Community Psychiatry Services
COMMUNITY SPECIALIST PSYCHIATRIC SERVICES - [Dr. A Rama]
The Gauteng Department of Health in conjunction with the Department of Psychiatry of the University of the Witwatersrand provides outpatient psychiatric services at district clinics in the metropolitan municipalities of Johannesburg and Ekurhuleni and the district municipalities of Sedibeng and West Rand.The service aims to deliver specialised mental health care that is comprehensive, accessible, and cost effective to all eligible patients residing in the clinics’ catchment area. The outpatient services usually operate during the hours of 8h00-16h00 on Mondays to Fridays, but may vary from facility to facility. (See attached list of these clinics.)
The treatment modalities include: pharmacotherapy (initiation, adjustment or reinstitution of medication regimen); individual and group therapy (utilizing principles of crisis intervention); education (of the patient, family and community).The district based clinics provide a secondary level service and any patient wishing to be seen at these clinics must be in possession of a referral letter.
These clinics are generally run by psychiatric nurses and operate on a booking system. All patients are received and assessed by the clinic nurses on specified days before being booked for either a medical practitioner (medical officer, psychiatric registrar or consultant psychiatrist) or a psychologist. Walk-in and emergency patients will be briefly assessed and appropriately referred or redirected by the nurse in charge. Referrals are generally received from three sources;
1) The Community.
a. In accordance with the Gauteng Health Dept. Policy on integration of mental health care into PHC services, it is expected that all patients from the community are seen at PHC (primary health care) level services first.
b. Only those requiring specialist care should be referred to the nearest district based mental health clinic with an accompanying detailed letter specifying attempted interventions and reason for referral. It is preferable that these referrals are discussed with the psychiatric clinic staff first.
c. Stabilised patients who no longer require specialised psychiatric care are to be down referred to a PHC level service closest to the patient’s home.
2) Patients discharged or transferred from hospital inpatient and outpatient facilities
a. Amongst the many services in the Service Package of District Mental Health is the provision of maintenance treatment of patients (adults, children and State Patients) discharged or transferred from hospital inpatient and outpatient facilities.
b. A discharge summary that provides the requisite information must accompany all patients following discharge from the ward or transfer from the hospital outpatient department to the District clinic. A copy of the discharge summary must also be handed over at the District Psychiatry Nurses /Hospital meetings or submitted to the Division of Psychiatry at Charlotte Maxeke Johannesburg Academic Hospital. This should be done by no later than a week post discharge for timeous distribution to the different clinics.
c. In the case of children and adolescents referred for follow up and maintenance treatment for limited period (usually six months) by District Psychiatry, a summary is required. The patients will report back to the referring institution for a specialist consultation as and when requested. A brief report including further plan of management is required to be sent with the patient for implementation and for the clinic records following this consultation.
d. In the case of State Patients (on leave of absence) referred for follow up and maintenance treatment by District Psychiatry a summary is required. The patients will report back to the referring institution for a specialist consultation as and when requested. A brief report including further plan of management is required to be sent with the patient for implementation and for the clinic records following this consultation.
3) The Private sector
- The referral procedure to District psychiatric services is as follows. All patients must reside within the catchment area served by the clinic (see attached list of clinics).
- A specific outpatient referral form or a letter providing detailed clinical information and motivating the need for the referral must be completed by the patients’ referring doctor /mental health professional and must accompany the patient during the first visit. All referrals received will be reviewed by the outpatient staff and prioritized according to the clinical needs. Proof must be provided if “exhausted medical aid funds” is the reason for referral.
- Patients will be informed by the staff of the date for their appointment (usually within a month) or if patients needs do not warrant this level of care they will be referred down to an appropriate level of care. Referring health professionals must ensure that patients have sufficient medication until the date of their first appointment.
- If the patients are on medication not available on the primary level Essential Drug List or on expensive tertiary level medications without having started on first line medication as in the standard treatment guidelines, they may need to be weaned off this medication or cross-titrated onto other medication.
Failure to comply with the above referral procedures may result in the patient being sent back to the referring doctor / institution.
- COMMUNITY CLINICS.pdf "Community Clinics details" in pdf format