One of the main problems facing the psychiatrist in forensic psychiatry is the distinction between malingering and mental illness especially in Zulu speaking patients. This study identified twenty items from the literature and clinical practice that separate malingering from mental illness. The validity of these items was assessed through an experimental, cross -sectional study design which compared two groups. These were a sample of fifty malingering African patients, male and female and a control group of fifty mentally-ill African forensic patients who were classified as State Patients. Since the data was categorical, that is, the outcome was either positive (that is malingering) or negative (that is mentally ill) the groups were compared by employing such methods as the chi-square test and Fisher's exact test. Seventeen items we re found to be statistically significant and were regarded as valid items that separate malingering from mental illness. Then the effectiveness of these seventeen items in separating malingering from mental illness was determined by calculating their sensitivity, specificity, their false positive rate and their false negative rate. The items fell into Group four categories or groups. Group I are those three items with a high sensitivity, a high specificity, a few false positives, a few false negatives, high positive predictive values and high negative predictive values. They were able to diagnose both malingering and sickness with a high degree of accuracy. Group 11 consisted of eight items with a high specificity, a few false negatives and high positive predictive values. i1 These items are good at diagnosing malingering patients directly. Group III consisted of six items with a high sensitivity, a few false positives and high negative predictive values. These items are good at diagnosing sick patients and therefore diagnose malingering indirectly by excluding mental illness. Group IV consisted of three items which did not show statistical significance between malingering and mentally ill patients. This study proved that seventeen items were able to separate malingering from mental illness to a statistically significant extent and are effective for the use in the diagnostic assessment of Zulu speaking forensic patients. / Thesis (Ph.D)-University of Natal, Durban, 1997.

The aim of this study has been to examine, in the light of recent events in the field of Health Care in South Africa, the remarks and claims made by the World Health Organization, and the American Psychiatric Association between 1976 and 1978 on Health Care services, as provided for Blacks, by the South African government. In two reports, these organizations instituted the earliest, and arguably most significant claims against South Africa's system of Health Care. This study sketches firstly the political genesis and social context of the WHO, and APA examinations. Secondly, this study evaluates responses made by the South African State to the critical climate inspired by the above mentioned reports, through a close analysis of recent events associated with the politics, and provision of Health Care Facilities - particularly with regard to Black South Africans. This analysis suggests that the governments' earlier tentative policy of privatisation (which was soundly condemned by WHO and the APA) has been even more enthusiastically pursued - in contradiction to it's avowed policies of Commu ity Health Care, and to the continuing detriment of those South African communities who are in most need of adequate Health Care services. The study concludes that the criticisms raised by the WHO and APA had the effect of inspiring positive reforms in South Africa's health services, but in no way thwarted the governments', at first only tentative plans, to increasingly privatise it's psychiatric and other medical institutions.

M.Cur. (Psychiatric Nursing) / There is an increase in the readmission rate of African psychiatric patients to psychiatric hospitals as determined by the records. This to a large extent involves those diagnosed as being psychotic of one category to another forming eighty percent of all patients in the admission wards for both the male and the female patients ...

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Thesis (M.A.(Industrial Psychology)--University of the Witwatersrand, Arts Faculty, 1996 / At a primary level the current study sought to investigate the post-traumatic stress responses of a sample of black township residents who were victims and witnesses of continuous civil violence [Abbreviated abstract. Open document to view full version]

