgent intervention.AimWe identify socio-economic, demographic, psychiatric and charge-related factors associated with the discharge of male State patients.MethodsWe reviewed the files of discharged and admitted forensic State patients at Weskoppies Psychiatric Hospital. Data were captured in an electronic recording sheet. The association between factors and the outcome measure (discharged vs. admitted) was determined using chi-squared tests and Fischer’s exact tests.ResultsDischarged State patients were associated with being a primary caregiver (p = 0.031) having good insight into illness (p = 0.025) or offence (p = 0.005) and having had multiple successful leaves of absences. A lack of substance abuse during admission (p = 0.027), an absence of a diagnosis of substance use disorder (p = 0.013) and the absence of verbal and physical aggression (p = 0.002 and p = 0.016) were associated with being discharged. Prolonged total length of stay (9–12 years, p = 0.031) and prolonged length of stay in open wards (6–9 years, p = 0.000) were associated with being discharged. A history of previous offences (p = 0.022), a diagnosis of substance use disorder (p = 0.023), recent substance abuse (p = 0.018) and a history of physical aggression since admission (p = 0.017) were associated with continued admission.ConclusionDischarge of State patients is associated with an absence of substance abuse, lack of aggression, multiple successful leave of absences and length of stay in hospital.

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Section: Introductionmentioning

confidence: 99%

Identifying factors associated with the discharge of male State patients from Weskoppies Hospital

Swanepoel

Lippi²

2017

S. Afr. J. Psych.

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“…17 of 2002 10 has resulted in the reduction of psychiatric beds, premature discharges, inadequate community-based resources with subsequent relapse and re-admission of patients involuntarily. 13 This high turnover results in earlier discharges and LOA, reducing the opportunity to abscond.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, the forensic mental health system has seen a burgeoning in the number of state patients since the advent of deinstitutionalisation – aptly named ‘Reinstitutionalization by stealth’ by Kaliski. 13 The MHCA has very stringent criteria for conditional discharge that few state patients fulfil. Thus state patients, most of them not returning from LOA, form a bigger proportion of our absconding population.…”

Section: Discussionmentioning

confidence: 99%

“…Locally, service integration has been hampered by infrastructure constraints, administrative challenges and limited political support. 11,12,13 Kaliski 13 points out that deinstitutionalisation, with its enforced psychiatric bed reduction and increased turnover of patients, has resulted in a paradoxical increase in the number of involuntary admissions. Thus, the population at risk of absconding is potentially larger.…”

Section: Introductionmentioning

confidence: 99%

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Absconding from a psychiatric hospital in Johannesburg, South Africa: Are we seeing a decrease since the implementation of the Mental Healthcare Act?

Arbee¹,

Subramaney

2019

S. Afr. J. Psych.

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BackgroundAbsconding from psychiatric facilities, the aetiology and impact of which have major socio-economic implications, has a multifactorial aetiological basis. Absconding patients are at higher risk of self-harm, violence, non-adherence, relapses, substance use and negative media attention. Most health professionals associate absconding with the escape of potentially dangerous psychiatric patients. Absconding causes fear and uncertainty, and portrays psychiatric services negatively. Identification of potential absconders would assist with risk assessment and prevention.AimThe aim of this study was to formulate an absconding rate as well as a descriptive profile of absconders since the inception of democracy and deinstitutionalisation.SettingThe study was conducted at Sterkfontein Hospital, a specialised psychiatric hospital outside Johannesburg.MethodsA retrospective record review of absconders from Sterkfontein Hospital in Johannesburg over 1 year was conducted.ResultsThe absconding rate was 7.83%. The characteristics of the typical absconder included single, unemployed male, early 30s, known to psychiatric services, diagnosed with schizophrenia and co-morbid substance use. An absconder is more likely to be a forensic patient not returning from official leave of absence.ConclusionThe absconding rate has decreased to less than half that of a previous study, and is within international norms. While the descriptive profile is of limited value, it does appear that psychiatric patients are being treated in a less restrictive manner resulting in fewer absconders and a change in the method of absconding. The implications for clinical practice are firstly that a clearer definition of the term absconding is needed as this will impact risk assessment and management. It is recommended that future studies separate forensic and general populations. Lastly, the formulation and use of a risk assessment tool may be of value.

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“…It states that a prisoner must as soon as possible after admission to a correctional centre be examined by a medical doctor or nurse. This practice will prevent what Kaliski 51 refers to as ‘re-institutionalisation by stealth’, whereby families of persons with severe mental illness who display aggressive and/or violent behaviour are encouraged to lay charges against them, resulting in an increased burden on forensic mental health services.…”

Section: Discussionmentioning

confidence: 99%

Forensic mental health services: Current service provision and planning for a prison mental health service in the Eastern Cape

et al. 2016

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ObjectivesNo research data exists on forensic psychiatric service provision in the Eastern Cape, Republic of South Africa. The objective of this research was to assess current forensic psychiatric service provision and utilisation rates at Fort England Hospital. This is important in improving and strengthening the service. A related objective was to develop a model for a provincial prison mental health service.MethodologyThis study is a situational analysis of an existing forensic psychiatric service in the Eastern Cape. The design of the study was cross sectional. An audit questionnaire was utilised to collate quantitative data, which was submitted to Fort England Hospital, Grahamstown. A proposed prison mental health service was developed utilising prevalence rates of mental illness among prisoners to calculate bed and staff requirements for an ambulatory and in-patient service.ResultsDuring the study period a total of 403 remand detainees were admitted to the forensic psychiatry division of Fort England Hospital. The average length of stay was 494 days and the bed utilisation rate was determined at 203.54%. We estimate that to provide a provincial prison mental health service to treat psychotic illnesses and major depression the province requires a 52 bedded facility and a total staff complement of approximately 31.ConclusionsForensic psychiatric services include the assessment, management and treatment of mentally disordered persons in conflict with the law and prisoners requiring psychiatric assessments. The Eastern Cape Province does not have plans or policies to assess and manage mentally ill offenders, resulting in an increased load on available services. We recommend that an inter-departmental task team, which includes Health, Justice and Constitutional Development and Correctional Services, should be established in the province, to develop a strategy to assist in the development of an effective and efficient forensic psychiatric service. This should be driven by the provincial Department of Health.

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Reinstitutionalization by stealth: The Forensic Mental Health Service is the new chronic system

Cited by 5 publications

References 15 publications

Identifying factors associated with the discharge of male State patients from Weskoppies Hospital

Identifying factors associated with the discharge of male State patients from Weskoppies Hospital

Absconding from a psychiatric hospital in Johannesburg, South Africa: Are we seeing a decrease since the implementation of the Mental Healthcare Act?

Forensic mental health services: Current service provision and planning for a prison mental health service in the Eastern Cape

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