ABSTRACT:
In South Africa, psychiatric hospital admissions are done in line with the MHCA No. 17 of 2002 and fall under three categories namely voluntary, assisted and involuntary admission. However, the successful implementation of this Act is hampered by a poorly resourced community-based mental health care system. The final decision to admit individuals is preceded by a series of micro-decisions by various stakeholders including the family or police and mental health care professional. There is also a lack of compliance, enforcement and oversight bodies to ensure PLSMI benefits. The Act presumes that a functional primary health care clinic can either refer to the community clinic for a psychiatric assessment, retain the individual admitted at that level, or refer upward to a district hospital with a functional psychiatric unit with sufficient resources. The underinvestment in community-based mental health care systems compels MHCPs to admit patients, who could have otherwise been managed in their communities, merely to ensure they receive care for their SMI. Moreover, such patients stabilise but often relapse shortly after being discharged due to a poorly resourced community-based system. This study will explore the experiences, challenges and ethical issues of admission practices of PLSMI in SA. Participants will be recruited through purposive and snowball sampling from three different sites in SA, namely, Kenneth Kaunda (no community psychiatry services), Sedibeng (offers community-based psychiatry services) and the City of Cape Town (outreaches psychiatry services from hospitals) given the varying levels of community-based care, access to and quality of secondary and tertiary care, and population needs. A multi-case study design (with each district being a case study) will be utilised with an explanatory approach to collect data through in-depth interviews. Data will then be thematically analysed.