RESIDENTIAL HOMES AND CENTRES FOR PEOPLE WITH MENTAL HEALTH NEEDS.

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Contributed by Administrator
Saturday, 07 July 2007

Kingdom Ministries Mental Health & Psychiatry (KMMH) in association with Community Mental Health & Psychiatry (CMHP) offers a wide variety of accommodation & services to mental health service users. Where adults and older people need help because they have a mental health problem, we can provide a range accommodation and services varying from independent residential living in group homes to larger care centres. We also manage a home for children with severe and profound intellectual disabilities

Who can have this service?

• Any South African citizen may apply. Some of our larger care centres and group homes are partially subsidized by the Western Cape Department of Health. To qualify for these centres you should normally live in the Western Cape Province.
• You must have a psychiatric diagnosis.
• You must have a serious mental health need and unable to reside within your current environment.
• You must be assessed by us to determine whether you are a suitable candidate for either a residential home or one of our larger care centres.
• This assessment can only take place once we have received your completed application

Will I have to pay towards this service?

Yes. We will tell you how much you are likely to pay after receipt of your application. Your final monthly fee will be determined and confirmed within 7 days of your assessment which includes an interview with the applicant and his/her nearest relatives at our premises

How do I get started?

You can email anel@mentalhealth.org.za requesting an Application Form,or contact Anel Pienaar, Director: Social Work KMMH at 021 981 9850 Nota: Afrikaans as korrespondensie taal word verwelkom.

Created: 14 November, 2007, 10:46

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HEAD OF HEALTH, WESTERN CAPE PROVINCE, SOUTH AFRICA, VISITS KMMH.

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Contributed by Administrator
Thursday, 14 June 2007

Prof. Craig Househam, Head of Health in the Western Cape Province of South Africa, visited House Miles Bowker at Stikland Hospital on a fact finding mission today. This visit came as a result of Roy Harris, CEO of Kingdom Ministries Mental Health & Psychiatry (KMMH), who recently made an urgent appeal before the Parliamentary Standing Committee on Health & Social Development to increase subsidies for level 3 service users.

The total health budget 2007/08 rises 9,6% to R7,095 billion and is set to continue to rise 9% on average on a yearly basis to reach R8,4 billion in 2009/2010. If history repeats itself, the mental health sector will not see any part of the year to year increased budget.

The increased demand on health services, fuelled by the influx of people from other provinces, places enormous pressure on the Department of Health (DoH) to provide quality services. Mental Health Not-for- Profit Organisations (NPO's) providing services to users who were traditionally the responsibility of the DoH, are in dire straits due to the fact that they were basically overlooked, even ignored in terms of the DoH budget over the last 6 years.

European Union (EU) contributions came to the rescue of some NPO's in 2005 as they only received 1 increase in subsidies in 6 years. In 2006, 2 year EU contracts were signed with the DoH, which were not honoured in its second year. The only verbal explanation that was given at the request of NPO's was that a percentage of the EU budget had to be re-allocated to another province. This move placed many reputable and already cash strapped mental health NPO's in crises, once again faced with closure.

As a consequence thereof, the mental health sector formed a group representing more than 100 mental health NPO's, referred to as the MHNS (Mental Health NPO Stakeholders) and started negotiations with the DoH. The outcome, though positive for some NPO's, failed to replace the EU Funding, leaving the NPO's in a worse off position than 6 years ago. The visit of Prof. Househam today, was hailed by KMMH as a step in the right direction, as the partnership between the DoH and Mental Health NPO's deteriorated over the last few years.

According to Roy Harris, one of the founder members of the MHNS, it is imperative to establish Provincial MHNS groups in all provinces to ensure a united front when negotiating with various Government Departments on mental health issues."The mental health sector will also have to start structuring and positioning itself to create an awareness of the needs of mental health care users and effectively advocate for the rights of all users. It is time we move away from the general accepted and self fulfilled prophecy that mental health is the stepchild of the health system."

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COMMUNITY MENTAL HEALTH WILL LESSEN SOCIAL EXCLUSION, SAYS WHO.

