Involuntary hospitalisation : the discrepancy between actual practice and legal requirements in the Lentegeur Hospital (Cape Town) catchment area.

Abstract

The aim of this study was to document the safeguards inherent in the Mental Health Act (MHA) of 1973, and to examine the extent " to which these are observed in practice. The research was conducted at Lentegeur Hospital in Mitchells Plain, Cape Town. The population consisted of 726 certified patients who were admitted involuntarily (i.e. under sections 9 and 12 of the MHA) from 01 January 1990 to 31 December 1990. Data for each of these patients was collected from the admission register, clinical files, administrative files, and the certified post book. In addition, the official hospital statistics were examined. Measurements obtained included demographic data, the validity of the document contents, the validity of the certification process, and an overall measure of the validity of each of t he certifications taking into account both document contents and observance of the time strictures set out in the MHA. Twenty nine patients (4,0%) were admitted by Urgency (Section 12), and 697 (96,0%) on Reception Order (Section 9). The study focused mainly on the Section 9 patients, because of the small sample size for Urgency admissions. It was found that 609 (87,4%) of the 697 admissions were legally flawed in terms of document contents criteria and the time limits in the certification process. Document content criteria were not fulfilled in: 3,0% of the Applications for Reception Order; 32,1% of Medical Certificates; 20,1% of Reception Orders; and 3,6% of Reports to the Attorney-General. In 40,0% of certifications the Report to the Attorney-General (G2/28) could not be traced. Examination of temporal safeguards revealed that the least satisfactory aspect was the delay in the completion of the post-admission Report to the Attorney-General. It was found that 32,3% of these Reports were not submitted on time. Reasons for the discrepancy ("gap") between legal standards and actual practice are discussed. Recommendations are made which could help minimise or eradicate this "gap". These include suggestions for changes in the document format, for the use of a certification booklet, for stricter control of late and inadequate documentation, and for inservice training of all those involved in the certification process.