In the first study of its kind in the Eastern Cape, a young Port Elizabeth doctor found strong links between mental illness and high levels of “lifetime substance abuse” in patients admitted to the acute mental health unit at the city’s Dora Nginza Hospital.

Before the study, carried out with the support of a grant by the Discovery Foundation, there were no other studies to inform policymakers on the links between substance abuse and mental illness in the province.

The research, by Dr Yanga Thungana, a psychiatrist at the acute mental health care unit at Dora Nginza Hospital in Port Elizabeth, supported by two professors from the Walter Sisulu University, Zukiswa Zingela and Stephan van Wyk, is the first in a series to build a case for a better treatment model for the province.

“We are going to do a few further studies to enable us to present the Department of Health with solid evidence for policy change,” Thungana said.

In his study, he looked at data of 12 months of admissions for patients who presented with first onset psychotic episodes.

Of the 117 patients that formed part of his study, 86 were men and 31 women. They were aged between 18 and 60, and 95 out of 117 had a history of long-term active or previous substance abuse and 116 had a documented history of substance abuse. This percentage was higher than in other studies done in South Africa, and Thungana said it was one of the things they would study further.

“Our study showed a very high prevalence of substance use (81.9%) in inpatients presenting with a first episode of psychosis and who were admitted to the Dora Nginza Mental Health Unit.”

He said more than 80% of patients admitted had a history of substance abuse.

“This result is higher than published data on substance use rates (30%-75%). This could be because of a combination of factors.

“Firstly, this could be sampling bias because of the inclusion of patients with both current and lifetime history of substance use.

“Secondly, this could be because of the perceived rising prevalence of substance use in the area. A study conducted in KwaZulu-Natal in patients with psychotic disorders showed that only 10% had no lifetime history of substance use.

“Most were brought to the hospital by their families, with a large number needing help from the police,” he said.

He said 66% of the patients in the study were unemployed.

The most common substance abused was cannabis at 59.8%, followed by alcohol at 57.3%.

“The high prevalence of lifetime substance use in this cohort compared to previous studies in South Africa requires further investigation and highlights the urgent need for dual diagnosis services in the Eastern Cape,” he said. Dual diagnosis services diagnose people with both mental illnesses and substance abuse problems.

“I think one of the things that stood out was that even now that the use of cannabis is legal, people shouldn’t think that it cannot be harmful – it remains a risk, especially for people with a family history of mental illness,” he said.

He added that the abuse of cannabis was more prevalent among younger patients, while older patients were more likely to abuse alcohol, and most patients were using two drugs at the same time.

“The most common combinations were: cannabis-alcohol-methamphetamine (23.1%), cannabis-alcohol (21.5%) and cannabis-methamphetamine (18.5%).”

He said their findings were comparable to other studies which show that patients using cannabis presented with a psychotic disorder at an earlier age than those with alcohol-use history.

In the study, 68.4% of those with substance-use history had used more than one substance group and most had used three or more substances in a lifetime.

“The study findings highlight the need for mental health services in the Eastern Cape to focus on dual diagnosis in order to address the challenge of substance abuse and its association with first episodes of psychosis.

“With the recent constitutional ruling on personal use of cannabis in South Africa, the high prevalence of use and its clinical correlates in association with first-episode psychosis requires further monitoring and evaluation to detect any changes in trends which may affect the need for mental health services,” he said.

“Preventative strategies focusing on substance-use disorder could also assist in addressing the growing burden of mental disorders in this region. Further prospective research is needed to confirm the higher prevalence of substance use reflected in this study.”

Thungana said they found a strong link between unemployment and substance abuse.

“It is difficult to say which come first. People with mental illness tend not to be employed, but even if they are employed their functioning is impaired, so they also have a large chance to lose their jobs,” he said.

The Eastern Cape Department of Health’s mental health programme was placed under administration by the former health minister Aaron Motsoaledi in 2018. According to the latest information supplied by the current Minister of Health Zweli Mkhize in September, there are only two psychiatrists, eight clinical psychologists and no counsellors working in the public sector in Port Elizabeth.

A new ward where patients can be sent for 72-hour observation will be opened at Port Elizabeth’s Provincial Hospital on Thursday. This followed the deaths of three patients within six months, most admitted for drug-related psychosis, who died while waiting for treatment in the city’s biggest emergency unit at Livingstone Hospital.

One of the patients set himself and a part of the building alight and two committed suicide. At the time, the nursing staff also went on strike, citing the dangers of having mental health patients “running freely” around the hospital and attacks on nurses.

Health spokesman Sizwe Kupelo said the new ward will significantly reduce the waiting times for admission at the city’s mental health facilities. MC