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Contributed by Administrator
Wednesday, 13 June 2007

1 JUNE 2007 | GENEVA -- The World Health Organization (WHO) signalled the urgent need for countries to provide a network of community mental health services at its Global Forum for Community Mental Health (Geneva, 30-31 May 2007). For the first time, WHO invited people living with mental disorders to attend the Forum, sending a message to countries that it is important to give a voice to this excluded group to claim their rights and secure their participation in society.

"Not only are community mental health services more accessible to people living with severe mental disabilities, these are also more effective in taking care of their needs compared to mental hospitals. Community mental health services are also likely to have less possibilities for neglect and violations of human rights, which are too often encountered in mental hospitals" said Dr Benedetto Saraceno, Director of the WHO Mental Health and Substance Abuse.

There are nearly 54 million people around the world with severe mental disorders such as schizophrenia and bipolar affective disorder (manic-depressive illness),. In addition, 154 million people suffer from depression. People living in developing countries are disproportionately affected. Mental disorders are increasingly prevalent in developing countries, the consequence of persistent poverty-driven conditions, the demographic transition, conflicts in fragile states and natural disasters. At the same time, more than 50% of developing countries do not provide any care for persons with mental disorders in the community. These disorders bring significant hardship not only to those who suffer from them, but also to their caregivers -- often the family, given the lack of mental health resources found in developing countries. As a result, 90% of people with epilepsy and more than 75% of people with major depressive disorder in developing countries are inadequately treated.

The call for community mental health services is especially timely since, in spite of a clear message from WHO in 2001, only a few countries have made adequate progress in this area. Also, in many countries, closing of mental hospitals is not accompanied by the development of community services, leaving a service vacuum.

"This topic should matter to everyone, because far too many people with mental disorders do not receive any care. The immediate challenge for low income countries is to use primary health care settings, particularly through community approaches that use low-cost, locally available resources to ensure appropriate care of these disorders" said Dr Catherine Le Galès-Camus, Assistant Director-General of WHO's cluster on Noncommunicable Diseases and Mental Health. "The challenge is to enhance systems of care by taking effective local models and disseminating them throughout a country. The WHO Global Forum for Community Mental Health was about showcasing models which are proving effective in delivering mental health care in resource-challenged situations," she added.

The Forum provided a foundation for sharing information, providing mutual support, and a sense of belonging for users, families and providers, and all who are interested in shifting mental health care from long-term institutions to effective community-based care. Forum partners included non-governmental organizations, professional associations and interested individuals. Prominent among them were BasicNeeds, the Christoffel Blindenmission and the World Association for Psychosocial Rehabilitation. The UK Department of Health actively assisted in the Forum, which was convened by WHO's Mental Health and Substance Abuse Department.

Viable options available to communities to improve the lives of people living with mental disorders and exercise their rights to community-level detection and treatment of mental disorders include:

• Integrating mental health care within the primary health care system;
• Rehabilitating long-stay mental hospital patients in the community;
• Implementing anti-stigma programmes for communities;
• Initiating population-based effective preventive interventions; and
• Ensuring full participation and integration of people with mental disorders within the community.

To implement these effective interventions, governments need to establish clear policies articulating these measures and then develop systematic plans with dedicated budget and agreed timelines. WHO provides technical support to developing countries to take these steps towards making community mental health care available within their countries.

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WHO CALLS FOR COMMUNITY HEALTH SERVICES TO ADDRESS MENTAL HEALTH ISSUES.

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Contributed by Angel Desai
Wednesday, 13 June 2007

The conclusion of the WHO's Global Forum for Community Mental Health in Geneva last month presented a consensus within the organization for the dissemination of a network of community mental health services among its member states. The Forum sought to address a increasing incidence of disorders related to mental health among developing countries in particular.

According to WHO officials, factors such as demographic change, natural disasters, internal and external conflict and socio-economic conditions have afflicted individuals living in the developing world disproportionately in terms of the mental health disorders these elements have engendered. In an unprecedented move, WHO organizers invited people living with mental disorders to the Forum, in an attempt to place a "face" on an issue which has been a focal point for global, social stigmatization.

Before the commencement of this Forum, WHO officials addressed mental health issues in 2001, citing it as an area of public health that has not been adequately confronted by member states. In an attempt to arrive at a resolution for improved worldwide services, the forum examined global models for mental health care, ultimately concluding that a network of community mental health services may provide more effective, and less exclusive services as compared to regional mental hospitals.

