Evaluation of mental health services in the free state Part III. Social outcome and patient perceptions

Objective. To assess patient functioning in the community, attitudes to the service and living and care preferences. Design, setting and subjects. Semi-structured interviews were conducted wit h 114 patients attending selected psychiatric outpatient clinics and with 2 2 'defaulting' patients traced from these clinics into the community. Results and conclusion. Social adjustment, community behaviour and psychiat ric functioning were within reasonable limits compared with those reported for discharged patients in international studies. Functioning was found to be poor in a small minority. Patients expressed their satisfaction with the mental health service, for example 96% of patients said that coming to the clinic helped them. However, they identified a number of problems, includi ng insufficient time spent with nurses and problems in receiving and paying for medication. Racial inequities in service provision were noted, for exa mple in rates of hospital admission, attendance at community clinics, and t ime spent in queues. Fifty-four black patients (63%) and 6 white patients ( 21%) reported a preference for long-stay hospital over community care. The expressed need for day care was high, with 61 black patients (72%) and 16 w hite patients (55%) requesting this facility. Almost half of the patients i nterviewed had consulted a traditional healer regarding their illness and 2 5% continued to do so. Differences between clinic attenders and 'defaulters ' were not significant. Recommendations include the need for additional inp atient beds as well as more community facilities and services.