Mental Health Services in Public Health

Rulaine Smith

Deputy Director: Occupational Therapy

District Specialist Mental Health Team (DSMHT)

Johannesburg Health District

Email: Rulaine.Smith@gauteng.gov.za

Cell: 063 862 4285

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District Specialist Mental Health Team Organogram

District Specialist Mental Health Team (DSMHT)

Psychiatrist (Head of Clinical Unit)

Deputy Director for Mental Health (Nursing)

Psychologist (DD)

Occupational Therapist (DD)

Social Worker (DD)

Admin Officer

NGO Governance Compliance Team (NGCT)

Professional Nurse

Medical Officer

Occupational Therapist

Social Worker

Dietician

Environmental Health Practitioner

Clinical Community Psychiatric Team (CCPT)

Psychiatrists

Registrars/Medical Officers

Clinical Psychologists

Occupational Therapists and OTTs

Social Workers

Psychiatric Nurses

Tshwane

Johannesburg

West Rand

Sedibeng

Ekurhuleni

Robertson et al (2021)

OT Role in a Community / Public Health Setting

• “Community Based Rehabilitation is a strategy within community development for the rehabilitation, equalisation of opportunities and social inclusion of all adults and children with disabilities.

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• CBR is implemented through the combined efforts of disabled people themselves, their families and communities and the appropriate health, education, vocational and social services.”

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• https://www.who.int/publications/i/item/9789241548052

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ILO, UNESCO, WHO Joint Position Paper 2004

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OT Role in a Community / Public Health Setting

OT and OTA Roles

• Task sharing and shifting
• Plan together (especially projects)
• Clear descriptions / instructions and recording
• Divide and conquer – you don’t have to physically be together for everything
• Upskill and capacitate
• Attend courses to gain knowledge and ideas for practical implementation
• Networking

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Hospital

• Structured, established services – e.g. closed groups, set number of sessions for diagnosis
• Generally well resourced in terms of HR, tools, materials and consumables
• “Luxury of time” for therapy
• MDT
• Family / care-giver consulted just prior to discharge

Clinics

(Community-Based Services)

• May need to start up services and may need to adapt known treatment protocols to suit patient availability
• Limited resources – use what is readily available to patients
• Assess, treat and issue a home programme within 1 session
• Task shifting / sharing
• Family / care-giver central to therapy

Project & Outreach Services

• Project: Health Promotion (talks in waiting areas)
• Project: Community Support (e.g. support groups)
• Project: Vocational rehabilitation (e.g. soup kitchen, beading, gardening)
• Outreach: awareness campaigns according to health calendar
• Outreach: NGOs (interactive reading, parenting workshops, low cost toys)
• Outreach: Faith-based organisations

Referrals and Teams

• Promote your service package offering
• Take time to introduce yourself to those who work
• Understand the roles they fulfill at the clinic
• Facility / operational manager!!!
• Services / programmes at clinic (e.g. HAST, MCWH, School Health, Family Medicine, Men’s Health, Clinical Forensic Medicine)
• Community health workers / ward-based outreach (WBOTs)
• Health professionals at clinic (especially nurses)
• Resources / sites near clinic (e.g. schools, NGOs, police station, substance abuse centres, )
• Nearest hospital

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• Get your own referrals
• Mental health screening

Screening Tool Sites

• https://www.medicalhomeportal.org/clinical-practice/screening-and-prevention/mental-health-screening-for-children-and-teens
• https://safesupportivelearning.ed.gov/sites/default/files/10-MntlHlthScrnTlsGrK-12-508.pdf
• https://pmhealthnp.com/screening-tools/

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Ideas on Where to Start

• Try contact OT (or rehab staff member) that was previously appointed there – handover
• Needs analysis for service delivery
• Just remember, you cant do everything
• Ensure service delivery package is not only reactive but includes strategies for health promotion
• PLAN & Organise your services
• Home programme for occupational dysfunction components
• Diary – booked patients VS walk-ins
• Laminated screening tools to limit copies required
• Group protocols
• Treatment spaces (e.g. gardening, soup kitchen)
• Don’t limit your thinking – innovative practice
• Critical professional “buddy”

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THANK YOU