TARA - The H. Moross Centre

TARA was built by Walter Tillet as a family home in 1938. It was named after a hill in county Meath in their native Ireland, a place of assembly and site of the Royal residence for many centuries. In 1942 the Government purchased the property to serve as the Inland Command Headquarters of the Union Defense Force. Following a fire at Brenthurst Tara was loaned to the Red Cross for their plastic surgery unit.

In 1945 one hundred and fifty military psychiatric patients were transferred for treatment from Potchefstroom together with Dr. Hymie Moross. This served as a good trial of Tara for ultimately accomodating non military neuropsychiatric patients. Dr. Moross became the first medical superintendent of Tara and pioneered the concept of the psychiatric team in South Africa. In 1969 the name of the hospital was changed to Tara, the H. Moross Centre, in recognition of his service. Since then the quality and range of treatment and service modalities have increased out of proportion to Tara s deceptively modest bed complement.

Today Tara functions as a 140 bed tertiary and quaternary care psychiatric hospital. It provides inpatient and outpatient psychiatric services as well as training, research and education facilities.

Patients are referred from other provincial hospitals as well as the private psychiatric sector. Tara has a proud reputation of being one of the foremost psychiatric hospitals in South Africa. The hospital is staffed by a highly qualified multidisciplinary team consisting of psychiatrists, psychologists, social workers. occupational therapists and nurses. Various categories of administrative and general maintenance teams ensure support for the efficient running of the hospital.

Patients are managed in specialised units, either as in or outpatients and admissions are voluntary or by consent . Once stabilised, patients are prepared for discharge and are referred to psychiatric community services or referred back to private professionals. The hospital does not only offer specialised patient care, it also serves as an important training centre for all categories of Mental Health Professionals and accommodates students from neighbouring universities, nursing colleges and medical schools. A community liason officer provides education to the public for the promotion of mental health. Stress management, assertiveness training and effective parenting courses are offered on a regular basis.

19491996

The Eating Disorder Unit is regarded by many as probably the finest of its kind in the country. It offers two inpatient programmes. The Bulimic programme which runs for six weeks and the anorexic programme with a variable duration of stay focus on the problematic behaviour related to eating as well as dealing with issues implicated in perpetuating these conditions. Bulimia Nervosa and Anorexia Nervosa may however coexist or alternate. Due to inpatient numbers and limited staffing, ongoing outpatient therapy is limited to an interim measure pre-admission or as follow-up post discharge.

The Adolescent Unit offers inpatient treatment for adolescents aged 12-18 years who may display disturbed behaviour, diminished functioning and suicidality. A comprehensive multidisciplinary team assesses and manages the patients. Scholars attend school on the premises when their conditions have been stabilised. The duration of the stay depends on the severity of illness and may range from weeks to months. Where necessary, patients who have been admitted will be followed up as outpatients once discharged.

The third of the superspeciality units is the Psychotherapy Unit where patients receive individual and group psychotherapy from a highly qualified multidisciplinary team. It is a short-term treatment ward (approximately six weeks) that places great emphasis on social, psychosocial and emotional aspects. Patients present with a wide variety of difficulties such as depression, anxiety, relationship and adjustment problems. These are often compounded by the individual s inability to identify and express feelings and internal pain, as well as lack of social support during times of distress.

Patients have the opportunity to explore an internal world within the safe boundaries of a therapeutic environment without negating the importance of coping in the social and working environment. The various forms of individual and group therapy provide space in which patients can be heard, understood and accepted. Occupational therapy and pharmacology compliment the programme. Support from friends and family is crucial after discharge to continue the work begun.

Three Biochemical Units, wards 6, 7 and 8, admit the greater part of the inpatients. The biochemical units take their name from the types of psychiatric illnesses that are treated. These include disorders such as schizophrenia, bipolar disorder, unipolar depression and anxiety disorders. These disorders have been shown to have organic or biochemical components and are treated primarily by physiological and pharmacological means. Most of the patients who are referred to these units have not responded well to treatment elsewhere, hence many people are seen with treatment-resistant depression and psychosis.

Thus it is at times necessary to use high doses of medication or electroconvulsive therapy depending on whether the benefits outweigh the risks of such treatment. Traditionally Tara has maintained an open ward system in that patients and/or their families have to agree to treatment and contribute to their own recovery. Facilities are available for short term seclusion in ward 7, but Tara does not have "lock up" facilities. Although medication is used, occupational therapy, psychotherapy and social work intervention also form an essential part of the overall management of most of these patients and all the wards utilise a multidisciplinary team approach to treatment.

