Access to substance abuse treatment in the Cape Town metropole ...

More documents

Recommendations

Info

“If all the addicts had to decide, I want to go for rehabilitation, out of my own and Iwant to come clean, then by all means we have a problem because now, howmany rehabs have we got? Not enough.” [LDAC]Even where services are available, they have limited capacity to provideaffordable (i.e. free or low-cost) services to clients from HDCs. TSPs reportedpressure to remain financially viable while serving poor clients – this sometimesresulted in indigent clients being refused treatment. For the poor, this hindersaccess to services:“Financially we're restricted. How do you say no? You can't. And then whathappens to us, because we've got overheads that need to be covered? So I thinkthat's one of our main constraints. We've had meetings with government. We'vebeen through the mill. All they did was say we're doing great work. We don't needthat. If we wanted we could have patted ourselves on the back. We need to knowhow government can assist organisations like ourselves. Other organisations arestruggling which are also catering for the under-privileged.” [TSP]In many cases, limited capacity to meet the demand for low-cost services leadsto lengthy waiting periods for affordable treatment slots. These lengthy waitingperiods often act as a barrier to treatment utilization, by diminishing motivation:“Yes there are State facilities that are free but the problem is, the disadvantage isthis, they have to wait for a long time. They are being put on a waiting list.” [TSP]“It was in November and they were saying they're not going to take on anybodynow until February the first. That makes people think where to now?” [LDAC]“For a state patient you will get in, in three months or so. (By that time) they'veoften relapsed in such a state that they're unwilling to come for treatment. Weoften say that when we get an application there's a therapeutic window ofopportunity. And it's so sad when that window passes.” [TSP]“You try and tell that lady that... it is going to take you at least 3 or 4 monthsbefore they will be able to admit him free of charge. He would have been put ona waiting list, by which time what's the point? He'll have committed more crimes,he may have overdosed.” [LDAC]85
The impact of availability and affordability on access is particularly salient amongindividuals requiring inpatient services. As outpatient TSPs commented:“Then looking at the need, I think the problem that we have is to get inpatientfacilities. We are really struggling to get places.” [TSP]“We still experience difficulty in getting people from under-resourced areas intoinpatient treatment.” [TSP]• Resource allocation to the health sectorKey informants also commented on the limited availability of ancillary healthservices for substance-abusing clients, including detoxification services in statehospitals:“(Hospitals and clinics)will assess and see whether there's a need for detoxthere, and then they will arrange the detox. Whether its happening is anotherquestion. People still do have difficulties…” [SAC]“We have experienced problems with detox, access to detox. Although there isa good partnership with us and the various health clinics, it is still difficult toaccess detox.” [TSP]This is partly because detoxification services compete with other, moreprioritized, medical conditions for scarce health resources such as bed space,staff time, and medical supplies:“One of the issues, briefly, is detox. There is an instruction that every hospitalhad to have detox beds. Now that is fine, except that I have to sit in the hospitalin a high trauma area, where they have to decide whether to give this bed todetox or whether to give this to a casualty that has just walked in, that is wherethe problem lies. That's one of the things for those who can't pay. People whocan pay we say go straight to the medi-clinic or the clinic, whatever it is, and getyourself detoxed. That is one of the big issues.” [TSP]“The subject's first reaction might be to go to casualty. They're not going to seeyou straight away because you're not a casualty. It's not like your arm is severedand there's blood. So you are actually the last person that they will assist if86
