5.3 Themes and Sub-Themes
5.3.1 Theme 1: Nature of Chronic Mental Illness
In the present study, it was found that all the patients admitted in the three mental health institutions have been diagnosed with one or more chronic mental illnesses.
Hence, PNs who care for patients with some of the above-mentioned disorders were interviewed.
5.3.1.1 Sub-Theme: Common Diagnoses
Although the three mental health institutions are situated in different districts, the results indicated that they share common admission diagnoses. These diagnoses include schizophrenia, substance-induced psychosis, schizo- affective disorder, bipolar
106 disorder, mood disorder, intellectual disability and ADHD, as reflected in the extracts below:
It’s mix up; we have substance induce, schizophrenia and mood disorders, so is mix up. (Participant 4, age 36, male).
In female acute; we are having schizophrenia, bipolar disorders, and then some major depression. (Participant 22, age 27, female).
We have schizophrenia, we have bipolar mood disorder, we have depression.
(Participant 21, age 64, female).
Schizophrenia, bipolar, mood disorder, substance-induced psychosis, yes, and schizo-affective. (Participant 28, age 30, female).
As outlined above, all of the patients admitted in these three mental health institutions have some kind of chronic mental illness. However, the most common admission diagnosis was reported to be schizophrenia.
It ranges from schizophrenia, schizo-affective disorder. We also have BMD; we have two or three of them but mostly is schizophrenia. We also have mental retarded patients; these ones can’t bathe themselves totally. (Participant 2, age 47, female).
Most of them is schizo, schizo plus diabetes. Others is caused by abuse I mean this what do you call drug abuse; but most of them is schizophrenia. (Participant 12, age 46, female).
Most of them; they are schizophrenic, some are bipolar. (Participant 30, age 30, female).
107 Some are diagnosed with a schizophrenia, some usually we have schizo- affective, but majority have schizophrenia. And others because of age, they have hypertension and diabetics. (Participant 25, age 30, male).
As if caring for patients with mental illness is not enough, the findings of this study discovered that PNs also care for patients with dual diagnoses. Some of the patients have extra diagnoses on top of the chronic mentally ill diagnosis. PNs stated that some patients suffer from medical conditions, which put more pressure and additional work on the nurses. These medical conditions include hypertension, diabetes, and epilepsy.
Now they have to give patients medication for mental illness and for other medical conditions. Patients with dual diagnoses would take more drugs than the ones with only one diagnosis and require the presence of a nurse.
Some of these patients have medical conditions like hypertension and epilepsy.
(Participant 10, age 55, female).
Some of them have this schizophrenia patients but they also have medical cases like diabetes and blood pressure. (Participant 11, age 56, female).
Schizophrenia, mental retardation and other medical conditions like hypertension, diabetics, epilepsy. (Participant 16, age 29, female).
Nurses who participated in the study revealed that almost all patients are not ordinary mentally ill patients; they have committed some form of offence. After committing an offence, the patients were evaluated, then declared mentally ill by a panel of health professionals. The fact that these patients committed criminal offences indicate that they are dangerous to the nurses and to fellow patients. The nature of offences that most patients committed are as follows: murder, rape, destroying of property and stealing, to mention a few.
108 Others, you find that maybe they burn the houses; others they even killed people.
Others, they killed their parents, mothers whatever. (Participant 12, age 46, female).
That’s all we have; in state patient, some of them committed murder, attempted rape and then destruction of properties. And some are those who used to steal and assault. (Participant 11, age 56, female).
Any state patients are those patients who did maybe killed people; ja, they commit this huge crime. But Invo maybe they have committed this malicious damage. (Participant 12, age 46, female).
But this ward is not the same as other wards because patients who are in here are only males and they have committed lots of things. Like dangerous things, that’s why they say it’s a closed forensic ward. In other words, is a maximum ward, where they keep people who have murdered people, raped. They did a lot of things like house robbery, a lot of things, many. Everyone you see here; they have been charged. They were supposed to be doing time in prison, that’s why they have classified them as state’s patients. They are the property of the state, ya. They are not fit to stand trial. (Participant 27, age 32, male).
The three MHIs in Limpopo admit patients on a voluntary and an involuntary basis.
These patients are divided into various categories or wards depending on their diagnoses.
It’s forensic ward, it falls under maximum. These patients that are here; they are transferred from maximum most of them. We have state patients and involuntary patients. (Participant 12, age 46, female).
We admit others from the holding cells; like those who are maybe declared involuntary mental health care user or those who are aah the forensic, state’s patients, yes. And then again, we are seeing also the observations patients. We just used to say observations patients, but we know they are patients, they are observatics. (Participant 24, age 60, female).
109 Yes, it’s a forensic ward, is like that one of maximum and the semi-closed.
(Participant 11, age 56, female).
They are only divided in home, according to their diagnoses. (Participant 21, age 64, female).
In the above-mentioned excerpts PNs reveal that all patients admitted in these MHIs have been diagnosed with one or more mental disorders, schizophrenia being the more prevalent diagnosis. In addition to the psychological diagnosis that the patients have, they suffer from other medical conditions. Some patients are admitted on a voluntary basis while others on an involuntary basis. One other notable factor is that the majority of the patients have committed criminal offences. As a result, these nurses are afraid.