What would become of a student like Cho in South Africa? We follow so much of American psychiatry, if they couldn’t get it right what chance would we have?
Dr Michael Ewart-Smith writes in What's New Doc
On April 16 2007 a 23-year old student, Korean-born Cho Seung-Hui, went on a shooting spree at Virginia Tech that eventually claimed 33 innocent lives including his own, the largest number of deaths in such shootings so far.
The incident at Virginia Tech received massive media coverage, partly because of the sheer magnitude of the tragedy. Within hours, investigative journalists were reporting Cho’s history of mental illness.
What would become of a student like Cho in South Africa, asks Dr Michael Ewart-Smith?
Our universities have nothing to compare with American in-house student support and campus security systems. The facilities for individual attention to, and tuition and accommodation of, seriously disruptive students within the teaching programme just don’t exist here. And it would be hard to justify them in the context of South Africa’s backlog of more basic educational priorities.
In Cho’s case they failed spectacularly. However, every teaching institution in South Africa should perhaps review existing mechanisms for assisting students who may be in need of psychological or psychiatric assistance.
In most cases a student who is identified as suffering from significant psychiatric problems will be referred to the state health service or the private sector. In the case of a student who may be in need of involuntary treatment, our 72-hour assessment period in terms of the South African Mental Healthcare Act would hopefully function much more effectively for all concerned than did the complicated Virginian charade, at least in Cho’s case.
Shortcomings in day-to-day running
But everyone involved in mental health care in South Africa is aware of shortcomings
in the day-to-day running of our well intentioned mental health legislation. Patients can fall through cracks due to such mundane factors as the absence in clinics of the mandatory forms, or to more profound shortcomings such as lack of appropriate staff or lack of accommodation in designated institutions.
Also, our constitutional commitment to privacy, confidentiality and autonomy, and the emphasis on the primacy of the needs of mental healthcare users, may well contribute
to extreme reluctance to invoke involuntary commitment to deteriorating institutions.
Opportunities may be missed to institute earlier treatment before dangerous psychotic behavioural disturbances actually occur. Even more worrying perhaps is the tendency to
discharge patients before the full benefits in patient care have been achieved. And all of this
takes place in the midst of massive shortcomings in community care facilities.
But when involuntary intervention is invoked, we hopefully carry out assessments, including the documentation of findings and recommendations, much more professionally than happened in Cho’s case.
Dr Michael Ewart-Smith was formerly principal psychiatrist at Sterkfontein Hospital. He is chairman of the South African Society of Psychiatrists task team on psychiatric disability and has a special interest in that field. He is an honorary clinical consultant in the department of psychiatry at the University of the Witwatersrand.
(This is an edited extract of an article first published in What’s New Doc, 2nd issue, March 2009. What’s New Doc is a publication for medical doctors, produced in association with Health24.)
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