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.
MENTAL HEALTH FOR PRISON OFFICERS
Recently I officiated at the Moshupa Boys Prison in a workshop organised by students of I.H.S Lobatse and today discussion will reflect on the workshop. The workshop focus was on prison officers’ mental health in the workplace.
According to the 2017 Mental Health at Work Report, “60 % of employees have experienced a mental health issue due to work or where work was a contributing factor at some point in their careers.” Prisons are no different as they are deemed a hostile, demanding and challenging work environment which could be to some extent be a habitat for poor mental health. As reported by Newsweek Online, a survey of Washington State Department of Corrections indicated that 20 % of participants displayed posttraumatic stress disorder (PTSD) symptoms. Another California study in 2018, did also highlight that 10% prison guards did contemplate suicide; a clarion call for dialogue on the matter.
In prisons there are issues of safety rising from violence by inmates which can have a bearing on the prison staff mental health state. Physical security and safety have been seen by the World Health Organisation as protective factors towards mental health.
Prison staff bear witness to traumatising experiences and events as relayed by prisoners or in court appearances. The warders interact a lot with inmates and get to understand their ordeal and get to know what transpired in the purported crime. This at times come to haunt the prison officers in the form of PTSD. PTSD can occur even when one is given a narration of a traumatic event!
Counselling services need be provided and debriefing is also a must as far as the mental health of warders is concerned. Debriefing entails giving an opportunity to individuals to relieve the experiences and emotions in order to allow for catharsis.
Mental health in the prison setup requires a two-pronged approach that seeks to help officers deal with their own issues and on the other hand address the inmates’ issues surrounding their sentencing and thus the need for a fully functional mental health service under prisons. Staff training on mental health issues should be provided to enhance understanding on mental disorders and encourage mental health promotion for both staff and prisoners. The workshop was worthwhile and I recommend that it be expanded to other prison centres!
INTERNATIONAL NURSES DAY: REFLECTING ON THE MENTAL HEALTH CHALLENGES OF NURSES
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”.