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Newsletter Issue 10 December 2019

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Newsletter Issue 10 December 2019 IssueUCT 10 –Department December of 2019Psychiatry Nadir and The UCT Department of Psychiatry began only a little overMental 50 years ago; it is only half as Healthold as the founding departments of the Faculty. Still, during this time, the Department has seen substantial growth, with staff contributions to our Department. I’m glad to see a appointedNewsletter on Provincial Conditions of staff now tribute to his lifelong work in this edition. Lentegeur, New Somerset, Red Cross Children’s War Memorial, and Valkenberg) and with staff on University Our Department’s structure is made up of various conditionsIssue of 10employment – December now representing about 2019 half committees (undergraduate, registrar, research, and the staff complement. academic) and divisions (addiction psychiatry, child and adolescent psychiatry, forensic psychiatry, general A potential downside of a large Department is that it’s psychiatry, intellectual disability, liaison psychiatry, no longer possible for everyone to be fully aware of neuropsychiatry, psychopharmacology and biological everyone else’s activities. With this in mind, an psychiatry, psychotherapy, public and community occasional Department Newsletter may well be useful mental health). This edition features the work of some in sharing information and experiences, and highlighting of the divisions including that of the Division of Public particular contributions. I’m very grateful to Toni and Community Health; a world-leader in this area, the Abrahams, who works in Intellectual Disability at Child and Adolescent Psychiatry and Mental Health Lentegeur Hospital for being willing to take this on. Division and the Forensic division. Our Department’s vision emphasizes the integration of Looking at the contents of this newsletter, I’m services, research, and teaching. Many of the reminded how much is going on in the contributions in this Newsletter speak to such Department. Many, many thanks to those who have integration. Dr Don Wilson has played a key role, for led and contributed to Department events such as our example, in addictions services, teaching, and research CME day, our Research day, and our Innovations for many years, amongst many other important project; these represent wonderful team efforts. Warm regards, Dan Stein Pic: Dan Stein These are the bullets: • Intinis ma volendi rehene eosanisquis suntur sitis dustis autem res doloriorem lamet fuga. Nequibusae prem qui doluptat repel maximendae ea que es et quas am ium vero im resto volorem qui su • A NOTE FROM THE HOD Given that evolution is based on maximizing fitness, evolutionary medicine asks the question, “why do vulnerabilities to illness persist?” There are different kinds of answers, but one of the best known is the “mismatch hypothesis”. Thus, for example, we need energy to survive, and we evolved in contexts where high calorie foods were not easy to find and were highly sought after; but nowadays the wide availability of sugary foods has been accompanied by an epidemic of obesity. It turns out that one of the fathers of evolutionary medicine, Randy Nesse, is also a psychiatrist. He has recently published a volume that summarizes his immense contribution to understanding the evolutionary aspects of emotion and emotional disorders: “Good Reasons for Bad Feelings”. The idea that negative emotions play crucial roles in adaptation and survival – helping us avoid overly dangerous situations for example - is a simple but powerful one, with profound clinical implications. Given that part of our evolutionary make-up involves having bad feelings, for example, addressing human suffering is a massive task. When it comes to this sort of task, knowing that the work is unending, our responsibility is nevertheless to make a meaningful contribution as clinicians and researchers. As always, our newsletter helps document the many ways in which members of our Dept are contributing to relieving suffering in the South African clinical context, a contribution that we can be proud of. Warm regards, Dan Stein P a g e | 2 IN THIS ISSUE COMMENTS Thanks to department colleagues and Division and Committee News others for submitting contributions to Addiction Psychiatry 4 the newsletter. If you have any Child and Adolescent Psychiatry and Mental Health 7 comments or suggestions for future Consultation Liaison Psychiatry 8 newsletter issues or would like to Forensic Mental Health 8 volunteer to be part of the newsletter Intellectual Disability Mental Health 9 team please make contact with the Psychopharmacology and Biological Psychiatry 12 editor. Neuropsychiatry 13 Psychotherapy 13 Public Mental Health 16 CONTACT DETAILS Registrar training committee annual reflection 19 Our transformation focus 2019 20 UCT Department of Psychiatry and Mental Health Social Responsiveness News Tel 021 404 2174 Fax 021 448 8158 Human rights for people living with mental illness and Department of Psychiatry and Mental intellectual disability 22 Health Western Cape Government: Health Departmental J-Block, Research Day 2019 23 Groote Schuur Hospital Observatory Featured NGO: AkaSnapshots Study Group 24 Cape Town, 7700 Website: UCT Department of Transformation and Innovation News Psychiatry How is our Website Faring? 