Specialist Neuropsychiatric Liaison Service

brain . mind . body integrative health

Hospital Admissions

Worldwide Patients are categorized diagnostically by using one of two WHO recognized International Diagnostic Systems. The entire healthcare system depends on applying either the ICD (International Classification of Diseases), or the DSM (Diagnostic and Statistical Manual), the latter being more prominently considered by South African authorities.

Patient Medical Aid Benefits and Healthcare Rights are critically determined by the individual’s DSM diagnostic formulation. Although strictly complying of Axis 1 to 5, the most relevant aspects of the DSM are:

Axis 3: Diagnosed physical illness e.g. Diabetes, Epilepsy, Parkinson’s etc.

Axis 1: Diagnosed mental illness e.g. Schizophrenia, Depression etc.

Each illness also has a corresponding ICD Code. Conditions on Axis 3 have numerous codes starting with letters A-Z, and conditions on Axis 1 have codes starting with F. Additionally Prescribed Minimum Benefit (PMB) conditions each carry a different PMB Code.

All Patients theoretically fall into one of three subtypes:

  1. Those suffering only a physical condition (Axis 3 only),
  2. Those suffering only a mental condition (Axis 1 only), and
  3. Those suffering “mental health” problems secondary to their physical condition (Axis 3 and 1).

Physicians and other medical- and surgical Specialists treat those Patients suffering only an Axis 3 condition, Psychiatrists treat mostly those Patients suffering only an Axis 1 condition, and Liaison Neuropsychiatrists focus on those Patients where prominent Axis 3 and 1 conditions are present simultaneously (or caused by one another).

“Liaison Neuropsychiatrists” concerns themselves therefore with “physical illnesses affecting brain or mind”.

Physical illnesses presenting regularly with Neuropsychiatric complications include Stroke, Dementia, Epilepsy, Parkinson’s disease, HIV, Traumatic Brain Injury, Cancer and many more.

Because of the prevalence and magnitude of many of these conditions, Neuropsychiatric service delivery has become perhaps the most focussed topic in healthcare in countries with advanced healthcare systems e.g. the USA, UK, Canada etc.

Sadly South Africa lags behind considerably in both State and Private Neuropsychiatric service delivery, which is ironic considering our rates of HIV infection, Traumatic Brain Injury (from accidents and violence), and aging population (Stroke, Dementia and Parkinson’s Patients).

In South Africa one may lead a perfectly healthy life (never being diagnosed with a “mental condition”), then develop a very clear physical illness such as Parkinson’s illness or Epilepsy, which then cause you to develop a complication such as hallucinations, followed by you promptly being labelled “Psychiatric”.

Specialists agree that Patients with only Axis 1 diagnoses suffering the so-called “conventional” mental illnesses, is best treated in tailor-made Therapeutic hospitals.

However, forcing the admission of Neuropsychiatric patients (with both Axis 3 and 1 conditions) to Therapeutic hospitals is grossly unethical as such Patient’s physical health treatment is almost always seriously jeopardized at such institutions. Thankfully a growing understanding amongst some will continue to drive further Neuropsychiatric service development.

Interesting the legislation and medico-legal frame (such as the Patient Charter, PMB provisions, Human Rights Act etc.) is in place to facilitate future optimal care delivery.

In line with international trends and standards, Healthcare Insurers (Medical Aids), Institutions (State- and Private Hospitals), and Service Providers (Doctors) in South Africa will have to become attuned to Patients executing their rights to be treated in appropriate settings for their specific DSM Formulated Diagnosis.

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