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n South African Psychiatry Review - The barriers preventing effective treatment of South African patients with mental health problems
Background : Consumer research was last conducted among South African patients with mental health problems in 1997/8 by GAMAIN (The Global Alliance of Mental Health and Advocacy Networks). Respondents at the time suffered primarily from anxiety and/or unipolar depression. Updated consumer research was conducted between February 2004 and April 2005 by Linda Trump of Cat Communications to find out how mental health patients were faring in the current South African environment and to determine which factors were mitigating most against their recovery. The study was funded by Cat Communications and partial grants from AstraZeneca, Eli Lilly and Solvay Pharma.
Method : The survey questionnaire was developed by Linda Trump and checked by Charmaine Hugo of the Mental Health Information Centre (MHIC), Dr. Colinda Linde of SADAG, and Dr. Eugene Allers of the SA Society of Psychiatrists. It was distributed and posted with a self-addressed envelope and freepost address to leaders and members of SADAG, the SA Bipolar Association, Central Gauteng Mental Health, the Schizophrenic & Bipolar Disorder Alliance (SABDA) and the OCD Association. The questionnaire was also e-mailed to the Schizophrenia Foundation, some members of SADAG and members of the Johannesburg Bipolar Support Group. In addition, it was hosted on the Health 24 and SA Bipolar Association websites.
Results : The sample comprised 331 respondents. 75% had a single diagnosis, with 25% having dual or multiple diagnoses. Diagnoses included unipolar depression (30%), bipolar mood disorder (40%) and schizophrenia / schizoaffective disorder (13%). 49% of respondents suffered from one or more types of anxiety. The median age of symptom onset for respondents was 26.5, with the median respondent waiting two years before seeking help. 69% of the cohort experienced a comorbid physical ailment, entailing chronic pain. 72% of the respondents saw two or more caregivers before receiving a correct diagnosis and it took more than a year for 55% of respondents to get a correct diagnosis. 74% of respondents received the correct diagnosis from a psychiatrist, with GPs, psychologists and social workers playing a minimal role in confirming diagnoses. 68% of respondents discontinued medication at some stage of their illness and only 46% of respondents ended psychotherapy because it had served its purpose. 40% of respondents did not know what type of psychotherapy they had. Only 20% of respondents could work adequately while ill and 19% of respondents became unemployed during the course of their illness. 26% (of 304 respondents) eventually separated or divorced as a direct result of their illness.
Conclusions : Ongoing education is needed to inform the public about the hazards of delaying treatment for psychiatric symptoms. Doctors need to be more forthcoming about potential side-effects and how to manage them. GPs, psychologists and social workers may need additional psychiatric education. Psychologists need to tell patients what methodology they are using and they need to be more upfront in setting objectives and discussing the desired outcomes of therapy. Ideally, psychotherapy should include the patient's partner or family when there are significant domestic tensions. Stigma needs to be reduced in the workplace.
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