CAPE TOWN- The Covid-19 outbreak in South Africa has added further strain to the country’s mental health services as an increased numbers of patients have relapsed on treatment and new psychiatric cases are rising due to the stresses caused by the pandemic.
the South African Society of Psychiatrists (SASOP) urged the National Department of Health and private hospital groups not to use psychiatric beds for non-psychiatric Covid-19 patients, due to an already acute shortage of beds.
SASOP board member and public sector national convenor, Dr Kagisho Maaroganye, says there is no adequate plan in place to support mental health patients during the pandemic. There is a chronic psychiatric bed shortage and a lack of psychiatric medication in the district health system to treat, manage or contain relapsed or new patients.
“The twin peaks of an increased rate of Covid-19 amongst psychiatric patients and increased incidence of relapses and new psychiatric cases, is bound to have these two distinct groups of patients arriving at psychiatric facilities at the same time, and possibly in large numbers,” he said.
Dr Maaroganye argues that accommodating Covid-19-positive psychiatric patients in the same ward as psychiatric patients who do not have the virus would be “unacceptable, for both ethical and humanitarian reasons”.
The long-standing critical situation in state mental health hospitals is exacerbating the Covid-19 crisis in South Africa, he said, while psychiatric patients are far more at risk of contracting the virus than the general population due to their high levels of co-morbidities.
“Psychiatric patients have for many years suffered from a minimal allocation of national healthcare resources to meet their needs and now, at a time that they are most vulnerable, they cannot once again be denied the rights afforded to medical and surgical patients for whom such mixing of patients would hardly be considered,” he said.
Many mental healthcare services are already burdened by crowded living conditions in psychiatric hospitals, are poorly-equipped and do not have adequate personal protective equipment (PPE).
SASOP urges the Department of Health and private hospital groups not to use psychiatric beds for non-psychiatric Covid-19 patients and recommends a number of steps that should be taken by health authorities and mental health care providers during this pandemic:
1) Heads of health establishments, healthcare providers, multidisciplinary mental health specialists and informal caregivers should continue to render mental health care services throughout the pandemic, as is their duty.
2) Psychiatric patients infected with or suspected of having Covid-19 and needing high care or intensive care (eg, ventilation) should be transferred to a medical facility without delay.
3) In anticipation of more psychiatric patients acquiring Covid-19 and/or relapsing from pandemic-associated stress, the capacity to accommodate psychiatric patients during this pandemic should be attended to with urgency and immediately.
4) The opening up of more psychiatric beds could be facilitated through a number of means including:
Fast-track the licensing applications of NGOs that can accommodate users with profound and severe intellectual disability in order to free up acute or specialist psychiatric beds.
Re-procurement of contracted beds at larger long-term facilities that can house users with complex mental illnesses with risk factors that cannot be contained in the community.
Along with infrastructure improvement, more psychiatric staff should be pre-emptively hired to help current staff cope with the expected influx.
Any decision to close an acute psychiatric ward should not be haphazard as this may lead to creation of a Covid-19 ward which lies unused. Rather, one hospital within a region should become a near-complete Covid-19 hospital, accepting infected patients from nearby hospitals so that other non-Covid-19 conditions can continue to be treated.
Government must engage the private sector to assist in addressing any shortfalls in hospital bed capacity.
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