TARA - THE H MOROSS CENTRE (TARA HOSPITAL) - [Dr. T Madigoe; Dr. S Fernandes]
Tara Hospital is located in Hurlingham, Johannesburg. It is a public sector specialised psychiatric hospital, one of three in Gauteng Province. The hospital renders specialised inpatient and outpatient services to adults and children with serious mental illness.
The service package for Tara Hospital constitutes that of a tertiary and quaternary level hospital. The hospital is both a provincial and national asset and provides some services that are not available in other provinces. The hospital has a total of 141 approved beds across nine wards (including four seclusion beds).
Eating Disorders & Adolescent Unit (Ward 1&2): 24 beds
Ward 1&2 houses two highly specialized units:
The Eating Disorders Unit provides inpatient care for patients aged 13 years and older with Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders (formally ED-NOS) who cannot be managed on an outpatient basis. Patients must be medically stable before being admitted to the unit, and have had any other severe psychiatric illness (e.g. schizophrenia) or substance use treated prior to admission. We currently have eight functional beds. The treatment programme includes pharmacotherapy, dietary counselling & nutritional support, nurse therapy, CBT-E psychotherapy (a specialized form of cognitive behaviour therapy for the treatment of eating disorders), group psychotherapy, occupational therapy, parental counselling or family support where relevant, and social work intervention if indicated. School-going patients on the higher stages of the programme are required to attend the Tara H. Moross School. Programme length is variable, but generally ranges between 12 and 20 weeks.
The Eating Disorders Unit also runs a small outpatient clinic for child, adolescent, and adult patients. The Eating Disorder outpatient clinic (ED OPD) is staffed by a psychiatrist, dietician, and psychologists. In the ED OPD, we screen new referrals to the inpatient unit, provide multidisciplinary treatment for patients for whom outpatient treatment is indicated, and follow-up some of the patients who are discharged from our inpatient unit.
The Adolescent Unit is an open ward that provides medium-term inpatient care for adolescents aged 13 to 18 years who have serious mental illnesses or psychological difficulties and who cannot be managed on an outpatient basis. We have 10 functional beds (six female and four male). The treatment programme includes pharmacotherapy, nurse therapy, individual and group psychotherapy, dialectical behaviour therapy (DBT) groups, occupational therapy, parental counselling, and social work support where indicated. Attendance of the Tara H. Moross School is also required for patients who are fit to attend. The multidisciplinary team works closely with parents and caregivers to manage our adolescent patients.
As Ward 1&2 is not a secure facility, we cannot admit patients who have severe behavioural problems or are acutely suicidal or homicidal.
Specific referral forms for the Adolescent Unit or Eating Disorders Unit and further information may be obtained by calling the ward at 011 535 3043.
Psychotherapy Unit (Wards 4&5): 23 beds
This is a highly specialized unit which offers patients a medium term inpatient stay where the primary modality of treatment is group and individual therapy. The unit currently has 18 functional beds and treats patients with personality, anxiety and mood disorders. Patients can be referred by the treating psychiatrist or psychologist, by completing a referral form. This can be obtained by calling 011-535 3011. Patients will then go on a waiting list, and be called for an interview to assess their capacity and motivation for the treatment program.
Parenting Day Programme: The above unit also offers a Day Programme for similar patients who also struggle with their parenting. This is a 4 week programme and referral forms can be obtained from the unit.
Biological Wards: 80 beds
Our Biological Wards have a total of 80 beds provisioned as follows:
- Ward 6 (open ward): 16 male and 16 female beds
- Ward 7 (semi-closed ward): 30 male beds
- Ward 8 (closed ward): 18 beds
- Age 18 years or older
- Physically well
- Primary diagnosis of a serious mental illness and requiring medium term hospitalization.
- This is by means of a referral form which can be obtained from Tara Admissions (011 535 3064) and should be faxed to 011 535 3184.
- Referrals are placed on a waiting list and are accepted for admission when a bed is available.
- Patients may be referred by psychiatric units in general hospitals, psychiatric registrars or consultants working at community clinics and psychiatrists in private practice. Patients following up at Tara may also be placed on the waiting list when admission is needed.
- Patients with serious medical or physical problems will be assessed for suitability on a case by case basis and may not be adequately managed at Tara.
- Patients need to have all relevant Mental Health Care Act documents completed and submitted to the Mental Health Review Board by the referring institution. Copies of the documents are to accompany the patient on admission.