Dr. Catherine Le Galès-Camus, Assistant Director-General of WHO's cluster on Noncommunicable Diseases and Mental Health, stated in a WHO press release,

"This topic should matter to everyone, because far too many people with mental disorders do not receive any care. The immediate challenge for low income countries is to use primary health care settings, particularly through community approaches that use low-cost, locally available resources to ensure appropriate care of these disorders...; The challenge is to enhance systems of care by taking effective local models and disseminating them throughout a country."

The question that remains is whether this rhetoric will materialize on a local and rural level and more importantly, if these
initiatives will prove to be feasible in a global setting.

Reference: World Health Organization. (2007) Community mental health services will lessen social exclusion, says WHO.
WHO Media Centre Notes.

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KMT: CONDENSED SUMMARY OF STRENGHTS AND WEAKNESSES

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Contributed by Roy Harris
Sunday, 03 June 2007

The strengths of KMT can be categorised in three main areas of the organisation:

• Strengths in terms of 'what we do':

• The fact that KMT is a registered Non Profit Organisation (NPO) serves as a great strength within the communities that we serve. Serving individuals in the mainly 'no income group' especially with our Mental Health discipline, confirms our motives as service provider and ensures the support of churches, businesses and the community at large
• We are well established in the various disciplines we operate in (Mental Health, Welfare, Training, Capacity Building, Potential Development etc.) resulting in our mission and 'what we do' being clearly understood and completely accepted, respected and supported by the communities.

• Strengths in terms of 'those who do it':

• Being a benevolent organisation with very limited access to funds, one of our strengths are the fact that many of those involved, do so not for the monetary reward, but for personal moral and religious convictions and motives. Example: A 24 hour cycle care for a severe intellectual disabled child will currently cost a government institution circa R660-00 with a probable staff ratio of 2 staff for 3 patients. The same services at a NPO will receive only R35-00 subsidy for the 24 hour cycle, from which they have to remunerate professional medical staff, caregivers and administrative staff, not forgetting maintenance on infrastructure etc.
• Another notable strength in terms of 'those who do it' is the fact that a larger percentage of these staff are 'purpose driven' (circa 45%) compared with a government institution which may have an average of 15 - 20% employees pertinently being driven by personal or religious conviction or purpose.
• 'Those who do it' in KMT are also more likely to not be bound to their absolute rights in terms of job descriptions, work hours etc. This becomes a major strength, especially when a NPO is cash strapped and cannot afford market related remuneration.

• Strengths in terms of 'how we get the resources to do what we do':

• 3.1. We can readily identify our principal support base from those personally touched, inspired, or motivated by what we do, and from those not directly involved, but who are influenced and impressed by what we do.
• 3.2. Because of the above factors, one tends to have easier access to a sympathetic ear in terms of press releases to community newspapers, community radio stations etc. than would be the case with a Government Institution.
• 3.3. The community becomes aware of the plight of the NPO, understanding that due to transparency and openness of the NPO, where projects can be visited, quality of services can be compared to i.e. Government services in relation to availability of funds etc.
• 3.4. Because of the Managerial structure of KMT with the Founders still being involved on a full time basis, there is no doubt in terms of commitment and passion when a plight needs to be made for funds to 'do what we do'. The challenge will arise when a 'second generation' will take over from the first.
• 3.5. We make sure we take advantage of our strengths to ensure maximum support.
• 3.6. We have full access to information about what our organisation is, what it does, and why money is needed in the furtherance of what goals.

What are the weaknesses of KMT?

