Abstract
D.Litt. et Phil.
The mentally ill population is one of the most neglected subpopulations of the Western World and this is most certainly the case in Southern Africa. With the restructuring of the mental health system, the process of discharging properly rehabilitated individuals from long term hospital stays into a strong community mental health support structure has become a priority. In order to embark on a process driven by an ethos of primary health care, the present inpatients in custodial settings need to be discharged into the open community. This process is termed deinstitutionalisation, and involves the discharge of all able patients from chronic or long-term custodial care institutions, into the open community as functional members, with all of the rights and freedom which this may
imply. Deinstitutionalisation as a concept embraces the essence of human rights, as
the person takes control of his/ her life circumstances with all of the accompanying
responsibilities. Present deinstitutionalisation practice in traditional South African long-term care facilities has no rehabilitation/ recovery focus with which to drive the discharge
process of patients. Barriers to the success of the process are the lack of rehabilitation services, poor discharge planning and process, and lack of follow-up and integration of community services. These would seem to be the biggest stumbling blocks to the success of a deinstitutionalisation initiative. The initial process of design and implementation of a viable programme, and one that addresses uniquely South African issues was challenging. This was because of the lack of information, and reliable reporting systems with which to identify availability and need of service, client subpopulations, and service provision agencies. A preexisting NGO system was described and assessed for service provision and success rates, and the same system was used to measure the availability and applicability of psychosocial rehabilitation service in South Africa. The process comprised describing a the necessary components required by a recovery-driven, psychosocial rehabilitation system, using international literature as well as the early findings and results of the changed system. Suggestions have been made in terms of necessary facilities and services required, as well as staff competencies and methods of
addressing historic issues of anti trust which have developed because of apartheid
mental health practice.