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Hope and Recovery in a Psychiatric Institution

Dr. J. S. Parker Lentegeur Hospital and UCT Dept of Psychiatry and Mental Health

Non-affective psychosis: 0.5% of adults, 50% of whom will require an acute admission

Bipolar disorder: 1.3% of adults, 30% of whom will require an acute admission

Substance-induced psychotic disorder: 1% of adults 50% of whom require an acute admission

1. Lund C et al. A model for estimating mental health services in South Africa. SAMJ 2000 1019-1024

2. WHO Mental Health Policy and Service Guidance Package: Planning and Budgeting to Deliver Services for mental Health (2003)

Door to door survey

Lifetime prevalence of CMD in SA: 30,3%

Anxiety disorders: 15,8%

Mood disorders: 9,8%

Substance Use Disorders: 13.3%

( Stein D. et al. Lifetime prevalence of psychiatric disorders in South

Africa. BJPsych. 2008: 192; 112-117)

Of those with a mental disorder, in the SASH study, only 25,2% had sought treatment in the previous 12 months and 5,7% (11,4% in W. Cape) had used any formal mental health service.

(Seedat S, et al. Mental Health Service use among South Africans fo4r mood, anxiety and substance use disorders. SAMJ May 2009: 99;

346-352)

Total Population W Cape (Census 2011); 5.8 million

60% Adults = 3.48 million

N-A psychosis: 0.5% = 16400 x 50% requiring admission = 8700 per year

BMD: 1.3% = 45240 x 30% requiring admission = 13572 per year

S-I psychosis: 1%; if 50% require admission = 17400 per year, if 10% do = 3480

Total=29752 (10% of S-I) – 39762 (50% of S-I)

Total beds = 632 ie 6-9 days per patient

• 872 Cairo Bimaristan

• 1247: Opening of Priory of St Mary of Bethlehem “Bethlem – Bedlam”, admitting “lunatics” 1377

• 1700: Bethlem still the only state institution in UK with 100 inmates

• Rapid growth of private institutions• 1750-1820: 16 public institutions for the

insane established in the UK.• 1847: 5486 patients in 21 asylums• 1914: Total in-patients in 97 state psychiatric

institutions in the UK over 112 000

• 1954:USA in-patient population: 553979

Taylor J. The architect and the pauper asylum in late nineteenth-century England. Ch 13 In Topp, Moran and Andrews: Madness Architecture and the Built Environment. Routledge 2007.

Foucault: Psychiatry was the product of the act of social exclusion of the “unreasonable” in large institutions as a result of the European Enlightenment’s obsession with reasonand the individual subject.

Roy Porter: “The rise of psychological medicine was more the consequence than the cause of the rise of the insane asylum. Psychiatry could flourish once, but not before, large numbers of inmates were crowded into asylums.”

Sally Swartz: “Urban, industrial society with concentrations of people in limited geographical spaces, with salaried workforces and disaggregation of systems of community care cannot afford the intrusion and disruption of eccentric behaviour.” .

Foucault M. Madness and Civilisation: a history of insanity in the age of reason. London: Tavistock 1971Porter R. A social history of madness: stories of the insane. London: Weidenfield and Nicolson, 1987.Swartz S. The great asylum laundry. Ch 10 in Topp, Moran and Andrews: Madness Architecture and the Built Environment. Routledge 2007.

“The Asylum” Francesco Goya -1792

Fight, flight and freeze

FIGHT, FLIGHT, FREEZE APPROACH

Rapid recruitment of defence mechanisms, unconscious AND conscious

Conceptual awareness (categorical)

Evaluative processing (dichotomous)

Cognitive enhancement (narrative)

Quick decisions – clear outcomes -highly effective - short term

Allostasis, less resilience, negative disposition

Limbic

Attentional monitoring Non-conceptual awareness Non-evaluative Present moment sensory

awareness Intentional Sustained Homeostasis, resilience,

positive disposition Allows for creativity -

limitless possibility! Prefrontal

Peter Senge “The Fifth Discipline”

“a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying,hopeful, and contributing life even with limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.”

Internal Conditions

Hope

Healing

Empowerment

Connection

External Conditions

Human Rights

A positive culture of healing

Recovery Oriented Services

The essence of spring.

Bridging the divide between a mental health institution and deeply scarred surrounding community by designing a mental health centre of the future.

In essence the concept of Spring is brought to life through healing people and the environment.

The first green psychiatric hospital in Africa

Efficient water use

Minimal carbon footprint

Waste recycling

Produce gardens

Green consciousness: Enviro-mental health

Green therapies

Cultural festival

A place of beauty

From stigmatized patient to green ambassador

Note: In all photographs where the identity of a mental healthcare user may be revealed, the informed consent of participantshas been secured.

BIKO

“The oneness of community is at the heart of our culture.”

I write what I like.

Bowerdean Press 1978

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#PsychologyFest