1. Staff, although committed as 'purpose driven for the cause' may become disillusioned after a period of time, or have a change of heart. In some cases, their personal financial situation may be left lacking, placing enormous socio economic pressure on their family lives. Some of these staff is also individuals who entered into such working relationship due to personal constraints where they would not, for some reason, be employed in any other open market. We sometimes refer to them as 'af vlerk voëltjies', who render tremendous contributions, but who are sometimes limited in their own emotional and or (in a lesser sense) intellectual abilities. The willingness to serve becomes more predominant than the able ness to (in some cases) which may weaken the operations of the organisation, whereas the organisation has no option, and cannot function without these individuals who at the end of the day, plays a major role in the success of the NPO, not withstanding the weakening factor.
2. The fact that KMT serves mainly the poorest of the poor, may be restrictive in the way it goes about to raise funds, i.e. if the NPO had to launch a lucky draw where the first price was a Mercedes Benz (these do not get sponsored anymore), members of the public with limited or no understanding may perceive this step as a waste of money, or that if the NPO has enough money to buy a Mercedes, they surely don't have a shortage of funds.
3. Another weakness may be the fact that the NPO has to compete with profit driven role players in the open market having much more access to resources, i.e. to train and equip people, advertising, marketing and more, resulting in a challenge to combat inefficiency that may rise from time to time.
4. We turn our weaknesses into strengths by first identifying those we are handling in a defensive way or ignoring, and then developing a plan of action to change them.

External What are the Opportunities for KMT? (Could be mergers, joint ventures, international partnerships etc...)

1. In the case of KMT, merging with another NPO is not an option due to the complexity of its composition of its different disciplines. It is factually correct to assume that most established NPO's in South Africa are worse off than was the case 10 years ago. Merging with any other NPO may be like two vagrants putting their assets together to ensure a better quality of life, or the blind leading the blind to see better...;
2. Joint ventures with private sector health groups i.e. Afrox may be a long term option; something that has not yet been pursued.
3. International partnerships have already been established in terms of training, advocacy etc.

What are the threats to KMT? (Could be competitors, tax introduced on your organisation etc...)

1. The major current threat for KMT, is the inability of the South African Government to fulfil its basic obligation to those in need according to the Constitution, and more specific the Mental Health Act of this country.
2. Just recently the Department of Health committed a breach of contract and non performance when they failed to honour signed European Union (EU) contracts with KMT and other Mental Health related service providers. Up to this day, no formal communication with the NPO's was received, except for a verbal comment that the contracts were cancelled due
   to unavailability of funds.
3. The only real threat, is the apparent 'integrity' challenge faced by NPO's in regard to the responsibility of the Government which is neglected and becomes the responsibility of the NPO, but without the principle that 'funds follow function'. This may lead to exploitation of the NPO as a cheap and inferior option to maintain Treasury budget targets. Notwithstanding the above Weaknesses, KMT has been working in partnership with various Departments over the years, addressing the need of all who require access to Mental Health Services.

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PREPARING THE SCHIZOPHRENIC PATIENT FOR TREATMENT BY J.ROSBERG, AND A. A. STUNDEN

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A major problem confronting psychotherapists who treat schizophrenia is how to make successful therapeutic contact with the patient. Too often the patient's bizarre behaviour drives the therapist away especially when the illness intrudes on the patient's ability to use ordinary human, communication. This problem can be so frustrating to both patient and therapist that each is unable to respond to the potential inherent in the therapeutic encounter. Therapists most often adopt this stance because they are not familiar with these problems and how to work with them. Few training institutions encourage therapists to engage the patient with schizophrenia in human terms so that a sense of relatedness can be established. Direct confrontation psychotherapy helps the therapist understand and quickly overcome the patient's psychological barriers to treatment. Treatment can begin with the rapid disruption of the patient's defensive patterns.

INTRODUCTION:

Because of the dramatic way it calls attention to itself, and the enormous amount of human misery and despair associated with its presence, schizophrenia has always been a special kind of illness that cannot easily be ignored. It demands treatment and it will not wait while we search for better answers. It urgently insists that we find swift solutions to its unique problems and forces us to apply all of our advance biological and technical resources even though we cannot be sure of their outcome. It challenges us to measure our professional commitment to treatment by the rapidity with which we provide maximum relief for the symptoms of its illness. In fact, effective treatment for schizophrenia has almost become synonymous with symptom relief. Still, this is not just a modernday issue. One has only to look at the variety of treatments our society has sanctioned for schizophrenia over the years to appreciate how long this problem has been with us.

Within this framework of necessity and conflict many of us have become honestly confused about how best to cope with the pressure of developing appropriate treatment for our schizophrenic patients. In this harried state we find it easy to ignore the person who is ill in our urgency to treat the illness. In our efforts to be responsive we allow ourselves to go back and forth in our treatment approach. We offer one thing only to change it and offer something else. We usually focus first on medication. If this is successful, and we have some experience with other forms of treatment, we may then try to help our patients learn how to cope with the psychological effects of their illness.

