South African Psychiatry - November 2018

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POLICY GUIDELINE or institution-based mental health care, admission under the MHCA surely does not apply. Rather, if a person suffers a relapse of their mental illness, the proprietor/ manager would apply to a hospital for an assisted or involuntary admission if the person lacks the capacity to consent and their relatives are not available. b. the proprietor/ manager to take responsibility for access to and provision of mental health care appropriate to the level of severity of the illness (15.6, 15.7, 17.7, 17.8, 17.9, 18.1, 18.2). Access to general and mental health care of PLWMI and/or ID appropriate to the level of severity of the illness, in equity with the provision of general health care, is the responsibility of the Department of Health. The NGO proprietor/ manager’s responsibility is to ensure that the NGO residents utilise the accessible mental health care services provided by the DOH. c. facilities to have a medical procedure room (16.7), sluice rooms (Annexure B, page 9) and registers for restraints and medicine dispensing (Annexure B page 20). The NGOs to which the guidelines are applicable serve a predominantly social role. Therefore, while they require a ‘first-aid’ room and an area to administer injections, they do not dispense medication, perform medical procedures, or use restraints. 6. There is a lack of clarity regarding financial, asset and human resource governance, apart from stating that the NGOs are funded by either or both Departments of Health or Social Development (2.3). In Annexure B pages 21 and 22, the relationship be between the ‘service provider’, NGO manager, NGO Board, and the Departments of Health and Social Development is not clear. There is no clause requiring evidence of self-sustainability without a DOH subsidy as a requirement for licensing. 7. The Policy Guidelines do not address the need for guardianship or custodial care of PLWMI and/or ID who do not have any relatives, or who are housed in NGOs at the request of social workers or the police because of abusive family homes or homelessness. 8. There is no guidance regarding intersectoral responsibilities for the care, monitoring or adjudication of the facilities. OUR RECOMMENDATIONS ARE: 1. Guidelines must distinguish between the different levels and types of care which NGOs may provide, acknowledging the wide range of individual need and the intersectoral nature of community-based services. They should be informed by the principles of the recovery model and inclusive development embodied in existing policy and legislation. Specific areas of overlap, for example with ECD centres and homeless shelters, should be addressed. The role of the NGO administered facilities to which these Guidelines are applied should not be conflated with that of designated health establishments: a. If there is a need for NGOs to provide certain health functions with the support of civil society, this must be delineated accordingly. Clear criteria for authorisation of individual NGOs to perform specified tasks is needed. b. Where the Department of Health needs an NGO to function fully as a health establishment, it should be designated and funded as such. 2. There is a need for guardianship or custodial care arrangements in the case of homeless or previously abused PLWSMI and/or ID. Access to legal assistance and intersectoral arrangements between at least the Departments of Health, Social Development and Justice are required. These processes should be covered in the guidelines. 