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Mental Health Series

Admission in mental health care institutions

The MidweekSun Admin

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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

The effects of dagga on mental health

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Recently the South African Supreme Court legalised the private use of dagga. Individuals are allowed to consume dagga in private and also grow for private use. The judgement brought mixed reactions on the issue and further fuelled the debate on dagga.

There are those who have used this judgement to the detriment of their own health. The crux of the matter though is that adverse effects of dagga cannot be underemphasised as far as mental health is concerned. Dagga use is quite popular amongst the youth which ostensibly explains the prevalence of dagga related disorders amongst them.

Effects of dagga are instant upon use. When dagga is smoked, it gets into the blood stream and then blood –brain barrier. This results in depressed brain activity, the end result being production of a dreamy state manifesting as delusions or hallucinations.

Delusions are altered thoughts whereby one may think he is a president when the reality is he is not. Hallucinations on the other hand is when an individual has distorted perceptions of reality like seeing a lion when it’s not there!

Others effects include:
paranoia,
panic attacks
anxiety
Impaired coordination and balance
Impairment in learning and memory

Various research studies have shown that heavy use of dagga facilitates the development of schizophrenia and substance use disorders. The amount of the drug used and the age at first use often place an increased vulnerability to develop these disorders. This explicitly explains why there are many youth who are having substance use disorders in our country.

Those using dagga may develop amotivational syndrome which basically means they have lost the willpower to do meaningful activities in life! This is basically the stroke that breaks the camel’s back, as other mental health problems may manifest from this.

Those whom are already diagnosed with mental health disorders can have symptoms of their conditions worsening when they use dagga. Depression and anxiety are often made worse by use of dagga. The false perception that taking dagga has a calming effect often predisposes those having mental health problems to take it in order to deal with their illness burden.

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Mental Health Series

Promoting mental health of the judiciary employees

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We always take workplace mental health issues universally but I would like to highlight that those working in the judiciary be it, Judges, Magistrates and court clerks, have peculiar conditions. I recently presented on the matter at Lobatse Magistrate Court wellness day and will share for the benefit of others.

Individuals under the judiciary employ play a critical role in Botswana mental health system. The Master of High Court appoints a curator bonis (trustee) to look into the custody of a mentally incapacitated individual whom cannot take decisions for self.

But how do the dynamics of their work affect their mental health? How can their mental health be promoted in the workplace?Judges, Magistrates and Court clerks preside over horrific criminal trials.

During trials they may be shown graphic images of the incident whilst at the same time there is narration! As highlighted in previous articles, Post Traumatic Stress Disorder (PTSD) may develop after hearing of a horrific accident or simply seeing images.

Various researches have indicated that many judiciary employees experience flashbacks of the incidents as they were narrated in court.Those working in courts may receive verbal onslaught from those being tried and their families.

A case in point is “Le tla immentioner” episode whereupon the Magistrate was attacked. Those experiencing this trauma may develop depression. Some may come up with maladaptive coping methods like indulging in substance use ultimately developing substance use and addiction disorders.

Judges and Magistrates are the custodians of justice and may experience stress when making judgements. They try by all means not to make erroneous judgements which exposes them to intense mental health exhaustion.

It is very important to highlight that mental health services should also be provided to them. Some of the following can be of help;Debriefing should be done after highly toxic court cases that are emotionally draining.

Health retreats should be plannedDepression and substance use screening to identify those having problems and then assist.

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