A clinic survey was undertaken to investigate the nature of psychiatric problems experienced by the primary health care (PHC) patient population in the Bisho-King William's Town area of the Eastern Cape Region. The study took as its point of departure research findings which attest to the high rate of psychiatric distress amongst this population group in different parts of the world and ohservations regarding the form of presentation in terms of physical complaints. Hypotheses posited relationships between psychiatric problems experienced by patients attending PHC clinics in the study area and four types of variables, namely; somatic complaints, socio-demographic characteristics, patterns of health service utilisation and patient satisfaction with health services. Using a quasi-experimental descriptive approach, a two-stage screening procedure sorted the patient sample into three groups on the basis of the degree of psychiatric symptomatology experienced. The triangulation of the results of between-groups analyses with case materials recorded during psychiatric interviewing provided for an ethnographic account of the cultural experience of distress in the study area. The screening process used standard instruments, the Self-Reporting Questionnaire (SRQ) in the first stage and the Present State Examination (PSE) in the second stage. A pilot study was conducted prior to the fieldwork for the main study. Using the SRQ, thirteen psychiatric paticnts and 31 general PHC patients were sampled for the pilot study and 148 PHC patients were sampled for the main study. Using the PSE, 11 and 57 PSE interviews were conducted in the pilot and main studies respectively. Between-groups analyses used chi-square and F-statistics to investigate possible associations with identified patient correlates (P<0.5). These were socio-demographic, utilisation and satisfaction variables, measured by a separate face-valid self-response instrument compiled for the purposes of this study. Psychiatric symptomatology was found to be statistically significantly related to age, marital status and educational level. Further, patients experiencing more psychiatric symptomatology reported significantly more illnesses requiring treatment, longer consultation periods and a greater number of sick bed days. No statistically significant relationships were found between psychiatric symptomatology and number of children, number of failures at school, amount of treatment utilised, number of consultations, or patient satisfaction with services. Descriptive analyses of symptom and syndrome profiles found certain somatic complaints to be particularly prevalent amongst the patient sample. These include headaches and various tension pains, decreased energy levels and digestive problems. Qualitative analysis of interview data found that many somatic and psychiatric problems experienced constitute culturally defined and meaningful experiences, especially 'umbilini' (or nerves), 'ufufunyana' (a possession state), and accusations of witchcraft. Interpretation of complaints from the local traditional healing perspective, revealed a more complex mode of communication between patients and the health delivery system than may be accounted for in terms of a simple biomedical model. The interpretive analysis in the study showed that some forms of presentation incorporating somatic symptoms, such as 'nerves' may he viewed as help seeking behaviour of the socially unempowered. Implications of the results are discussed in relation to the need for improved identification and management of psychiatric distress at PHC level facilitated by a better developed referral network and closer interaction between biomedical and anthropological perspectives.

The understanding of the pathways that clients take prior to admission to a mental health institution, is a vital factor in planning to reduce delays in seeking treatment. Studying the pathways may also help in the identification of sources of delays in the receiving of care and suggest possible improvements. Although western medicine plays an important role in the control of disease, traditional medicine continues to play an important role in the health care of black African communities. They, therefore possess unique attitudes, values and beliefs, about health and illness, which integrally infiuence their health behaviour. This study aims to increase the understanding by health professionals of pathways to care taken by clients before they are admitted to a mental health institution, so as to enhance heath service planning. It also aims to determine the socio-cultural and economic factors, as well as satisfaction with different service providers. The sample in this study consisted of 15 clients, who were between the ages of ten and fifty-nine years. These clients were males and females who were admitted for the first time in a mental health institution (MHI) (TownHill Hospital, Pietermaritzburg). The interview questionnaire, was administered, by the researcher.This study has demonstrated that, Africans still believe in traditional and faith healers as their first port of call when they are mentally ill. Their help seeking behaviour is determined by their cultural beliefs and values. The study also demonstrated the high involvement of the South African Police Services (SAPS) in the pathway to mental health institution by intervening to protect family or public and also transporting the client to a mental health institution. The Primary Health Care (PHC) is very seldom used Economic factors like unemployment strongly infiuence the mental health of people and also affect their social functioning, as it is shown by the high levels of unemployment in the sample. Some of these clients resort to living on the streets, because they cannot find employment and are homeless. The study has also shown the importance of education and training of health professionals in PHC, in identifying the first signs of mental illness when clients present themselves and making available the psychotropic drugs at the PHCC as this is the first port of call for clients. Psycho education of traditional healers, spiritual healers, SAPS and community should be implemented on when and how to refer clients, how to handle mentally ill clients. / Thesis (M.Cur.)-University of Natal, Durban, 2001.