3. Adequate financial support and sound governance are essential to the observance of basic human rights of NGO residents. a. Clearer guidelines on the financial management by the facility and its Board, and their relationship with the funder(s) is required. b. The amendment of Regulation 6, Government Gazette No. 38182 of 6 November 2014, added “Within available resources” to the State’s obligation to pay subsidies to appropriate non-profit organisations for the provision of community care, treatment and rehabilitation. Clarification as to the State and civil society’s respective financial obligations is essential. FINALLY, THERE IS NO ACKNOWLEDGEMENT BY THE NDOH OF THEIR INTER-DEPENDENCE WITH OTHER GOVERNMENT DEPARTMENTS, NGOS, CIVIL SOCIETY, USERS, AND THEIR FAMILIES, FOR THE CARE OF PLWSMI AND/OR ID. IF THE HUMAN RIGHTS OF SUCH VULNERABLE AND MARGINALISED PEOPLE ARE TO BE OBSERVED, IT IS VITAL THAT ALL ORGANISATIONS INVOLVED IN THEIR WELL-BEING WORK TOGETHER IN A COLLABORATIVE MANNER. We trust that the Policy Guidelines will be revised accordingly, and that the subsequent drafting of regulations will be accompanied by a thorough consultative process with all relevant stakeholders 88 * SOUTH AFRICAN PSYCHIATRY ISSUE 17 2018
Freedom Starts Now Olanzapine 5/10 mg Venlafaxine tablet Sertraline Hydrochloride 50mg tablet Risperidone 1/2 mg tablet Topiramate tablet All Neurocare brands fall within MMAP and MPL reference pricing. No co-payment applicable. 8,9,10 Fluoxetine 20 mg Capsules Dedicated to Life by making quality medication affordable References: 1. ZYLIN Package Insert. 13 April, 2007. 2. ZYDUS-FLUOXETINE Package insert. 3 February, 2005. 3. ODIVEN Patient information leaflet. 9 July, 2007. 4. EPITOZ Patient information leaflet. 14 September, 2007. 5. ALZIDO Package insert. 5 December, 2013. 6. ZOLANZ Patient Information Leaflet. 11 June, 2015. 7. RISPONZ Patient information leaflet. 27 June, 2008. 8. https://www.medikredit.co.za/attachments/article/29/MMAP_issue_2053_20_204_20September_202018. xlsx Accessed on 11/09/2018. 9. http://www.medscheme.com/wp-content/uploads/2012/10/Medicine-Price-List-MPL-Complete-List-September-2018.pdf. Accessed on 11/09/2018. 10. SEP Reduction as of 04/09/2018. S5 Odiven 37,5 mg Tablets. Each tablet contains venlafaxine hydrochloride equivalent to venlafaxine 37,5 mg. Reg. No.: A41/1.2/0440. S5 Odiven 75 mg Tablets. Each tablet contains venlafaxine hydrochloride equivalent to venlafaxine 75 mg. Reg. No.: A41/1.2/0442. S3 Epitoz 25 Tablets. Each film-coated tablet contains 25 mg Topiramate. Reg. No.: A41/2.5/0711. S3 Epitoz 50 Tablets. Each film-coated tablet contains 50 mg Topiramate. Reg. No.: A41/2.5/0712. S3 Epitoz 100 Tablets. Each film-coated tablet contains 100 mg Topiramate. Reg. No.: A41/2.5/0713. S5 Alzido 5 mg film-coated tablets. Each film-coated tablet contains 5 mg donepezil hydrochloride. Reg No: A45/5.3/0939. S3 Alzido 10 mg film-coated tablets. Each film-coated tablet contains 10 mg donepezil hydrochloride. Reg. No.: A45/5.3/0940. S5 Zydus-Fluoxetine 20 mg (capsules). Each capsule contains fluoxetine hydrochloride equivalent to 20 mg fluoxetine. Reg. No: A37/1.2/0265. S5 Risponz 1 Tablets. Each tablet contains 1 mg risperidone. Reg. No.: A41/2.6.5/0937. S5 Risponz 2 Tablets. Each tablet contains 2 mg risperidone. Reg. No.: A41/2.6.5/0938. S5 Zylin 50 Tablets. Each film-coated ZYLIN tablet contains sertraline hydrochloride equivalent to 50 mg sertraline. Reg. No: A39/1.2/0596. S5 Zolanz 5 mg Tablets. Each tablet contains 5 mg olanzapine. Reg No.: A43/2.6.5/0666. S5 Zolanz 10 mg Tablets. Each tablet contains 10 mg olanzapine. Reg. No.: A43/2.6.5/0667. 02/Neu/04/18/AD Zydus Healthcare SA (Pty) Ltd, Block B, Southdowns Office Park, 22 Karee Street, Centurion, 0157. Tel. No.: +27 (0)12 748 6400.
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ISSN 2409-5699 ABOUT the discipline
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Features EQUINE ASSISTED 7 PSYCHOTH
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FROM THE EDITOR Dear Reader, welcom
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South African Psychiatry - November 2018

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