Child & Adolescent Psychiatry

-Child, Adolescent and Family Unit:

3.1       GENERAL PSYCHIATRY

3.1.1    Inpatient care unit (40 beds):

Following the fire at CMJAH the acute wards have been relocated from the purpose built psychiatric wards of 486 and 487 to wards 584 and 586.

584 is able to accommodate 22 male MHCUs and 586 22 female MHCUs

Due to the shortage of child and adolescent beds in the system, both wards will admit up to two adolescents each, from the age of 16yrs. Adolescents between the ages of 14yrs and 16yrs, who require an acute admission, will be discussed by the relevant consultants and determine appropriateness of admission to an adult psychiatric ward.

1. A) Admission Procedure:

-The hospital is designated as an acute 72-hour assessment and acute psychiatric care and treatment unit

-Emergency Department walk–in patients and emergencies transported to the CMJAH via SAPS or EMS, will be managed as per the casualty protocol. They will be screened, triaged and referred for assessment to the psychiatric team.

-Patients will be assessed in the emergency department by the psychiatric doctor on call and if appropriate admitted to 161, a designated area in the    Emergency department for MHCUs, to await a bed in the psychiatric unit.

-Individuals requiring admission will be assessed under the Mental Health Care Act No 17, of 2002. Admissions to the unit may be voluntary, assisted or involuntary.

-All patients are then assessed by a consultant psychiatrist on the post intake round the following morning and a decision made to admit to one of the acute wards

-Direct referrals to Psychiatry from the community psychiatric clinics, district hospitals, private clinics, private general/specialist practitioners or any other health care practitioner must be discussed with the psychiatry registrar on call. Their contact details can be obtained via the CMJAH switchboard: (011) 488 4911.

-Acceptance of cases will depend on the discussion with the consultation-liaison consultant and will reflect the appropriateness of the referral and the bed availability.

-Cases within the hospital will be assessed by the consultation-liaison team prior to transfer to the wards

1. B) Treatment Programme:

-Treatment in each of the wards is provided by a team consisting of the Psychiatry, Clinical Psychology, Nursing, Social Work and Occupational Therapy disciplines.

-Treatment is provided on a bio-psychosocial model

- MHCUs receive pharmacotherapy as well as various individual and group therapeutic interventions according to their needs.

- MHCUs with co morbid medical conditions will be referred to other medical disciplines within the hospital.

- Should longer term care be required the MHCU will be referred to TARA, a specialised psychiatric hospital,

- Should an involuntary MHCU not be able to be managed in our unit they will be referred to Sterkfontein hospital, a specialised psychiatric hospital.

- MHCUs requiring Electroconvulsive Therapy will be referred to either TARA or Chris Hani Baragwanath Hospital.

3.1.2    Outpatient care unit:

-All new outpatients must be in possession of a referral letter from a mental health care practitioner or medical practitioner stating the reason for referral and what has been done so far in terms of stabilization

- Patients referred from lower levels of care as a result of unsuccessful management options can be referred for outpatient care. Once stabilized these patient will be referred back to their referring providers

- All new referrals will be screened for appropriateness to attend a tertiary/quaternary level clinic.

- In the event that the referral is inappropriate for the clinic, alternative suggestions will be made and the patient directed to the most appropriate service, for e.g. secondary level community psychiatric clinic, social services etc

- Referral of in-patients on discharge from the CMJAH inpatient unit to the CMJAH OPD, will include a completed discharge summary of all in-patient procedures, assessment, treatment and progress. 

- The Departments of Psychology and Occupational Therapy render separate routine out-patient services

- The clinic operates on a Wednesday and Friday

- In the event of uncertainty regarding referrals to the psychiatric outpatient clinics at CMJAH, the referrer can contact the clinic staff directly on the following telephone numbers: (011) 488 3551/3885

3.1.3    NEUROPSYCHAITRY - [Dr K Lowton]

  Neuropsychiatry Clinic & Services

- The clinic offers an integrated service for patients with comorbid mental illness with certain neurological conditions and HIV.

- A completed specific referral form (which can be obtained by contacting our clinic) is required from the referring clinician (psychiatrist/psychiatry registrar/neurologist). It should provide results of relevant investigations

- The patient will be contacted to set up an appointment.

- The clinic operates on Monday

- If already an in-patient, the team will consult in that ward and managed further as appropriate.

3.1.4   CONSULTATION LIAISON SERVICES

- A 24hr service is provided to other disciplines within the hospital to asses and manage any in-patient that presents with mental health pathology or concern.

- Common reasons for referral include assessments after attempted suicide, the assessment of co-morbid psychiatric and medical conditions, personality and capacity assessments, sedation and pain intervention.           

- The individual is referred by the treating doctor to the psychiatric C&L doctor during working hours and to the psychiatric doctor on call after hours. Their contact numbers are available through switchboard or the ED

- Cases will be discussed and reviewed with the consultant covering C&L and managed further as appropriate

3.2 CHILD, ADOLESCENT AND FAMILY UNIT (CAFU) - [Dr Alicia Porter]

Services offered:

- The full range of psychiatric out-patient services is provided for children and adolescents ranging in age from 0 to 18 years. These include the assessment and management of:

• Primary psychiatric disorders (e.g. depression, ADHD, anxiety etc.)
• Emotional and behavioural problems
• Family and social problems
• Abuse and violence related problems
• Consultation to specialized services -autistic children and children with dual diagnoses of intellectual disability and psychiatric disorder
• Consultation with the departments of education, welfare and the criminal justice system when requested.
• Consultation liaison work with paediatric services in CMJAH. CAFU supplies a psychiatry/paediatric liaison service to all in-patients in paediatric wards.
• The Unit is on call during working hours for all children and adolescents referred.
• The Unit admits patients regularly for investigation and treatment to the two child wards (at Chris Hani Baragwaneth Hospital and Tara Hospital) and the adolescent ward at Tara Hospital.

Referrals:

- Referrals to the Unit are at a tertiary or quaternary level. All referrals are screened by the Unit for suitability.

- Any referral source may refer a patient, but only after the parent/caretaker calls the Unit for a referral is the case considered for acceptance.

- The Unit does not accept any referrals if the parents/caretakers do not contact the Unit directly.

- In the event that the referral is inappropriate for the clinic, alternative suggestions will be made and the patient directed to the most appropriate service, for e.g. secondary level community psychiatric clinic, social services etc.

Referrals are made to 011-481-5103

4) The Private sector

- The referral procedure to District psychiatric services is as follows. All patients must reside within the catchment area served by the clinic (see attached list of clinics).

- A specific outpatient referral form or a letter providing detailed clinical information and motivating the need for the referral must be completed by the patients’ referring doctor /mental health professional and must accompany the patient during the first visit. All referrals received will be reviewed by the outpatient staff and prioritized according to the clinical needs.  Proof must be provided if “exhausted medical aid funds” is the reason for referral.

- Patients will be informed by the staff of the date for their appointment (usually within a month) or if patients needs do not warrant this level of care they will be referred down to an appropriate level of care. Referring health professionals must ensure that patients have sufficient medication until the date of their first appointment.

- If the patients are on medication not available on the primary level Essential Drug List or on expensive tertiary level medications without having started on first line medication as in the standard treatment guidelines, they may need to be weaned off this medication or cross-titrated onto other medication.

Failure to comply with the above referral procedures may result in the patient being sent back to the referring doctor / institution.

• COMMUNITY CLINICS.pdf"Community Clinics details" in pdf format