1. Mental Health Care Services in the North West Province
Presentation to the Portfolio Committee
Cape Town
15 March 2017

2. Presentation outline Background Introduction
The State of Mental Health care Services in the province
Package of Services
Mental Health Beds in Specialised Hospitals
Designated psychiatric units attached to general hospitals
Private hospitals licensed to render in-patient services
Units for 72-hour assessment in general hospitals
Primary Health Care Services
Community Mental Health Services
Coordination of services
Mental Health Review Board
Number of deaths by year
Staff establishment
Budget and expenditure trends
Key challenges
Conclusion

3. Background
The North West Province is South Africa’s fourth smallest province and occupies 8.7% of SA’s land area
It has a population of 3.7 million (Stats SA 2011 census)
This represents 6.7% of SA’s total population
Shares borders with other provinces: Limpopo, Gauteng, Free State, and Northern Cape
Also shares borders with Botswana to the West and North

4. NWP Population by District: 2016

5. Map of the North West showing the four districts of the province

6. Health service delivery platform
District Health System:
4 district municipalities
19 local municipalities (sub-districts)
2 Tertiary hospitals
3 Regional hospitals
12 district hospitals
49 Community Health Centres (CHCs)
270 Fixed clinics

7. Introduction
Mental health services in the province are provided in line with the Mental Health Act and National Mental Health Policy Framework and Strategic Plan
There are two specialised hospitals, two designated hospitals, two 72 hour observation units
The department has also licensed three private hospitals that provide mental health services
At community level the services are integrated into Primary Health Care
There are no NGOs licensed to provide mental health services

8. The State of Mental Health care Services in the province
Mental Health Services organised in line with the Mental Health Care Act (Act 17 of 2002)
Two (2) mental health specialised hospitals:
Bophelong psychiatric hospital
Witrand hospital for intellectual disability

9. Witrand hospital

10. Psycho geriatric unit

11. Old Bophelong hospital

12. Old Bophelong hospital

13. Patients recreation day at Bophelong

14. New Bophelong hospital

15. New Bophelong hospital

16. Residential area under construction at the new Bophelong hospital

17. Package of Services Witrand Hospital Bophelong Hospital
Intellectual disability
Acute psychiatric services
General psychiatry for designated status
Sub-acute psychiatric services
Child and adolescent psychiatry
Forensic observation
Psycho-geriatric services
State patients
Physical medicine and rehabilitation
Long term/Rehabilitation services
Mentally ill prisoners services
Adult OPD
Child and adolescent OPD

18. Mental Health Beds in Specialised Hospitals
Approved beds
Used beds
Planned for new hospital
Bed utilisation rate as of 3rd quarter 2016/17
Witrand
982
851
N/A
81.6%
Bophelong
368
282
384
87.6%

19. Bed distribution by specialty at the old Bophelong hospital
Service package
Approved
Used beds
General Psychiatry
Acute care 72 51
Medium term to long stay
147
120
Forensic mental health services
Mental observations 10
Acute State patients 65
Medium to long stay State patients 74 36
Total
368
282

20. Bed distribution by speciality at the new Bophelong hospital
Beds per service package
No. of beds
General psychiatry: 234
Acute 90
Medium-long stay
120
Long term (psycho geriatrics) 24
Forensic Psychiatry: 150 60
Medium- long stay 70
Mental Observations 20
Total
384

21. Bed distribution by speciality at witrand hospital
Service package
Number of approved beds
Number of used beds
Acute Physical Medicine and Rehabilitation 15
Acute Psychiatry
116
Medium to long stay
851 (Intellectual disability)
720
Chronic psychiatric patients
Total
982
851

22. Number of beds in designated psychiatric units attached to general hospitals
Name of Hospital
Service package
Number of beds
Taung District Hospital
Acute psychiatry 20
Job ShimankaneTabane (JST) Provincial Hospital 60

23. Taung hospital designated unit

24. Private hospitals licensed to render in-patient services
MultiCare Hosp, Potchefstroom ( 26 beds)
- Voluntary care
Parkmed Hosp, Klerksdorp (60 beds)
Kgatelopele Wellness Centre ( 50)

25. Units for 72-hour assessment in general hospitals
These are units in general hospitals listed to provide 72-hour assessments to exclude physical/ medical conditions as prescribed by the Mental Health Act.
Two hospitals (in addition to the two specialized hospitals) are currently listed for 72-hour assessments:
Tshepong Hospital (10 beds)
Mafikeng Provincial Hospital (26 beds)

26. Primary Health Care Services
Primary Care Services for Mental Health are provided as an integral part of Primary Health Care.
These would be ambulatory visits from patients either discharged from hospitals to community care or initiated on treatment within primary care.
Currently mental health coordinators are appointed in 11 of the of 19 sub-districts.
An ideal situation would be to have a Mental Health Coordinator per sub-district to champion the preventive and promotive aspects of Mental Health Care in the area of jurisdiction.
This ideal situation has always been difficult due to shortage of personnel.