- Patients who are assessed as being too medically unwell to be managed in a psychiatric hospital will not be admitted and shall be returned to the referring institution/practitioner following a discussion with them. A letter detailing the reasons for not admitting the patient will be sent back with the patient.
- Treatment in each of these wards is provided by a team consisting of the Psychiatry, Clinical Psychology, Nursing, Social Work, Occupational Therapy, and Dietetics disciplines.
- Patients receive pharmacotherapy as well as various individual and group therapeutic interventions according to their needs.
- Electroconvulsive Therapy is also available for in- and outpatients who require it.
Child Unit (Ward 9): 10 beds
This unit provides tertiary/quaternary care for children, and is one of only three such units in the country. Currently six beds are operational within the unit, due to insufficient numbers of nurses to safely run the full unit.
The treating psychiatrist can refer patients by faxing a detailed referral letter to Tara Admissions (Fax number: 011 535 3064) for the attention of the Child Psychiatrist, Ward 9 or alternatively by contacting the Child Outpatient Clinic (011 535 3110) to discuss the referral with a Child Psychiatrist. All referrals are screened by the multidisciplinary team for suitability.
The ward programme depends on the child’s caregivers working closely with the multidisciplinary team. During their admission the children attend the Tara H Moross School, which is based on the hospital premises, if assessed by the team and found fit for school attendance.
Adult OPD: The adult outpatient department offers multidisciplinary tertiary level care, attending to approximately 700 patients per month. The services available include psychology, occupational therapy, psychiatric and nursing care. The unit serves mental health care users who reside in the local community and are in need of specialised tertiary care. Such patients are referred by means of a detailed referral letter from their treating practitioner. Further details regarding the referral process can be obtained by contacting the outpatients department on (011)535-3067.
The psychiatric follow-up clinics include consultant, registrar and nursing clinics. The nursing clinics were stopped for a period of time but have once again resumed and the number of patients attending these clinics for follow-up is steadily increasing. Consultant psychiatric clinics are run on a daily basis for patients requiring tertiary level care. The facility also has a specialised eating disorder clinic, which focuses on a multidisciplinary team approach involving a consultant psychiatrist, psychologists and a dietician (see “Eating Disorders Unit” above). The unit currently offers a weekly outpatient bipolar support group and a new group, focusing on recently discharged patients, is due to begin this year.
The psychological services available to the outpatients include individual, group and family therapy, which are all accessed through a formal referral process. Most recently, both long and short term outpatient DBT groups have been started. Outpatient occupational therapy, dietetics and social work services are also available.
The unit aims to provide regular follow-up, support and rehabilitation to mental health care users in the community, with the ultimate goal being to prevent rehospitalisation, optimise functionality and promote the recovery of patients.
Child Outpatient Clinic: This unit sees approximately 250 children, adolescents and parents per month. It provides tertiary level multidisciplinary child and family mental health services. It also provides outreach to schools in the catchment area. The direct number for the Child Outpatient Clinic is 011 535 3110. Parents/ legal guardians need to contact the clinic directly to make an appointment. Attending the Child Outpatient Clinic depends on the catchment area as well as level of care needed. Children with pure learning difficulties will be directed to the Department of Education. The Child Outpatient Clinic does not have the capacity to perform forensic assessments.
Lufuno Neuropsychiatry Centre
The Lufuno Neuropsychiatry Centre comprises of three clinics described below:
The Neuropsychiatry Clinic provides tertiary level neuropsychiatry services to our designated catchment area. A completed specific referral form (which can be obtained by contacting our clinic) is required from the referring clinician (psychiatrist/psychiatry registrar/neurologist). It should provide results of relevant investigations and be faxed to the clinic. The patient will be contacted to set up an appointment. The clinic offers an integrated service for patients with comorbid mental illness with certain neurological conditions and HIV. Patient will be charged fees according to the Department of Health (DOH) payment schedules.
The HIV Clinic provides outpatient HIV/AIDS management (ARV’s included) for the surrounding community in a designated catchment area (as per DOH zones). Patients can be transferred to the clinic via the standard DOH transfer form which must include all the relevant details. Patients will receive ARV’s plus treatment of HIV related illnesses but not treatment for other chronic conditions that can be treated at PHC level. Complicated cases that cannot be managed at this clinic will be referred to Helen Joseph Hospital. This is a free service.
