"The prohibition of discrimination against mental healthcare users who are now entitled to the same level of care as non-mental healthcare users is a decidedly positive step towards changing the ethos of mental healthcare," says Kurt Worrall-Clare, Legal Advisor for the Hospital Association of South Africa (Hasa).
Commenting on the Mental Healthcare Act (Act 17 of 2002) ("the Act") that was promulgated with immediate effect on 15 December 2004, along with the associated General Regulations published on the same date, Worrall-Clare says: "The use of positive language in both the Act and the regulations may also help address the stigma traditionally attached to mental healthcare users and their healthcare services providers."
Worrall-Clare goes on to say that Hasa – which represents the majority of private hospitals in the country – has issued guidelines to its members regarding the implementation of the legislation and regulations in a private hospital and/or treatment centre with a view to ensuring absolute compliance with these guidelines.
Improving care"The main premise of the Act appears to be grounded in ensuring that mentally ill patients receive ‘the least restrictive and/or intrusive intervention’," says Worrall-Clare. "These ‘interventions’ will be administered through the implementation of clear protocols that are outlined in the Act which govern when the state, individuals and/or medical practitioners may intervene in the lives of the mentally ill or detain these patients - without consent - for the purposes of appropriate treatment.
Hasa has developed procedures which will ensure that mental healthcare users are not unnecessarily prejudiced or inconvenienced, including providing an adequate supply of the necessary forms; training staff on completing these forms and on protocols for transferring patients who cannot receive private care to public sector mental healthcare establishments.
"It also provides for greater involvement of mental healthcare patients in the care they receive. Mental Health Review Boards have also been established to ensure that patients are correctly identified and treated. The net result is that medical practitioners will, as of now, be compelled to consider mental healthcare establishments and, ultimately, psychiatric hospitals, as a last resort."
Hasa is, nevertheless, concerned about certain aspects of the Act including:
- The limitation on self-admission of minors to individuals older than 18 years, which may prove problematic in instances where the parent or guardian may refuse permission for younger minors;
- The probability that medical schemes and/or mental healthcare providers will contest the benefit schedules or the interpretation thereof; and
- The exclusion of certain mental health conditions from the list of prescribed minimum benefits.
"At this stage, we are also concerned about the relative dearth of original documents – especially the application forms that patients and their assessing/admitting doctors must complete before mental healthcare services can be provided," says Worrall-Clare. "To avert a potential crisis, Hasa members have secured permission to implement a temporary solution to make use of limited copies of the respective documents until the originals are readily available."
The guidelines issued by Hasa to its members also include a strong recommendation that they ensure that they read the Act and its concurrent regulations and understand its provisions; and use the guidelines to both interpret and implement the prescribed procedures appropriately.
"In the interests of mental healthcare users, we have encouraged our members to work with their counterparts in the public sector during this immediate transition phase," concludes Worrall-Clare. "Not only will this approach help all stakeholders come to grips with the new Act from a practical implementation perspective, but it will also ensure that the care provided to mentally ill patients is not compromised in any way."