27. Community Based Mental Health Services
Community Mental Health Services include:
Community residential care (including assisted living and group homes)
Day care services
The province does not have any NGO licensed to provide community mental health services
The initial number of beds planned for the new Bophelong psychiatric hospital was 648, however this was reduced to 384 to cater for a community component of Mental Health Services in line with mental health legislation, policy and norms.
The 264 beds that were reduced from the new hospital have been allocated to different sub-districts as Community Residential facilities or Half Way Houses.
The first 60 bed Community Mental Health Centre has just been completed Dr Kenneth Kaunda district. The second 20 bed facility is under construction at Boitekong near Rustenburg.

28. Community Psychiatric unit at Witrand

29. Planned community residential beds per district
No. of planned community residential beds
Dr Kenneth Kaunda district
122
Ngaka Modiri Molema district 98
Dr Ruth Segomotsi Mompati 94
Bojanala district
150
Total
464
A detailed breakdown of planned beds per sub-district is available

30. Coordination of services at provincial level
The Mental Health Programme falls under the Directorate of Health programmes, and is managed at director level with all other programmes related to non -communicable diseases.
The post structure has provided for three managers at Deputy and two Assistant Directors level, the latter two of who are responsible for administration of the Mental Health Review Board, and the two posts are currently vacant.
The National Mental Health Policy Framework and Strategic Plan adopted by all MECs and the Minister of Health advise that all provinces should have a Directorate for Mental Health headed by a Director. This has not been possible due to budgetary constraints.

31. Coordination at district level
The National Mental Health Policy Framework and Strategic Plan require a District Mental Health Specialist Team to be established within each district.
The terms of reference for these teams is contained in the policy framework.
A full team for a district has been estimated to cost around R3.5 million, but even if it is not possible to recruit all the components of a team, having some coordination and planning in a district is essential.
11 of the 19 sub-districts have mental health coordinators.

32. Mental Health Review Board
The province has one Provincial Mental Health Review Board, which was first appointed in 2007 in line with the Mental Health Care Act requirements
Composition: 4 persons that include, 1legal person, 2 Mental Health Care Practitioners and 1community member
Appointed for 3 years (contracts were extended every 2 years)
Current contract expires on 31 March Advertisement made on national and local newspapers, short listing and interviews conducted. Appointment letters issued, and new board members to start on 01 April 2017

33. Schedule of meetings of the Mental Health Review Board
Members meet weekly (every Wednesday for 2-4 hrs) depending on the workload)
The board caters for all 4 districts

34. Functions of the Board
Screen all documents from all 4 mental health hospitals ( admissions, discharges, transfers, leave of absence, periodical reviews, and appeals)
Conduct support visit to hospitals providing mental health services to check compliance
Conduct in-service training during their visits

35. Number of deaths at Witrand by year
Died Where
2012/13
2013/14
2014/15
2015/16
2016/17
Total
Died in Witrand Hospital 28 24 26 17 19
114
Died at Potchefstroom Hospital 2 3 7 5 18 35
Died at Klerksdorp Hospital 1
Died at Tshepong Hospital
Died at Baragwanath Hospital
Died at Medi-Clinic Potch
Died at home during weekend leave
1 (ID) 31 29 33 37
154

36. Number of deaths at Bophelong by year
Died Where
2012/13
2013/14
2014/15
2015/16
2016/17
No date
Total
Died in BPH 1 5 3 11
Died at MPH 2
Died at Home 15

37. Causes of deaths
All patients in Witrand and Bophelong died of medical conditions (details available)
Monthly morbidity and mortality meetings take place and cases are discussed
Depending on the need cases are referred to district and provincial patient safety group
Corrective measures are taken where applicable

38. Clinical Psychologist Occupational Therapist
Current staff establishment of Bophelong and Witrand hospitals for health professionals
Hospital
Category
Professional Nurse
Medical Specialist
(Psychiatrist)
Medical Officers
Clinical Psychologist
Social Worker
Occupational Therapist
Bophelong
Total posts
105 2 10 9 7 1
Vacant 18
Vacant funded
Filled 87
5/8 8 5
Witrand
158 3 15 13 32 6
126

39. Budget and expenditure trends of Bophelong and Witrand
Financial Year
Hospital
Allocated Budget
Total Expenditure
Available Budget
% Expenditure
2013/14:
Bophelong
105,286,500
106,773,986
(1,487,486)
101%
Witrand
225,276,500
242,077,345
(16,800,845)
107%
2014/15
121,096,859
114,177,275
6,919,584
94%
260,767,109
261,459,382
(692,273)
100%
2015/16
120,835,422
119,821,542
1,013,880
98%
266,318,700
263,102,827
3,215,873
99%
2016/17
142,910,175
99,217,593
43,692,582
69%
287,509,166
224,582,062
62,927,104
78%

40. Key challenges
Inability to recruit and retain psychiatrists/scarce skills due to rurality of the province
Inadequate funding affects expansion of community mental health units (half way houses) and services
Infrastructural challenges

41. Conclusion
In conclusion, the North West Department of Health believes that as the WHO defines Health as “a state of complete physical, mental and social wellbeing, and not only the absence of disease or infirmity”, for health services to be responsive to the needs of communities, mental health should be central to planning and delivery of health services.

42. Thank you