The moment, however, we believe that our patient is not responding well to treatment, we look to the patient as the source of our failure. We no longer concern ourselves with improving our treatment plan but, instead, we begin to explore how our patient might be thwarting our treatment efforts. Finally, we label our patient intractable or treatment resistant. This argumentum add hominum permits us, with the exquisite illogic of which only humans are capable, to discharge our frustration by blaming our patients for our lack of success. When this occurs frequently enough we begin to expect treatment failure. We start to program ourselves and our patience so that no one treatment is successful. We begin to behave in ways that insures that treatment failure takes place. Some aspect of the illness called schizophrenia has become iatrogenic.

With difficult, longterm patients, this problem is more distressing. The types of treatment these patients receive are seldom fixed by their needs or potential to respond. The length and character of their clinical history determine what they are offered. After patients who seek treatment, with this kind of history in their clinical charts, are almost certainly doomed to receive no treatment that will help them. No treatment will be offered that will realistically address their potential for change and thus their strengths as human beings. These patients will only find a reaffirmation of their already well documented and all too obvious weaknesses. They will be told, once more, that they cannot benefit from treatment because they are schizophrenic.

If we are to overcome this pessimistic outlook, we must first accept that many of the dysfunctional consequences of schizophrenia can be changed by influencing or modifying the emotional and behavioural reactions of the patients to their illness. We must concede that the illness does not exist in the absence of the person who is sick. We must acknowledge that the dysfunctional behaviour we see in our patients is associated with but not necessarily caused by the condition. And, most important, we must admit that these behavioural and emotional patterns exist in a form unique to each patient.

Consider, for example, the patient who withdraws from others. This behaviour is not analogous to the rise in temperature that is pathognomonic for a specific disease. Social isolation is not a symptom of schizophrenia. It is better understood as a personal choice that is determined by the patient's interpersonal style or character development. Social withdrawal is a protective reaction made by the patient in the face of their illness and is not an inevitable consequence of the illness itself.

Therapists who believe in the importance of changing the patient's dysfunctional behaviour must be aware of these basic ideas if they are to approach their patients with any hope of success. They must have some appreciation for the psychological character of the illness as it exists within the unique interpersonal framework of the individual patient. As stated in our paper on Stephanie: "Regardless of etiology, however, no one is ever justified in assuming that the ultimate consequences of the illnessthat is, the maladaptive psychologic and interpersonal behaviourare intractable and therefore not subject to change or modification. These issues of intractability are seldom related to any biologic reality but, instead, are more often a function of the inability of the treating professional to believe that psychologic treatment can be effective".

PREPARING THE PATIENT FOR TREATMENT

The idea of "preparing the patient" for treatment, is a logical extension of these concepts. Some psychological assessment must be made of the patient's needs and ability to respond to the treatment relationship. This evaluation must include an exploration of the patient's psychological resources, both positive and negative sufficient to decide how they can be integrated into the treatment process. Thus, in this first contact the therapist must search out what the patient will permit the clinician to access and influence. That is, the therapist must discover the patient's behaviours that can most easily be changed.

The case of Stefanie, as described by us in1989 offers an interesting opportunity to examine these ideas in the context of real clinical material. What follows is a brief process analysis of this consultation. This analysis, some of which is in Rosberg's own words, describes how he used direct confrontation psychotherapy to prepare the patient for treatment.

Rosberg was invited to consult regarding Stefanie in the autumn of 1987. At the time of the consultation she was a 32yearold,
never married, caucasian female with no children who was an inpatient in a Swedish psychiatric hospital. Never able to attend school, she had been taught to read and write in the institutions providing her with treatment. At age four, she started psychotherapy and was described by her first therapist as "so frightened I couldn't get her to sit in my lap". From the age of 13 she was treated in hospitals and institutions primarily in Sweden. She had been treated with phenothiazines without effect.

When first seen, Stefanie was confined to bed in five point restraints. Rosberg gives his present recollections of that meeting as follows:

"It was clear she was not going to allow me to join with her. She viciously rejected me when I said "hello" by spitting on me until I was drenched. Then, when that didn't work, she yelled at me to kill her, to hit her, to cut her head off and, most important, to leave her alone.

