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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

INTERNATIONAL NURSES DAY: REFLECTING ON THE MENTAL HEALTH CHALLENGES OF NURSES

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Today’s reflection will be on the Nurses’’ day that was celebrated worldwide on the 12th of May. The day is celebrated in remembrance of the birth Florence Nightingale who is the pioneer of modern day professional nursing. The theme for this year is “Nurses: A voice to lead-Health for All.”

Nurses are the backbone of the healthcare system as in every health care facility they are there to provide care. They are the single largest group of professionals in the clinical field.
The crux of the discussion is that professional nurses experience burnout and workplace stress because of the nature of the demands of the nursing job. These emanate from working long hours, emotional exhaustion from dealing with vulnerable and ailing clientele, experience of traumatic events, fulfilment of high professional and public expectations and low reward outcomes for their efforts.

The nurses’ already volatile ordeal is further compounded by incidences of nurses being assaulted, emotionally abused, physically abused, sexually assaulted and cyber bullied by the same individuals that they seek to render care for.

The above highlighted challenges can be emotionally draining to the nurses and even facilitate development of mental health problems if they are not attended to promptly. This has been affirmed by various studies.

A review paper done by Vasconcelos and others in 2016 highlighted that the risk of exposure to HIV and poor relationships with administrators as other associated factors that facilitated development of mental disorders.

The review found the following as affecting most of our nurses; post-traumatic stress disorder, acute stress reaction, generalised anxiety disorder, depression and over indulgence in substances.
Nursing managers, the patients as well members of the community need to play a pivotal role in ensuring protective factors towards nurses’ mental health are availed.

The good thing is that this can be ensured by helping nurse build resilience, having debriefing sessions for nurses working in trauma care and having measures like retreats to name but a few. Nurses need to be healthy for them to be custodians for “health for all”.

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Mental Health Series

WHAT WE EAT CAN AFFECT OUR MENTAL HEALTH

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I had a chat with friend over the weekend and he felt that dieticians placed at psychiatric hospitals are misplaced. The basis of today discussion will be herein a response to this.

Nutrition does play a critical role in mental health hence the need for dieticians to be involved in this field as it is the case now. As noted by the research team led by Joseph Firth, “nutritional deficiencies resulting from insufficient intake of nutrients critical to human health are a risk factor for psychiatric and mental disorders.”

Our brains needs food for them to function optimally. Concentration, memory, analysing to name but a few can all be attained by a “well fed brain.” If the brain is deprived of nutrients, it can incur oxidative stress which results in brain cell damage. Brain cells are irreplaceable and their damage facilitates the development of some mental disorders Experience of mental health problems may also be associated with poorer diet and physical health.

Poor nutrition has been implicated in the onset of schizophrenia by various research findings. Studies on schizophrenia patients indicated that the nutrients Zinc and Selenium were found to be compromised whilst in others there was insufficient Vitamin D deficiency.

Other research conducted has determined that the following supplements: zinc, magnesium, omega 3, and vitamins B and D3 are essential in elevating people’s mood, relieving anxiety and depression. Insufficient Omega-3 fatty acids has additionally been linked to low mood, poor concentration, cognitive decline and poor comprehension.

It is clear from the discussion that good nutrition is critical for our mental health and that dieticians are relevant in mental health. An affordable balanced diet which contains the essential nutrients is necessary to be taken to ensure that mental health is uplifted. Nutrition alone cannot ensure our mental but it has a significant adjunctive role. As posited by local author Lindo Morolong, “what you feed your body shapes your health.”

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