Schizophrenia in KwaZulu-Natal : a study of certified patients, accessibility to mental health services and risk.
Schizophrenia is a debilitating mental illness. The prevalence of schizophrenia is of concern and highlights the chronicity of the illness (Kaplan & Sadock, 1998; Warner & de Girolamo, 1995). It is therefore important that greater understanding ofthe variables affecting and potentially contributing to schizophrenia is sought. This study deals with three separate areas: 1. Creating a database and describing the socio-demographic profile of 615 certified patients diagnosed with schizophrenia between the years 1995 and 1996, hospitalised at Fort Napier. 2. Exploring whether a meaningful geographical model of socio-demographic variables of schizophrenia can be built, and whether it can determine areas of high schizophrenia sensitivity. Such a perspective of schizophrenia (exploring the combined effect of all the variables connected to schizophrenia) has not been previously researched rather each variable has been studied independently. The model utilised in the Geographical Information Systems (GIS) offers an opportunity to graphically overlay these individual variables and then examine the potential effect. It was only possible to explore sociodemographic variables within this Masters research project. 3. Determining the geographical accessibility ofthe public provincial hospitals offering psychiatric services to the population, (particularly to persons with schizophrenia). This is relevant to the provision of maintenance programmes and early intervention as encouraged by recent research (Hodges, Byme, Grant & Johnstone, 1999; Yung et al, 1998). The socio-demographic profile of the certified patients at FNH correlated with most of the international findings. The presentation of schizophrenia remained constant in South Afiica in comparison to international countries and cultures (Warner & de Girolamo, 1995). Overall, the pattern produced by the schizophrenia sensitivity model was unclear other than high and low schizophrenia sensitivity ranges being evenly spread throughout KZN. The model has yet to be further refined to increase its sensitivity to schizophrenia risk. Although statistical significance was not established, the accessibility model suggested that large parts ofKZN fall within the range of easy accessibility in relation to the 19 provincial hospitals that provide a psychiatric service. The potential of the schizophrenia sensitivity model and accessibility model, in spite of the crude and incomplete variables utilised was evident. The GIS was a powerful tool and utilised in this study to collect (from surveys and other databases), store (retrieval and query), manipulate (transforming data, analysis and modelling) and produce data output (data reporting, such as maps and reports) (Foote & Lynch, 1995). The GIS has been a very effective tool in working with epidemiological information and it would be of great use in service planning. It is strongly recommended that there be greater collaboration between mental health services and the GIS Unit, Department of Health.