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Mental Health Series

Admission in mental health care institutions

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Most of our avid readers often enquire about the procedure for admission at mental health institutions. The admission process and the general provision of mental health services is guided by the Botswana Mental Disorders Act of 1971(currently undergoing review) and the Criminal Procedure Act Chapter 08 for forensic situations.

There are basically two categories for admission in a mental health facility which are voluntary and involuntary. We will focus on the involuntary admission for this discussion. Involuntary admission is two pronged, being an urgency order and a reception order. In an urgency order, a relative or a Police Officer of the rank of Seargent and above can make an application for an individual who is deemed to be a danger to self or others to be admitted on account of mental illness, as ratified by a medical certificate.

Under this order an individual is admitted for a period not exceeding 14 days and can be extended or stopped by a District Commissioner (DC) upon getting a report on the patient. As the name implies, urgency order is done on the basis of emergency.

Getting to a reception order, the process is different. A relative or someone over 21 years who has been with an individual who seem mentally unwell for over 48 hours, makes an application to the DC’s office. The patient/client then is assessed by a medical officer who will produce a medical certificate with observations and indicating whether the patient needs to be managed in an institution. The DC will then use the guardian/relative/parent application to make a determination as to whether the individual can be given a reception order to facilitate an admission. The reception orders is valid for a period of 30 days and may be extended when patient has not adequately improved.

Involuntary admission is only used in instances when a patient has no insight and ability to make decisions. In a situation whereby patient is able to consent and voluntarily agrees for admission let it be so. Whilst it is vital that patients be admitted when necessary, efforts should be made to deinstitutionalise mental health services with some cared for at home.

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Mental Health Series

Addressing bullying in schools

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I came across a news story online from ABC News that a nine year old boy committed suicide following bullying. The boy had disclosed being gay which culminated in him being bullied by fellow schoolmates. The central point of today’s discussion is bullying and its ramifications.

Have you seen kids refusing to head for classes for lame reasons? They could be experiencing bullying. Bullying is a phenomena that is rampant in our schools. It is a destructive and deliberate pattern of humiliating and harming others whom are vulnerable. The act of bullying happens consistently with victims most of the time being helpless to fight.

Those who bully can do it in so many ways that include;
Kids being punched
Their things being spoiled
Kids being teased
Nasty rumours spread about the victim
Victims being threatened
Victims being coerced to bring gifts

According to one study, those whom are bullied are at an increased risk for mental health problems, headaches, and problems adjusting to school. Others maybe sad and lonely and have tendencies of absconding from or being anxious when summoned to go to school. The commonest mental health problems include depression, parasuicide, conversion disorders and substance use disorders. A long term damage to self-esteem is possible in these circumstances.

Dealing with a child who is being bullied is difficult. Parents and guardians should avoid at all costs to blame the child for being bullied. Active listening is a basic tenet to help the child. A child who is bullied often finds it difficult to tell people thereby it is important to listen and try to address the issue.

Our school system need to have anti-bullying programmes and also employ resident mental health professionals to address this problem. As Michelle Obama once said, “we explain when someone is cruel or ac ts like a bully, you do not stoop to their level.” Let’s address this!

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Mental Health Series

Narcistic personality disorder explained

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In the Greek mythology, there once existed a god known as Narcissus. At one point Narcissus went to a pool to quench his thirst and the moment he bent to sip water he saw his image. He got stuck with admiration of his image in the pool that he died right in the pool because of thirst. He got so absorbed in himself that he neglected other important life aspects.

In this era we still have people with Narcissus traits in our midst. A personality disorder known as narcissistic personality disorder was named after Narcissus. The individuals whom are often self-centred, have absolute disdain for others, have misplaced feelings of self-importance and uniqueness are often diagnosed with narcissistic personality disorder when they seek psychological help.
Other symptoms of the disorder may include;

Showing arrogant behaviour and attitude
Lack of empathy for other people
Believe that people are envious of him/her
Using or exploiting others to reach own goals
Having some sense of entitlement on leadership positions even when they have no qualifications
Exaggerate achievements and talents
Demanding special treatment when attending occasions
Monopolise conversations

The society often views the individuals having the disorder as controlling, egocentric, intolerant of others viewpoints and ultra-sensitive when criticised. Individuals with this disorder often have problems interacting with other employees in the workplace and have relationship problems. This extreme confidence is often a mask for a fragile self-esteem which often predisposes them to depression.

1 % of the world population is often affected by the disorder; with more males than females affected. Offspring of parents with the disorder are at a high risk of developing the disorders themselves! Disorders of personality are in most cases difficult to deal with but narcissism is chronic and most difficult to deal with. Psychotherapy especially group counselling maybe ideal to assist individuals with narcissistic disorder in order to try facilitate relationships with others. Medications maybe used to treat any complications or other symptoms.

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