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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

WOMEN AND MENTAL HEALTH

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March the 8th marked the International Women’s Day under the theme ‘balance for better”. “The Mental Health Series” would like to glorify all women and bring to the fore pertinent issues in relation to their mental health.

Women to a greater extent are affected by mental health problems more than men. Notably depression and anxiety are the commonest mental disorders that affect women. According to the World Health Organisation, depressive disorders account for close to 41.9% of disability from neuropsychiatric disorders among women compared to 29.3% of men.

Apart from gender specific determinants, a lot of socio-economic factors make women susceptible to having mental health problems. Women incur pressures from their many roles especially as single parents in many of the households. Gender discrimination in the workplace and political sphere, violence in various forms, sexual abuse, income inequality and poverty all account for the development of mental illness in women. Women also experience bullying in social media which as well can lead to lead to mental illness.

We all need to acknowledge the risk factors to mental illness that are peculiar to women and find ways to mitigate against them. Women often find it essential to seek health services and thus need to be encouraged to continue the feat as that will go a long way in helping women. We indeed need to balance for better the programmes that can empower women and serve as protective barriers from development of mental illness.

Women should have equal opportunities for economic growth, jobs and enabled to lead as that will augur well for their mental health. A worrisome issue in sport is the income inequality which renders women as inferior; has to be addressed as a matter of urgency!

There is need to nurture the mental health of women. It is nigh men reflect and do away with gender based violence. The effects of violence are far reaching hence the need to change for upliftment of mental health.

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Mental Health Series

WHAT REALLY CAUSES MENTAL ILLNESS?

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Over the weekend, one reader put it to me that I explain if indeed witchcraft causes mental illness.

My position was that I cannot confirm or deny that witchcraft does cause mental illness. However, it is an open fact that there is no exact cause for mental health disorders but there are various risk factors that can lead to development of mental illnesses. Research does indicate that many of the mental health conditions are caused by a combination of environmental, biological and psychological factors.

Like many of the diseases, mental illnesses as well have a genetic predisposition meaning the illness runs across families. This is suggestive of the fact that if one has a family member with mental illness, there are highly likely to develop one themselves because it has been passed through genes. Having genes for mental illness does not translate to the conclusion that one will have the illness as there are also environmental factors needed to trigger the illness. Brain injuries have been seen to facilitate the development of mental illness.

For example, people who have incurred brain injuries often display aggressiveness which could be linked to certain areas of the brain being affected. Some individuals develop mental illnesses as a result of factors during birth and childhood. A case point is when an infant is deprived of oxygen during a difficult delivery; mental health problems like autism spectrum disorders may suffice. Malnutrition during child development may hinder brain development hence development of some mental illnesses. We previously discussed how poor attachment goes on to facilitate development of mental health problems later on in life.

Substance use has an influence in many of the mental disorders. Illnesses like anxiety, depression, paranoid schizophrenia are somewhat influenced by long term substance use even though there may be other influencing factors as well. Lastly relationship problems, marital problems, work stressors, marital problems and poverty have all been seen to influence mental illness development. Mental illness is complex. We all need to acknowledge the fact that it is an illness like any other and avoid myths surrounding the illness as they are not in any way helping!

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