Page 1 and 2:
Access to substance abuse treatment
Page 3 and 4:
CONTENTSINTRODUCTION ..............
Page 5 and 6:
5.4. SUMMARY.......................
Page 7 and 8:
al., 2004; Reddy et al., 2003; Shis
Page 9 and 10:
1.3. IS ACCESS TO SUBSTANCE ABUSE T
Page 11 and 12:
1.4.2. Racial disparities in the ne
Page 13 and 14:
illegally and are unregulated by th
Page 15 and 16:
CONCEPTUAL MODELThis study’s conc
Page 17 and 18:
presenting problems and ability to
Page 19 and 20:
need for services is the most immed
Page 21 and 22:
This study focuses specifically on
Page 23 and 24:
METHOD3.1. STUDY AIMS & OBJECTIVESA
Page 25 and 26:
the researcher to explore possible
Page 27 and 28:
esidential areas from each of the s
Page 29 and 30:
3.3.2.4. Data collection: controlsF
Page 31 and 32:
o Problem recognition, Desire for h
Page 33 and 34:
Table 1.Domains and measures compri
Page 35 and 36: The 19-item MOS-SSS measures functi
Page 37 and 38: information on the accessibility of
Page 39 and 40: RESULTS: PHASE ONE4.1. VARIABLES AS
Page 41 and 42: efficacy to stop using drugs for mo
Page 43 and 44: (Table 6). Effect sizes were large
Page 45 and 46: were 2.4 times more likely to not a
Page 47 and 48: esteem scales (Table 9). Stigma als
Page 49 and 50: Table 10.Logistic regression coeffi
Page 51 and 52: 4.2.2. Model 2: Predisposing variab
Page 53 and 54: poverty scale, and the variable “
Page 55 and 56: of the model increased significantl
Page 57 and 58: controls had greater self-efficacy
Page 59 and 60: and R1000 per month than their fema
Page 61 and 62: subjects earning less than R500 per
Page 63 and 64: and race (Table 16). This indicates
Page 65 and 66: were 3 times more likely to earn le
Page 67 and 68: (which are higher for Black/African
Page 69 and 70: substance use or remain abstinent d
Page 71 and 72: monetary needs rise, subjects repor
Page 73 and 74: with improved awareness of services
Page 75 and 76: 4.4.4.4. Predictors of “community
Page 77 and 78: • In historically disadvantaged c
Page 79 and 80: RESULTS: PHASE TWODuring qualitativ
Page 81 and 82: 5.1.1.3. Government’s responses t
Page 83 and 84: “Part of the government's agenda
Page 85: putting extra strain and pressure o
Page 89 and 90: availability of affordable services
Page 91 and 92: completed a hospital-based detoxifi
Page 93 and 94: “I have thirty beds that are unus
Page 95 and 96: “I don't see it amongst the bona
Page 97 and 98: going to be a good day. So, yes it
Page 99 and 100: in the fourth week they relapse, it
Page 101 and 102: esponses to treatment, in part, are
Page 103 and 104: • Awareness of appropriate treatm
Page 105 and 106: This perception is prevalent in Col
Page 107 and 108: substance abuse problem - without a
Page 109 and 110: o These community influences are lo
Page 111 and 112: 6.2.1. Awareness of substance abuse
Page 113 and 114: informational support can improve a
Page 115 and 116: salient for low-income groups who h
Page 117 and 118: diminishing self-efficacy and motiv
Page 119 and 120: self-efficacy and negative percepti
Page 121 and 122: 6.3. TREATMENT SYSTEM FACTORS ASSOC
Page 123 and 124: This study found that limited resou
Page 125 and 126: 6.4. RECOMMENDATIONSBased on study
Page 127 and 128: • As findings suggest that female
Page 129 and 130: • While the affordability of trea
Page 131 and 132: To address these barriers, we argue
Page 133 and 134: o To ensure objectivity, this needs
Page 135 and 136: egistration process should gather i
Page 137 and 138:
REFERENCESAday, L.A., & Awe, W.C. (
Page 139 and 140:
First, MB; Spitzer, RL; Gibbon, M;
Page 141 and 142:
Myers, B., & Parry, C.D.H. (2005).
Page 143 and 144:
Ross, M.W., Williams, M.L., Timpson
show all

Access to substance abuse treatment in the Cape Town metropole ...

Create successful ePaper yourself

Delete template?

Save as template?