When she raged at me to leave her alone she offered me the entrée into her life I was looking for. She had given me a way to access her psychosis and her life. When she told me she wanted to be alone she had acknowledged the presence of our relationship. When she told me she didn't want me in her world, I knew I had finally forced her to leave the consuming narcissism of her psychosis and join the reality of my world".

In this first contact, Stefanie's desire to be left alone gave Rosberg the diagnostic information he needed to begin treatment. She had revealed that she needed to protect the equilibrium of her psychotic, psychological world by keeping out everyone. She implied that if she was to be safe she needed to be alone. She conveyed that she could enforce her will if she made the risk to the therapist to great for treatment to continue. And, she behaved as if she could best shield herself from Rosberg's
intrusion by trying to terrorize him as she herself had been terrorized.

Rosberg recognized that if he was persistent he could penetrate her unique psychological response to her illness and force her to change. He also realizes that if he was to influence Stefanie successfully he had to persuade her that he could outlast her without violating her. He continues: "To convince her of this I became angry. Not the artificial anger of the actor, but the genuine and realistic anger of someone who has been outrageously violated and vilified. I raged at her that she was a dictator and a miserable beast. She began telling me what a rotten person she was and that I should kill her because of it. We began sharing with each other our thoughts and feelings about her condition. She became convinced of my desire to outlast her no matter how hard she tried to drive me away. She began to listen to me and to pay attention to this crazy man (Rosberg) who might really be more powerful than she was. During her contact with me, she moved from a psychotic queen autocratically ruling their fantasy castle, to a psychotic queen under siege who recognizes the need to come out to negotiate with her besieger. I had established a sense of relatedness with her".

Rosberg had forced Stefanie to take the first step toward establishing a sense of relatedness. At this stage she had no idea that the compromise that had been extracted from her might be the beginning of the treatment relationship. She only knew that her well practiced interpersonal style had been ineffective and that she had been required to access other, different behaviours to cope with the interpersonal demands placed on her by Rosberg. She had started to change. Together, out of their respective needs, they had forged the beginnings of a relationship that could be beneficial to both. They had begun to create what Lidz and Lidz have described as "a relationship in which the patient can examine his life together with the therapist and begin to assume responsibility for him".

CONTACTING THE PERSON WITH SCHIZOPHRENIA

Though we do not know the cause of schizophrenia we can still treat it effectively and with predictable outcomes. As little as we know about the condition, however, we know even less about how to modify it in isolation from the psychological influence of the person who carries it. Because of this we must conclude that the diagnoses "schizophrenia" cannot be applied in isolation from the individual who hosts the illness and, that treatment cannot begin without a careful assessment of the person in whom the illness is housed. When the diagnosis of schizophrenia is used it must refer to a process that occurs between patient and condition in which one influences the other: that each, the illness and patient, exists in an independent, existential framework, with unique needs and demands. All of which must be met understood an integrated by the therapist if the patient is to survive or get better.

When we look on treating the patient with schizophrenia in this way we are faced with an enormous task. How can we possibly develop effective treatment for the infinite combinations potential between the illness and the person who has it? How can we expect to find and apply a common denominator to the treatment process such that some treated will be better than no treatment regardless of the patient?

If we are to solve this puzzle we must stay focused on the interaction between patient and illness. We must remember that much of the behaviour called schizophrenic is the patient's psychological response to the illness itself. And, that the patient does not want to be sick but no longer knows how to get better. If we are to impact this dilemma effectively the therapist must intrude uniquely into the life of the patient so the fundamental choice faced by all patients can be made; whether to maintain a false sense of psychological equilibrium and comfort that supports the dysfunctional behaviour or, with the therapist's help, to struggle to achieve whatever change is possible.

With this approach the initial contact with the schizophrenic patient becomes the most important and revealing part of the treatment process. The therapist quickly uncovers the essence of the patient's psychological disorder and the direction that must be taken if treatment is to be beneficial. Most important, the patient rapidly discovers that change is possible when the therapist and therapy are an effective and safe reality in their lives.

