SUBSTANCE ABUSE

1. Reduce school attendees admitting to drink alcohol and smoke tobacco.

2. Reduce the use of illegal substances including cocaine, mandrax, heroin and marijuana.

3. Reduce the consumption of alcohol and other drugs among women and especially pregnant women.

1.1 The latest Report of Mental Health and Substance Abuse.
1.2 Health learning materials on alcohol, cannabis, mandrax and other drugs in local languages.

2.1

3.1

4.1 Clinics have regular visits by mental health trained staff where training includes care of substance abusing patients.
4.2 Patients are able to request visits by social workers.
4.3 In problem (urban) areas staff attend workshops on relevant substance abuse.
4.4 Patients needing detoxification for substance abuse withdrawal symptoms have entry to clinic care via NGOs, teachers, employers, traditional healers, police and are referred rapidly to general hospitals with detoxification facilities and have a social worker to arrange follow up and social reintegration on discharge.
4.5 Patients referred to clinics by NGO, teachers, employers, traditional healers and police (not requiring detoxification) are given appointments with periodically visiting specially trained mental health nurses.
4.6 Clinic staff have rapport with their communities and are culturally accessible to substance-abusing patients to discuss their problems or have their families discuss their problem with them.
4.7 Patients with TB, STD/HIV, mental disorders and families with violence are sufficiently at ease with staff to be able to bring out any problem of alcohol or drug abuse.
4.8 In the clinic catchment area or district of the clinic, staff are able to work when required with correctional services, educators, labour, welfare and NGOs (e.g. Alcohol Anonymous).
4.9 Staff can identify tobacco, alcohol and marijuana abuse and provide basic counselling for behaviour changes and referral to NGOs specialising in substance abuse.
4.10 Staff are aware of the age groups at risk and the predominant social settings in the community for substance abuse: e.g. male youth of 10 – 15 age, limited social integration in the family, shebeens and people who have been in prison.
4.11 The clinic arranges meetings between SANCA and parents and teachers to initiate a drug prevention, education and early identification programme.
4.12 Staff participate in life skills programmes in schools and discuss substance abuse.
4.13 Staff mount community awareness programme with youth, NGOs and CBOs.
4.14 The clinic is maintained as a smoke free zone.
4.15 Staff are able to recognise the problem of foetal alcohol syndrome and include education on this with antenatal groups.
4.16 Staff identify patients needing referral, do this with patient compliance, accept patients back for follow up and assist with family reintegration.
4.17 Staff identify school children with behaviour problems and discuss with parents and teachers the possibility of drug involvement.

5.1 All patients are referred to the next level of care when their needs fall beyond the scope of competence of clinic staff.

6.1 All patients attending clinics for service receive health education.

7.1 Patients records kept up to date.

8.1 Community encouraged to initiate community based services.
8.2 In client and community discussion staff advise on harm reduction strategies (cigarette smoking, alcohol, glue sniffing) and collaborate with traditional healers who assist substance-abusing clients.

9.1 Staff collaborate with other sectors like education, correctional services, labour, welfare as well as other relevant NGOs and CBOs to improve mental health.
9.2 Staff collaborate with traditional healers for involvement in improving mental care at community level.