26 NEWSLETTER TEAM: Student Psychiatry Society 26 Toni Abrahams [email protected] Staff News Delcia Liedeman-Prosch Prof Stein receives a lifetime achievement award 28 [email protected] Beds for registrars on call 28 Registrar year end dinner 28 Goodbye to Staff 29 Welcome to Staff 29 Bradley Knight joins the department 29 PASS Staff News 30 Congratulations 30 Department year end picnic 30 Psychology Indaba: Somewhere over the rainbow 30 Lightmind 32 P a g e | 3 DIVISION AND COMMITTEE NEWS ADDICTION PSYCHIATRY highlighted the need to advocate for the examination of the current view of drug use as criminal under South HARM REDUCTION: African law. COMMON SENSE OR The event was well attended by a diverse NONSENSE? audience including policy advocacy groups; By G Sibeko, A Scheibe, S Shelly, L Dannatt, T Gerardy, L doctors; nurses; social Weich, S Allie, F Ashburner and N Higgens workers and representatives from The Division of Addictions Psychiatry hosted a Social substance treatment Responsiveness event “Harm Reduction: Common centres. Presentations Sense of Nonsense” on 17 September 2019 at provoked thoughtful Valkenberg Hospital. Presenters included Dr Goodman conversation amongst Sibeko, Dr Andrew Scheibe, Mr Shaun Shelly, Dr Lisa participants and will Dannatt, Ms Tara Gerardy, Dr Lize Weich, Ms Shaheema hopefully be a step in an ongoing conversation Allie, Mr Fergus Ashburner. There was additionally a regarding improving access to care focussed on harm video compiled from inputs of several service users reduction for people who use drugs. from TB HIV Care. What is harm reduction? Harm Reduction International defines harm reduction as referring to “policies, programs and practices that aim to minimize negative health, social and legal impacts associated with drug use, drug policies and drug laws. Harm reduction is grounded in justice and human rights - it focuses on positive change and on working with people without judgment, coercion, discrimination, or requiring that they stop using drugs as a precondition of support.” Drug use, including heroin and methamphetamine is increasing in South Africa. Strategies that solely rely on Above left to right: Dr Lisa Dannat, Fergus Ashburner, abstinence, or are purely prohibitionist in focus, are Dr Lize Weich, Ms Tara Gerardy, Nasif Higgens and Ms ineffective to manage substance use disorders. Shaheema Allie (front). The harm reduction approach has been implemented in This conversation highlighted the need for South Africa South Africa for several years, and the evidence of its to adopt an evidence-based approach to managing the effectiveness is increasing. However, there is still much harms related to drug use. The speakers demonstrated resistance to the idea, despite the evidence. Much of how harm reduction is patient-centred; aligned to this resistance is linked to stigma and discrimination medical ethics and protects human rights. Speakers also towards people who use drugs and moral views around drug use. P a g e | 4 DIVISION AND COMMITTEE NEWS Harm reduction and policy Drug policy as it stands is not focussed with protecting people from danger, harms or any science. Instead it aligns with the United Nations Single Convention on Narcotic Drugs that describes drugs are a “serious evil” and that society needs to approach this evil by either incarcerating people who use drugs or focusing on abstinence-based approaches. The “prisoner or patient” binary limits our thinking and choices and excludes a significant proportion of the continuum of care and evidence-based and effective practices. Until we reconceptualise the approach to drug use and frame it as part of the human condition, rather than ‘evil’, we Harm reduction in people with a dual diagnosis will not be able to implement effective responses. Substance use disorders are highly prevalent among Clinical consideration those with severe and enduring mental illness and it negatively affects the health and wellbeing of these Working with people who use drugs requires a person- patients. Substances are often complexly entwined with centered approach that necessitates a collaborative psychiatric illness, whether by alleviating symptoms or relationship that emphasizes empathy, autonomy and side-effects from medications or by reducing boredom support
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