As we have suggested elsewhere, treating schizophrenia is different from treating any other kind of disorder. Yet, because we are dealing with human beings, the principles underlying behavioural and emotional change through psychotherapeutic intervention are the same. The major problem facing us today is how to teach these tactics to others so that our patients may be redirected into a life more consistent with what is normal. Though a cure for schizophrenia is not yet possible, we must recognize that patients can change and the quality of their lives improve with the tools we have available.

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REPORT URGES ACTION ON MENTAL HEALTH.

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Source: iol.co.za

There is only one psychiatrist for every half a million people in North West Province, according to a report on mental health policy released on Friday.

The ratio for the Western Cape is one per 111 111 - a 45-fold difference.

The report, by the University of Cape Town-based Mental Health and Poverty Project, said mental ill-health was strongly associated with poverty and social deprivation, and had to be prioritised to break this "vicious cycle".

It said a survey had shown that 16,5 percent of South Africans suffered from common mental disorders such as depression, anxiety and substance use disorders over a twelve-month period.

Some important steps had been taken to develop policy and legislation for mental health in South Africa.

However, there were major gaps between policy and practice.

There was wide variation between provinces in the level of mental health resources and services, as shown by the figures for North West and the Western Cape.

In addition, only three of the nine provinces had been able to say how much they spent specifically on mental health.

Project co-ordinator Dr Crick Lund, told Sapa there was no internationally-recognised "ideal" ratio of psychiatrists to population, but the project had two years ago recommended a range of between 0.3 and one per 100 000.

As far as he knew this was the norm the department of health was now using in planning.

But this ratio was for treatment only of severe psychiatric conditions, not milder ones such as moderate anxiety and depression.

"The Western Cape probably exceeds those norms, but that doesn't mean it's adequate. That was a bare bones figure, a minimum," he said.

Lund said there was an international push for mental health services to be scaled up in low and middle income countries.

The report called for mental health to be prioritised in South Africa, and for the development of a new mental health policy - currently in draft form only - to be speeded up.

It also urged increased involvement of consumer, family and other organisations in raising public awareness and preventing stigma.

Mental health should be integrated into wider poverty alleviation and development policies. - Sapa

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FINANCIAL CRISES FOR POOR MENTAL HEALTH NPO'S AS DEPARTMENT OF HEALTH OFFICIAL ENJOY

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28 April 2009

Staff of more than 150 Non Profit Organisations providing services to people with intellectual and psychiatric disabilities in the Western Cape Province, are awaiting a dark and dreadful long-weekend without food for their families, transport and more as the Department of Health (DoH) failed to do their transfer payments of subsidies owed to them.

According to Roy Harris, CEO of Community Mental Health & Psychiatry (CMHP) formerly known as Kingdom Ministries Trust Mental Health & Psychiatry (KMMH) more than 84 of his employees couldn't be paid.

Mr Tony Joseph's (Deputy Director: Finance), responsible (among others) for the whole ordeal, didn't bother to return a call made to him by Harris, even though he was informed that the press was making enquiries as to what was happening.

In a desperate attempt to rectify the situation Harris sent an email to the Head of Health, Prof. Keith Househam, Western Cape Province South Africa, saying: "I have received some calls today from NPO's in distress complaining that they wouldn't be able to pay their staff on time as the DoH had not processed subsidy payments. I was just (18h45) contacted by 'Die Burger' regarding the matter.

I made enquiries at the DoH this morning and was told that 'due to all the public holidays' they weren't able to process payments, which obviously is not acceptable and has an immense negative effect on our organisations and staff.

1. No correspondence or warning or explanation was given to any of the NPO's and we found out by chance that payments were not going to materialize before the end of the month. Most organisations make use of a debit order system to pay staff. My own organisation's debit orders (84 staff members) are deducted on the 28th of the month in order to be available in the staff members accounts on the last day of the month.
2. Debit orders now lapsed and this exercise is costing me more than R7500.00 to arrange a loan in order to pay staff as soon as possible. This amount excludes bank penalties we will have to pay. Amounts are less for the smaller NPO's but the negative effect and consequences similar.
3. This now has a further ripple effect as staff members who have personal debit orders and commitments are charged penalties in their personal capacity averaging about R450 for staff who have basic debit orders (policies etc.) not forgetting their personal credit score that may be effected negatively.
4. Staff members do not understand that the non payment is due to the forbearance of the DoH and it influences their morale and attitude tremendously, placing extreme pressure on management and patients/clients.
5. Some staff just stay away from work with the excuse that they don't have travel money or food to eat.
6. This is the second year that we had to go through this extreme mental, social and financial distress without any apology or recovery strategy or offering compensation for financial losses.
7. This payment is part of the previous financial year's contract and has nothing to do with the new contracts that were signed late, also due to a delay from the DoH.