The VCT Clinic is a walk-in service for any member of the public. HIV/AIDS information, testing and counselling, as well as health education groups are offered. Patients must be able to consent for the procedure. Rapid HIV tests are used. Patients falling out of the catchment area will be referred appropriately in the event of a positive HIV test. This is also a free service.
Operational times: 8am- 3:30pm, excluding weekends and public holidays
Contact: 011 535 3210; Fax Specific Referral forms to: 011 535 3117
STERKFONTEIN HOSPITAL (SFH) - [ Adj. Prof U Subramaney]
- General and Forensic psychiatry (approximately 50% each)
- Tertiary level inpatient care - Southern Gauteng
- Forensic services - Southern Gauteng (Mental observations as well as care treatment and rehabilitation of state patients)
- Forensic services for North West Province (Mental observations: 30 male beds (+3 at Krugersdorp prison), 5 adolescent male beds, and 5 female beds). State patients: 20 female beds, 10 adolescent male beds and 250 male beds.
- Male adolescent psychiatry (Forensic, for which there are 10 beds), OPD assessments of children (aged 10-14) in terms of Criminal Capacity
- Centre of Excellence: Dual Diagnosis Unit. an inpatient unit for the management of substance use disorders in the context of other psychiatric diagnoses (15 beds, mixed gender with separated units).
- Integrated Living Unit (ILU)
- ARV Centre/ Neuropsychiatric Unit
- HCT Centre
- Staff Clinic
- Electroconvulsive therapy (ECT)
Sterkfontein Hospital is a designated specialized psychiatric health establishment which renders care, treatment and rehabilitation services to mental health care users in accordance with the Mental Health Care act no.17 of 2002, after they have undergone a 72 hour assessment from a facility listed to conduct such an assessment in line with the provincial plan. This means that patients are referred for further involuntary care (Sec 34).Occasionally users are transferred under Sec 33.
The hospital also provides Forensic services - both mental observations and rehabilitation of state patients (latter under section 42 of the MHCA). These are patients that would have undergone a 30 day observation period (CPA section 77, 78 and 79) following the commission of a major crime for which they were found not fit and/or not responsible by virtue of the insanity defence.
- All mental health care users shall be discussed with the doctor on-call/the consultant prior to admission; telephone contact (011 951 8000); Unbooked cases may be returned to the referring institution assessment of the user and the referring health practitioner. Sec 42(State patient) referred by the courts shall not be sent back, unless discussed with the consultant on call.
- Any patient with serious medical or physical problems will not be accepted unless the doctor on call, upon consultation with the consultant on call if necessary, is satisfied that the referral is appropriate and the resources at the hospital are equipped to manage the patient.
- For referrals to the DDU, all potential users to be referred formally thereafter will be screened at an interview by the MDT to establish appropriateness for the programme. (Consultant Dr Tiaan Schutte)
- For ECT referrals, patients will be admitted following a discussion with the consultant (Dr Fiona Maynard /Dr Zaheeda Ibrahim). Documentation to be discussed - currently the institution will accept these referrals as assisted or involuntary patients.
Criteria for patients to be admitted to SFH
- Mental health care users who have undergone 72 hour assessment (Section 34 – for further involuntary care).
- Section 33 (involuntary patients); criteria in terms of MHCA NO 17, of 2002 (limited number only, upon discussion as stated above)
- Section 42 (state patients)
- Mentally ill prisoners
- Observandis (male and female, including adolescent males). These are awaiting trial detainees referred in terms of the CPA
- DDU admissions - see above.
- ECT admissions - see above.
Any patient who comes as a walk-in or an inappropriate referral will be thoroughly assessed by the on-call doctor and be discussed with the consultant before being referred to a facility listed to conduct 72 hour assessment or be admitted for 72 hours assessment depending on his/her mental status.
Patients referred with incorrect or incomplete forms will not be accepted unless the referring institution takes necessary steps to ensure that these are corrected and the on call doctor is satisfied with the criterion after discussing the matter with the consultant. To note again, that a certification to Sterkfontein hospital is a legal process and incorrect paperwork amounts to an illegal detention of the MHCU.
The patient’s family shall be notified about his admission as per the hospital admission policy.
A report of all "sent back" patients will be completed by the on call doctor who would have seen the patient stating:
- date and time; reason for sending the patient back; name of the doctor who saw the patient; consultant spoken to; nurse present at the time of; consultation; referring facility/person; physical and mental status at time of consultation; adequate notification of referring practitioner as necessary.