How to Access State and NGO Mental Health Services in South Africa - Part Three

If you have reached the point where you know you need help, but you can't access private health care and aren't sure where to turn next, then this series is for you.

Part one: What brings people to counselling and other mental health services? What if you are not ready to meet with a mental health professional?

Part two: What to do if you are ready to start meeting regularly? How does the public health system work? How do you find nearby services?

Part three: This is an emergency; what should you do? What if a family member or friend refuses to go to the hospital?

Part Three

Part two of this series covered how to proceed in non-emergency situations. But what if you (or someone) are facing an emergency or need to go to the hospital?

How to access a hospital

Public mental health hospitals are considered secondary-level facilities, meaning they must be referred by a primary-level facility (community clinic). If you are a known facility patient, you may call your treating team, and they will explain the steps to take.

New patients are required to bring a referral letter. Your community clinic, local GP or psychiatrist, will assist with this.

Remember: Hospitals do not provide better care than clinics; they address specialised problems. There is no need to attend a hospital unless your situation requires it.

What if it is an emergency?

Emergencies are situations that require immediate intervention to reduce imminent harm or risk. In mental health terms, risk can include risk to someone's personal or professional reputation.

If you (or someone) are experiencing an emergency, visit a nearby casualty/emergency department (preferably near your home). Ask a friend or family member to accompany you.

Answering yes to the following questions suggests risk.

• Are you experiencing constant overwhelming and incapacitating sadness or anxiety that prevents you from functioning?
• Are you struggling to control an impulse to kill or seriously harm yourself or another person?
• Have you started hearing and seeing things other people can't hear or see?
• Have you started believing things that others say are delusional?
• Have your thoughts and movements slowed down dramatically?
• Are your thoughts racing and are you unable to sleep?
• Has your behaviour become risky or hypersexual and are you acting out of character?
• Is this a new state (not a chronic diagnosed condition) and is it getting worse?
• Are you unable to function?

Answering yes to the following implies a lower risk.

• Are you confident that you can and will keep yourself and others safe?
• Are others confident that you are not a risk to yourself or society?
• Are you able to function from day to day?

What to do if someone needs to go to the hospital refuses?

I'm sorry if it applies to you since this experience can be upsetting, difficult and scary. Fortunately, there are systems in place, and help is available.

If someone has a mental illness or suspected mental illness, they are a risk to themselves or others and refuse to go to the hospital – you can call the South African Police Services (SAPS). The Mental Healthcare Act 2002 (Section 40) obliges SAPS to assist in bringing the person to a nearby hospital or clinic that offers emergency services.

Calling the local station commander and reminding them of their responsibility is sometimes necessary. Be polite; they don't do this every day. You can find the act here: https://www.gov.za/sites/default/files/gcis_document/201409/a17-02.pdf

What else can you do to help?

Does the person have a psychologist or a doctor? If so, an accompanying referral letter from them can help improve the chances of being seen quickly. If necessary, TherapyRoute.com can help you find a private mental health care professional.

Ask the psychologist or doctor to call the emergency room ahead of the patient to discuss the case with the on-call doctor. If they do this, ask them to address the referral letter directly to that doctor.

Sometimes it helps to complete the paperwork beforehand. A family member or associate is required to complete Form 4 before involuntarily admitting a patient. You can download the form here: https://www.safmh.org.za/documents/MHCA%2004%20form.pdf.

The admitting doctor is required to complete Form 5. They should have one. If not, you can download it here: http://www.kznhealth.gov.za/townhill/MCHA_05.pdf.

For more advice, contact the Mental Health Help Line - 0800 12 13 14