Psychiatric clinics battle to meet demand
Psychiatric staff at clinics across Gauteng are facing ever-increasing workloads as more patients need their help, yet there are fewer and fewer healthworkers to attend to them.
Chiawelo Clinic is one of 55 clinics in Gauteng that offers psychiatric care at primary health level, trying to bring treatment closer to those who are mentally ill and unable to travel to hospitals to collect medication.
Almost 1000 psychiatric patients attend the clinic each month, yet only two fulltime psychiatric nurses, one part-time sister and a nursing assistant run the entire service.
Two doctors visit every Monday and see up to 80 patients between them, usually new patients and those with problems.
Dr Yusuf Moosa, a senior psychiatrist, is one of only two psychiatrists employed by the Mental Health Program in Central Wits region.
The psychiatrists supervise the doctors and provide support for all the clinics in the entire region.
‘This usually involves a huge amount of travelling as the clinics are widespread,’ says Moosa.
He laments the loss of senior psychiatric nurses, who are in great demand in the UK and Saudi Arabia. Psychiatrists are also in short supply in the public sector and earn one tenth of what they would in private practice.
Sister Caroline Seguba has come out of retirement to help out at Chiawelo, and works half-days. Paging through the dog-eared statistics book, Seguba shows that 990 patients visited the clinic in August, 570 men and 420 women.
‘The clinic is growing,’ says Seguba. ‘HIV is also bringing more patients because people get depressed about having HIV and need help.’
Outside, patients are restless, complaining that we are stealing Seguba’s time and lengthening their wait. Seguba is constantly interrupted by both staff and patients needing attention.
One of the obstacles to successful treatment is patients who stop taking their medication, explains Seguba.
‘Some stop taking their medication because they feel well and think that they have been cured, while others like schizophrenics lack the motivation to take regular treatment,’ says Seguba.
Alcohol and dagga also plays a big role both as a trigger for mental illness in Soweto and is a reason for people to stop their medication.
In the past, nurses would do home visits to patients who hadn’t come to collect their medication but staff shortages and Soweto’s high crime rate have made this impossible.
‘We would do house visits or phone if a patient has not come to collect their medication for a while but we are so short of staff we don’t have the time and also transport is a problem,’ says Seguba.
‘The injection is our drug of choice for many clients who don’t take their medication regularly,’ she adds.
Mpho has been a regular at Chiawelo for many years. When he was a schoolboy, he started vomiting and getting visions of his forefathers and sangomas ‘ what psychiatrists would call a psychotic episode.
That was 10 years ago. Since then he has been on medication for bipolar mood disorder. The neat 28-year-old is now a third year IT student and believes that the medication has ‘made me the person I was before I got sick’.
But few of his fellow students know that he has a mental illness and it is not something he shares easily because there are so many misconceptions about mental illness.
‘I feel like anybody else. I don’t feel mentally ill,’ says Mpho. He once stopped taking his treatment because he felt so well, but suffered a relapse and ended up in hospital.
‘So now I know that I have to take the medication until I disappear from the earth,’ Mpho smiles.
Nozipho Ntsimbi, the only patient who agrees to give her surname and to have her photograph taken, was brought to Soweto’s Chiawelo Clinic three years ago by her sister.
‘I am bipolar. Before my treatment, I used to do things too over. I would sing a lot and when I would sing, I would be very loud. I would also work a lot, more, more, not stopping. I was overdoing things,’ explains Nozipho.
‘Since I started the tablets, I have become normal and I am just level.’
Nozipho and Mpho are both stable patients and health workers say that their illness should be seen as a chronic illness ‘just like diabetes and high blood pressure’.
‘There is a lot of stigma about mental illness,’ says Seguba. ‘Some people don’t want to mix with our patients, but a person who is depressed is not mad. There needs to be better understanding.’
‘People have this misconception that a person with mental illness must look crazy and talk to themselves,’ says Moosa. ‘But they there are various forms of mental illness. For example, a person could have had loss in the family and be so severely affected that they can’t function properly.’
Treatment is a combination of medication and counselling. But some drugs, particularly the older ones, have side-effects such as stiffness, tremors, blood in the saliva. Others cause patients to look dull and zombie-like.
Newer drugs have fewer side effects but are usually very expensive, costing up to R500 a month in comparison to R24 for the older drugs.
Despite its many difficulties, Chiawelo also has an active occupational therapy department that offers activities for patients who not able to find to hold down steady employment. Although most of those attending the clinic are stable, only about a quarter are employed.
Occupational therapist Thandi Dlamini runs the ‘rehabilitation club’ where patients are able to do craftwork, woodwork, sewing, gardening and play indoor games.
‘We don’t want our patients idling in the township. So we encourage them to do handwork and teach them life survival skills,’ says Dlamini.
Some higher functioning patients are also paid a little stipend to help with the filing and cleaning.
‘A person with mental illness faces many hardships. But if they take their medication and do rehabilitation, it makes a big difference,’ says Dlamini.
Dlamini organises quarterly outings for patients and holds community awareness events every October, mental health awareness month. She is particularly anxious to spread the message that drugs and alcohol can trigger mental illness ‘because nowadays our young ones start taking liquor and drugs when they are still at school’.
Despite the staff shortages, Seguba is cheerful: ‘If we complain, there are still all these patients to get through. So we can be miserable or we can just get on with serving our community as we said we wanted to.’
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