South African Psychiatry - February 2019

REPORT
hard, patient-oriented outcomes (e.g. readmission
or repeat offending) may be upgraded, and RCTs
downgraded, for strength of evidence. Their updated
schizophrenia guidelines should be published soon.
I ATTENDED AN NHS TRUST AUDIT OF
PSYCHIATRIC CARE, SOMETHING
WHICH, IN THEORY AT LEAST, NHI WOULD
INTRODUCE IN SOUTH AFRICA. THE AUDIT
WAS MAINLY AROUND PRESCRIBING
PATTERNS; REFLECTING ON THE VARYING
PROPORTIONS OF MEDICINES USED AND
CHANGES OVER TIME. THERE WAS SOME
DISCUSSION AROUND THE PRESENCE
OF AND PRESCRIBING FOR PHYSICAL
COMORBIDITIES. HOWEVER, THERE
WAS LITTLE RELATION OF PRESCRIBING
PATTERNS TO CARE OUTCOMES. THIS I
THINK MAY BE RELATED TO A GLOBAL
UNCERTAINTY REGARDING OUTCOME
MEASURES IN PSYCHIATRIC CARE, BUT
NEVERTHELESS IT RENDERS A CLINICAL
AUDIT SOMEWHAT LACKING IN MEANING.
PHYSICAL HEALTH IN PEOPLE WITH
SEVERE MENTAL ILLNESS ALSO FEATURED
IN A SESSION IN WHICH RESULTS OF THE
HOME, STEPWISE AND PRIMROSE TRIALS
WERE PRESENTED. THESE TRIALS ARE
WELL WORTH LOOKING OUT FOR AND
WILL PROBABLY REINFORCE THE NEED
FOR HEALTH SYSTEMS WHICH PROMOTE
COLLABORATIVE AND INTEGRATED
CARE.
Deinstitutionalisation also featured, with symposiums
on residential facilities and community-based
mental health care. Although highly pertinent to
South Africa, I was unfortunately unable to attend
these. I did however speak to members of the
National Collaborating Centre for Mental Health, the
organisation presenting on community psychiatry.
Interestingly, they are having to re-examine their
mental health system as those with severe illness
are falling through the cracks. This was evident in the
numbers of homeless people in both London and
Birmingham, some of whom were clearly unwell. With
a comprehensive welfare system and ample shelters
in the cities, it’s possible that mental illness and
personality factors perpetuate the homelessness.
One of the plenary sessions was given by a journalist,
Sathnam Sanghera, author of “The Boy with the Top
Knot and Marriage Material”. He spoke of how, in his
early twenties, he realised his father and sister had
schizophrenia.
HE TERMED SCHIZOPHRENIA AS THE
LEPROSY OF TODAY AND DESCRIBED
GREAT DIFFICULTY IN ACCESSING
APPROPRIATE CARE FOR HIS FATHER
WITHIN THE NATIONAL HEALTH SYSTEM,
WHICH HE FELT NEGLECTED SEVERE
MENTAL ILLNESS EXCEPT DURING
PERIODS OF AGGRESSION.
His words of wisdom conveyed caution regarding:
• awareness campaigns which have inadvertently
led to the prioritisation of mild to moderate
common mental illness;
• a recovery orientated approach which may
cause false expectations and a sense of
personal failure among people with severe
illness and their carers;
• the reluctance to use the risk of violence as a
lobbying tool for better mental health services
and preventative care.
A meeting of the RCPsych Africa Division included
representatives from Kenya and Ghana. Discussion
revolved mainly around UK training opportunities
for psychiatry registrars. At the gala dinner, I had the
pleasure of meeting Dr Altha Stewart, the APA chair,
who remembered all the South Africans she had
met at the APA congress in May.
I SAT WITH THE RCPSYCH TREASURER AND
ONE OF THE LAY TRUSTEES, AND LEARNT
MORE ABOUT THE RCPSYCH, AND OF THE
GAPS IN MENTAL HEALTH CARE IN THE
UK, WHICH ARE VERY SIMILAR TO MANY
OF OUR ISSUES.
Overall, the congress was excellent and very
enlightening. I am grateful to my SASOP colleagues
for the sponsorship. Among all the lessons I learnt is
the certainty that we will also become, in the words
of Professor Sir Simon Wessely of the RCPsych for
the UK, the “calm, trusted, and authoritative voice in
mental health” for South Africa.
REFERENCE:
1. Freeman MC, Kolappa K, de Almeida JM,
Kleinman A, Makhashvili N, Phakathi S, et al.
Reversing hard won victories in the name
of human rights: a critique of the General
Comment on Article 12 of the UN Convention
on the Rights of Persons with Disabilities. Lancet
Psychiatry. 2015;2(9):844-50.
Lesley Robertson is a community psychiatrist working in the Sedibeng District and is jointly appointed in the Department of
Psychiatry, University of the Witwatersrand, Johannesburg, South Africa. Correspondence: Lesley.Robertson@wits.ac.za
SOUTH AFRICAN PSYCHIATRY ISSUE 18 2019 * 51