Members of the Psychology, Nursing, Occupational Therapy and Social Work Departments work together with the specialist medical staff to provide a holistic management approach. Where appropriate patients are classified according to income so that the full range of services can be rendered to them at costs in keeping with their financial position.

On each unit the psychology team, usually consisting of a psychologist and interns, functions as an integral part of the multidisciplinary team. They are responsible for psychometrically assessing patients, where necessary, to assist with decisions about diagnosis, treatment and management. They offer psychotherapy on an individual basis, as well as working with families and groups.

Occupational therapy (OT) can be seen as a holistic problem solving process where an individual s unique problems are treated through applying purposeful activity. At Tara hospital. OT is an integral part of the multidisciplinary team approach to psychiatric treatment and rehabilitation. Occupational therapists at Tara work both as clinicians and educators. Each ward and unit within the hospital is served by an occupational therapist. Patients are assessed according to psychological, emotional, biological and spiritual components as well as in their functional spheres namely personal management, work, social and leisure. An individual treatment programme is drawn up with the aim of teaching patients coping techniques and lifeskills training as well as assisting them in improving their quality of life.

Treatment occurs both in groups and individually through mediums such as: craft activities, work related activities, recreational activities and group activities. Group activities include stress management, assertiveness, social skills, art therapy, balanced lifestyle, home management etc. Each activity is chosen and adapted to allow the patient s individual needs to be met and the programme differs from ward to ward. In addition, the occupational therapists are involved in the hospital entertainment programme, the ward programme, patient and family education, support groups and work rehabilitation.

Social workers form part of the multidisciplinary team and their role varies according to the needs of the unit in which they work. Their work ranges from individual, group, marital and family therapy to educating and preparing patients both for their discharge and for understanding the nature of their problem. Whatever the psychiatric problem may be, the psychosocial implications for the patients and their families are enormous.

The social workers at Tara Hospital are aware of this fact and therefore go to great lengths in attempting to alleviate or minimise the way in which the illness may impinge of the patient s individual. social and occupational functioning and help to integrate the person back into their family and into society as a whole. The social work department also offers an Employee Assistance Programme.

Multidisciplinary outpatient services are offered to both adults and children at Tara as well as otherwise poorly serviced areas such as Alexandra. The Alex/Tara Children s Clinic is an outpatient child and adolescent unit which runs clinics on a daily basis from Tara Hospital and Alex East Bank Clinic, Alexandra. A multidisciplinary team assesses and treats children with a range of special needs. These include children with emotional problems such as depression or anxiety, behavioural problems such as attention deficit disorder and pervasive developmental disorders such as autism.

Therapeutic interventions include individual therapy for parent and child, group therapy, behavioural programmes, medication and parental guidance such as step courses. A Parent Resource Centre, providing information on childhood development and disorders is available at the clinic.

The Adult Outpatient Department provides the following services during working hours for persons older than 18:

• Consultative & advisory services for new patients.
• Psychiatric assessments and recommendation regarding treatment and supportive therapy.
• Psychometric testing.
• Psychological assessment.
• Social work counseling.
• Follow-up of discharged patients.
• Ongoing educational and support groups for outpatients and their families.

Patient participation is encouraged in all services at Tara and families are also actively involved in the assessment, planning and treatment of their family members experiencing psychological problems, as well as in the prevention of a relapse of the condition. Staff at Tara adopts a holistic, humanistic approach in the care of each patient. They act as advocates for them in terms of the Mental Health Act No.18 of 1973. which ensures protection of the individual s human rights.

In addition to patient care Tara is responsible for training staff at both undergraduate and postgraduate levels. The consultants supervise and train psychiatry registrars sitting for their specialist exams. Fifth and final year medical students also receive exposure and training in psychiatry. Tara has a high turnover of nursing and occupational therapy students as well as psychology interns.

Clinical research is also a priority and currently many sponsor and investigator driven projects are running. On-going multidisciplinary research within the hospital aims to uphold and improve the standard of care and knowledge of psychiatry and to further the preventative aspect of mental illness.

The motto of Tara is "Resurgat vis animi", let the vigour of the mind be restored. This motto appears on Tara s crest, as does the Phoenix to symbolise birth or resurrection. The crossed swords refer to the earlier use of the property as a military hospital.

For more information you may also contact:

• The Superintendent, Dr. Emma Bondarenko
• The Matron in charge, Matron Wendy Blott