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

someone else needs the bed or needs to be assisted. So that person sits thereand waits until somebody can help them.” [TSP]For poor clients, the limited availability of state detoxification services acts as abarrier to treatment, particularly because inpatient facilities generally requireclients to be detoxified prior to admission:“Because the inpatient treatment requires us to have detox. They don't acceptthe person without it. So when you get to the rehab centre they turn the personaway if they get there and they’re still withdrawing. Because they don't have amedical team to look after the person.” [TSP]Similarly, many treatment facilities require clients with co-occurring psychiatricdisorders to be stabilized prior to admission. However, state mental healthservices are often unwilling or unable to treat drug-induced psychiatric problems.Clients thus fall through the cracks of the health system, with neither mentalhealth nor substance abuse services accepting responsibility for clients with cooccurringdisorders:“I have this guy now; he's a psychiatric patient of ten years at X communityhealth care. So his family brought him, and I'm waiting for …treatment centre tolet him be admitted. But at one stage he got so berserk man, he did strangethings. And I thought to myself, no man, he was a psychiatric patient and he's stillgetting medication. So I phoned the psychiatric nurse and she said the personcan come in for assessment. But they sent that person back home and said nothere's nothing wrong. I'm so convinced there is something wrong… The whole ofthe interview he was like fiddling and staring and gnashing on his teeth, and Ithought no this man needs some psychiatric intervention. But they just say it's nota psychiatric case, it's because of the alcohol. They say its withdrawalsymptoms...and you can see there's something wrong with this person but fromtheir perspective there's nothing wrong.” [SAC]The state’s allocation of personnel and financial resources to the health andsocial welfare sectors also hinders access to substance abuse treatmentindirectly by shaping the way in which the substance abuse treatment system isorganised. For instance, the state’s allocation of resources impacts on the87