Xhosa psychiatric nurses stand unique at the interface between Western mental health care and indigenous healing in South Africa. They stem from a cultural history that is embedded within traditional health care discourses and yet are trained and work within a Western psychiatric model. In embodying the intersection between these two paradigms, they are faced with the challenge of making sense of such an amalgamation. These nurses' views are thus valuable in reflecting this intersection and illustrating many of the central concerns that surround it. This study explicates the views of these nurses toward traditional healers and their potential role in mental health care in South Africa. In addition, it illuminates some of the cultural dynamics at work amongst these subjects as they struggle to make sense of their unique cultural position. Using a questionnaire-based methodology, the views of Xhosa psychiatric nurses in a psychiatric hospital in the Eastern Cape, toward traditional healers and their role in mental-health care, were examined. The findings reveal that the vast majority of these nurses believe in traditional cosmology, involve themselves in traditional ritual practices and regularly visit traditional healers as patients. In suggesting ways in which indigenous healing and Western mental health care can work together, 75% of the nurses were in favour of a general referral system between the hospital and traditional healers, most (77%) agreed that certain patients would be better off being treated by both the hospital and traditional healers than they would if they were only being treated by the hospital alone, and 85% of the subjects agreed that patients who are already seeing traditional healers should check if psychiatric medication might help them. These findings indicate that these nurses operate across two healing systems which are at this point not conceptually compatible. This results in deep cultural tension for the nurses. In being entangled in the dialectical tension created in this context, the nurses manage the incongruencies in three general ways: a) Most, in one form or another, incorporate beliefs from both systems into an integrative model, b) some assimilate their cultural belief system into the Western mental health paradigm, throwing off their beliefs in traditional healing, and c) others remain ambivalent in the dialectic between traditional and Western health care discourses. Although this may suggest that these nurses reside within a cultural milieu that is somewhat unhealthy, at another level, in managing and containing the incompatibility between the two systems, these nurses ensure a space for on-going and healthy critique of the underlying assumptions involved in this health care malaise.

M.A. (Psychology) / Please refer to full text to view abstract

M.Cur. (Psychiatric Nursing) / In this research an attempt was made to identify manifestations of depression in black children and give mental health education to their mothers in an attempt to alleviate the state of depression in the children. A questionnaire was structured as a tool for collection data. The instrument was based on a standardized depression scale which was used cross-culturally by the World Health Organization during 1983. The non-probability sampling procedure was carried out utilising a purposive sampling method in compiling an experimental and a control group of mothers of depressed children in a quasi-experimental research design. A mental health education programme on depession was developed which was given to mothers in the experimental group. The individual method of teaching was utilised based on adult education principles. At the end of the mental health education session, each mother got a brochure in the language preferred by the mother. Mothers from the control group did not have any discussions on depression. The study was done over the period of three months from 6 August 1988 to 26 October 1988. The analysis of gathered data was computerised using the Mann-Whitney U-test of SPSSX for the independent group and the Wilcoxon matched-pairs signed-ranks test for the dependent groups. The non-parametric statistics of the Z-va1ue and two-tailed probability was utilised. The findings on the comparison. between the experimental group pretest and the control group pretest revealed that there were not any statistical difference in eight of the ten variables of depression i.e. helplessness, anxiety, sleep disturbance, school problems, interpersonal relations, self concept, guilt feelings and the disturbance of perception. The other two variables, suicide and physical functioning, were not included because they showed significant statistical difference prior to experimentation. There was no significant statistical difference between the eight variables of the state of depression in the findings of the control group pretest with the control group post test. That means that if mothers of depressed children do not receive mental health education, the children's state of depression could remain the same. In conclusion, mental health education to mothers of depressed children seems to have a positive effect on a child's emotional stability. It can contribute substantially to diminishing the occurance of childhood depression.