Pathways to inpatient mental health care among people with schizophrenia spectrum disorders in South Africa.
OBJECTIVE
This study examined service utilization patterns and pathways to specialist mental health services among individuals with schizophrenia spectrum disorders in the Western Cape, South Africa, an area that has undergone deinstitutionalization since the mid-1990s.


METHODS
Individuals who were consecutively admitted to any of the three psychiatric hospitals in the Western Cape from February 2007 to January 2008 were interviewed. Data on demographic characteristics, psychiatric history, service utilization, and pathways to care were gathered from service users, their relatives or associates, and hospital files. Univariate and multivariate analyses examined differences between high- and low-frequency service users.


RESULTS
Of the total sample (N=152) most were first seen at the primary care level (62%). However, very few received treatment at this level (26%), and many (22%) were admitted directly to the psychiatric hospital, bypassing other treatment options. These service utilization patterns differ from the requirements listed in the recently adopted Mental Health Care Act (2002), which states that unless a patient has been recently discharged, he or she should be admitted for 72 hours of observation before referral to psychiatric hospitals. Compared with low-frequency service users, high-frequency users were younger, had lower income, tended to rely more on disability benefits, and were more likely to bypass other levels of care and be admitted directly to the psychiatric hospital. Poor medication adherence was the most likely precipitant for the episode of illness among all users.


CONCLUSIONS
The study highlights the inadequacy of current community mental health services in providing for the needs of people with severe mental illness. In South Africa, as in many other middle-income countries, there is an urgent need to develop community-based care.
Lund
Crick
C
Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Rd., Rondebosch, Cape Town 7700, South Africa. crick.lund@uct.ac.za
Oosthuizen
Piet
P
Flisher
Alan J
AJ
Emsley
Robin
R
Stein
Dan J
DJ
Botha
Ulla
U
Koen
Liezl
L
Joska
John
J
D000328:Adult; D019091:Critical Pathways; D005260:Female; D006778:Hospitals, Psychiatric / Q000458:organization & administration*; D006801:Humans; D007297:Inpatients; D007407:Interviews as Topic; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D013019:South Africa; D011795:Surveys and Questionnaires