Issues at Evuxakeni Psychiatric Hospital: Skills Retention, Mental Health Review, Family Involvement, Referral System

1. Briefing to the Select Committee on Women, Children and Persons with Disabilities Department of Health, Limpopo 27th February 2013

2. Outline of Presentation

3. Introduction The purpose is to brief the Select Committee on Women, Children and Persons with Disabilities on the following issues that were observed during the committee’s oversight visit • The lack of a skills retention strategy of the Limpopo Provincial Department of Health • Concerns over the absence of the mental health review board • The extent of family involvement in the lives of disabled patients at the Evuxakeni Hospital • Poor referral systems • Poor condition of facilities particularly for the mentally disabled patients at the Evuxakeni Hospital

4. Background • Evuxakeni first opened its doors to the public in 1985 as a Psychiatric Care and Rehabilitation Centre, under the auspices of Life Care • The Government entered into a 20 year contract with Life Care which entailed Build, Operate and Transfer • In 2005 the centre was handed over to the Limpopo Department of Health, and the Department converted it into a Psychiatric hospital • Evuxakeni Psychiatric Hospital, with an approved 400 beds, was opened and commissioned to serve the Mopani district

5. Services Offered at Evuxakeni Acute Psychiatric Services • 35 total acute beds (out of 60 approved) are operational • 10 for females, and 25 for males • Managed by staff from Nkhensani Hospital, as the original plan of hospital did not cater for acute services Sub-acute Psychiatric Services • No ward for this service, patients are mixed with Acute, due to space limitations Chronic Psychiatric Services • 360 total chronic beds (out of 330 approved ) are operational • Includes Forensic patients (often less than 10)

6. Skills Retention Strategy The department has developed a Skills Recruitment and Retention strategy, which is approved, however it is not fully funded and therefore it is partially implemented (Strategy document-handout)

7. Skills Retention Strategy • The department continues to address staff (health professionals) shortage, through direct intakes • Accommodation for health workers is prioritized through the Housing policy that favours obligatory staff

8. Mental Health Review Board • Mental Health Review Boards are appointed in all 5 districts in the province, since April 2011 • The Mopani Mental Health Review Board is a highly active structure that enhances the services of Mental Health in district • The board holds its meetings regularly per schedule

9. Family Involvement • Approximately 60% of families involve themselves with the disabled patients and mental health care users. • These patients visit their families however there are challenges such as stigma and crime that may have been committed by the patient while sick that prevents the patients from undertaking these visits. • Some patients remain unknown, despite efforts by Social workers to trace relatives, such patients remain institutionalised for years

10. Referral System

11. State of Facility (Evuxakeni) • The facility is 28 years old and in need of revitalisation • The institution was scheduled for revitalisation during the 2013/14 financial year, however it had to be postponed in order to accommodate the construction of Siloam Hospital as a National Presidential priority project. • The health brief and business case will still be undertaken during the 2013/14 financial year