Depression

Updated 23 June 2014

Psychiatric admissions: the steps

Many people who care for loved ones with a serious mental illness may have to make difficult decisions regarding whether or not the person should be hospitalised.

Meet Clare. She's been caring for her schizophrenic brother for the past four years. He is on medication and is an outpatient, but things have got seriously out of hand in the last three days. Would you know what to do in a psychiatric emergency?

Most psychiatric conditions can be managed effectively on an outpatient basis. But in some cases, more intensive care in a mental health facility may be necessary. But how would you know the difference and which procedures should you follow?

The Mental Health Care Act (MHCA), which was promulgated on 15 December 2004, clearly stipulates the steps family members and other carers can take to ensure that someone gets the help they need.

Voluntary admissions the easiest
The most advantageous step for all involved, including the person in need of psychiatric help, is if the person willingly agrees to be admitted to a mental health facility for in-patient treatment.

But this is unfortunately not always possible. What can be done if someone clearly needs help, but refuses to be treated or is unable to make a decision?

Other types of admission
These types of admissions are classified as follows:

  • Involuntary care, treatment and rehabilitation: when someone who needs to be hospitalised is incapable of making informed decisions due to his/her mental health status and refuses health intervention
  • Assisted care, treatment and rehabilitation: this means the provision of health interventions to people incapable of making informed decisions due to their mental health status and who do not refuse the health interventions. An example would be a mentally ill person who is found wandering the streets and is unaware of what is happening to him/her.

Steps to follow for assisted care:

  • An application can be made by the spouse, next of kin, partner, associate, parent or guardian. If the above are incapable, unwilling or not available, a health care provider may apply. The Act stipulates that the applicant must have seen this professional in the preceding seven days.
  • The person must then be examined by two mental health care practitioners. At least one of them must be able to conduct physical examinations. If the findings of the two differ, the superintendent must arrange for a third practitioner to examine the person.
  • Once it is established that assisted care is necessary, the person must be informed of the decision in writing and the superintendent must arrange for the person to be admitted within five days.
  • A copy of the application must be sent to the relevant Review Board and the latter must investigate the matter within 30 days. Based on the investigation, they could either request the hospital to continue treatment or to discharge the patient. The patient has a right to lodge an appeal during this 30-day period.
  • The patient's mental health status must be reviewed after six month and every 12 months thereafter.

If the person regains his/her ability to make informed decisions and recovers, the patient will be discharged.

Steps to follow for involuntary care
Involuntary care should be considered if there is reasonable belief that a person has a mental illness and is likely to inflict serious harm to him/herself or others, or if treatment is necessary for the protection of the financial interests or reputation of the user.

In such cases:

  • The spouse, next of kin, partner, associate, parent or guardian can fill in an application form. These are obtainable at hospital admission wards, clinics and police stations.
  • The person must then be examined by two mental health care practitioners. At least one of them must be able to conduct physical examinations. If the findings of the two differ, the superintendent must arrange for a third practitioner to examine him/her.
  • Once it is established that assisted care is necessary, the person must be informed of the decision in writing and must be admitted within 48 hours.
  • A medical practitioner and mental health care practitioner must assess the physical and mental health status of the user for a period of 72 hours. They must decide if the involuntary care must be continued and whether it should be on an out- or in-patient basis.
  • The superintendent must inform the applicant of the findings 24 hours after this 72 hour-period.
  • If the superintendent does not agree that person needs involuntary care, he/she will be discharged. If the person needs outpatient treatment, he/she will be discharged under certain conditions.
  • Should the person require inpatient treatment, the superintendent must submit a written report to the Review Board for approval.
  • If the Review Board grants the request, they have to submit the documents to the High Court.
  • The patient, spouse, next of kin, partner, associate, parent or guardian may lodge an appeal against the decision within the first 30 days. In such cases, the Review Board will have to investigate and make a final decision.

- Ilse Pauw, Health24, updated July 2011

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Depression expert

Michael Simpson has been a senior psychiatric academic, researcher, and Professor in several countries, having worked at London University in the UK; McMaster University in Canada; Temple University in Philadelphia, USA.; and the University of Natal in South Africa.

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