Assertive community treatment in the South African context

Although the integration of psychiatric services into the community has potentially been beneficial to many patients, this transition has not been without problems. A major obstacle to establishing successful community-based treatment in South Africa has been that the reduction in number of inpatients beds did not coincide with the development of adequate community resources. This, in combination with our patients' poor socio-economic circumstances, has contributed to a substantial increase in the so-called "revolving door" or high frequency use phenomenon in state psychiatric facilities. Clearly, there is need for a renewed approach to address this problem in our setting. With this in mind the APH in the Western Cape appointed three community treatment teams in January 2007. This publication serves to give an overview of the Stikland Psychiatric Hospital team's experiences in the first 12 months since establishment. To date, we have been confronted by several challenges that complicate the successful implementation of an "assertive" outreach service in the South African context. However, there seems to be some hope as early findings demonstrate a reduction in number of admissions as well as inpatient days. Furthermore there has been a very positive response from service users, their families and other staff members leaving us to conclude that this initiative seems to be a much needed step in the right direction.