Dear Prof. Househam, I truly believe that you for one, are doing your utmost best under very difficult and trying circumstances. I apologise for complaining to you, but with so many of the officials who do not take ownership or pride themselves in their work, you are always our last resort. I hope you will be able to assist us so this matter does not repeat itself in future."

Prof. Househam immediately replied later that evening and investigated the matter early the following day.

These organisations, already cash strapped, are only subsidized to a maximum of 30% of actual cost and are now feeling the financial and social harm and the consequences thereof caused by a few health officials who really just don't care, leaving many with additional bank costs, no food or transport for their families, and anxious patients. Promises had now been made to transfer funds early in May 2009

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PSYCHOSOCIAL REHABILITATION (PSR): PRINCIPLES AND PRACTICES IN SOUTH AFRICA By Roy Harris (CEO), Community Mental Health and Psychiatry (CMPH)
Cape Town, South Africa

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United States Psychosocial Rehabilitation Association Article for 4th Issue of the USPRA and PSR/RPS Canada International Newsletter: 2009

Real Psychosocial Rehabilitation (PSR) is primarily a process of continual and facilitated change. It is a metamorphosis in the making, working towards required goals. These goals should be designed by the very people who make use of the services themselves. Essentially PSR is about helping individuals within a community. It is a process whereby every individual strives to discover their true purpose in life. With this enlightenment, we naturally become more passionate about our lives, living it to the fullest and making a greater contribution to the community within which we live.

The goals of this process are not simplistic and therefore not easily defined. Every individual has their own unique set of goals and aspirations. These goals and aspirations differ not only from individual to individual but also between cultures and countries. This is especially evident in South Africa where we have a very diverse and cosmopolitan population with no less than 11 official languages.

The Core Principles of Psychosocial Rehabilitation play an enormous role in goal setting. The unfortunate reality is that since the inception of de-institutionalization in the 1990's, the South African government has not been able to take a leading role in promoting PSR.

The practical implementation and knowledge of PSR remains limited, especially within the various South African government ranks. This is not necessarily due to a lack of interest but rather the result of limited resources. In South Africa, de-institutionalization is seen as a way to save on stringent budget deficits. It is common practice for individuals to be discharged from hospitals and placed in dilapidated old hospital buildings instead of being integrated back into the communities, which is one of the goals of PSR.

As a result thereof, budgets do not move with the clients. This places an enormous burden on the few Non Profit Organizations (NPO's), willing or able to take on the role and responsibility of the core functions which, according to the South African Mental Health Act, should remain the responsibility of the state.

However, it is not all doom and gloom! The focus now, is on establishing community based services and integrating mental health services into primary health care. Despite all the challenges described above, there is a group of community organizations known as MHNS (Mental Health NPO Stakeholders) who have taken on a new attitude. This group represents more than 150 community based projects focusing on service delivery in the communities of the Western Cape. They are well represented and recognized by the Western Cape Department of Health, having a good working relationship. They are planning on expanding to all 9 provinces of South Africa within the next 2 years.

The MHNS seeks to advocate for those without a voice; to ensure consumer participation on all levels of decision making, and to focus on recovery as the ultimate goal, by ensuring the following:

1. Constant bi lateral communication and collective planning with relevant government role-players.
2. Access to the appropriate services for all in need thereof.
3. Community integration within the constraints of limited resources.
4. Self determination of the clients' future, (Greek=parakletos: to walk alongside with) rather than to make decisions on their behalf or dictate to them. We find life coaching techniques to be very helpful in this area of facilitating rather than causing change.
5. Engaging clients on an equal level, assisting them in an almost spontaneous way in their living, working, learning and socializing environment.

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