The purpose of the Lentegeur Spring Foundation is to bring alive this beautiful name, helping the hospital to evolve into a place that gives birth to hope through re-connection in every possible way!

1. Welcome
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2. Hope and Recovery in a Psychiatric Institution
Dr. J. S. Parker
Lentegeur Hospital and UCT Dept of Psychiatry and Mental Health

9.  Non-affective psychosis: 0.5% of adults, 50%
of whom will require an acute admission
 Bipolar disorder: 1.3% of adults, 30% of
whom will require an acute admission
 Substance-induced psychotic disorder: 1%
of adults 50% of whom require an acute
admission
1. Lund C et al. A model for estimating mental health services in
South Africa. SAMJ 2000 1019-1024
2. WHO Mental Health Policy and Service Guidance Package:
Planning and Budgeting to Deliver Services for mental Health
(2003)

10.  Door to door survey
 Lifetime prevalence of CMD in SA: 30,3%
 Anxiety disorders: 15,8%
 Mood disorders: 9,8%
 Substance Use Disorders: 13.3%
( Stein D. et al. Lifetime prevalence of psychiatric disorders in South
Africa. BJPsych. 2008: 192; 112-117)

11. Of those with a mental disorder, in the SASH
study, only 25,2% had sought treatment in the
previous 12 months and 5,7% (11,4% in W.
Cape) had used any formal mental health
service.
(Seedat S, et al. Mental Health Service use among South Africans fo4r
mood, anxiety and substance use disorders. SAMJ May 2009: 99;
346-352)

12.  Total Population W Cape (Census 2011); 5.8
million
 60% Adults = 3.48 million
 N-A psychosis: 0.5% = 16400 x 50%
requiring admission = 8700 per year
 BMD: 1.3% = 45240 x 30% requiring
admission = 13572 per year
 S-I psychosis: 1%; if 50% require admission
= 17400 per year, if 10% do = 3480
 Total=29752 (10% of S-I) – 39762 (50% of S-I)
 Total beds = 632 ie 6-9 days per patient

14. • 872 Cairo Bimaristan
• 1247: Opening of Priory of St Mary of
Bethlehem “Bethlem – Bedlam”, admitting
“lunatics” 1377
• 1700: Bethlem still the only state institution
in UK with 100 inmates
• Rapid growth of private institutions
• 1750-1820: 16 public institutions for the
insane established in the UK.
• 1847: 5486 patients in 21 asylums
• 1914: Total in-patients in 97 state psychiatric
institutions in the UK over 112 000
• 1954:USA in-patient population: 553979
Taylor J. The architect and the pauper asylum in late nineteenth-century England.
Ch 13 In Topp, Moran and Andrews: Madness Architecture and the Built
Environment. Routledge 2007.

15.  Foucault: Psychiatry was the product of the act of social
exclusion of the “unreasonable” in large institutions as a
result of the European Enlightenment’s obsession with reason
and the individual subject.
 Roy Porter: “The rise of psychological medicine was more the
consequence than the cause of the rise of the insane asylum.
Psychiatry could flourish once, but not before, large numbers
of inmates were crowded into asylums.”
 Sally Swartz: “Urban, industrial society with concentrations of
people in limited geographical spaces, with salaried
workforces and disaggregation of systems of community care
cannot afford the intrusion and disruption of eccentric
behaviour.” .
Foucault M. Madness and Civilisation: a history of insanity in the age of reason. London: Tavistock 1971
Porter R. A social history of madness: stories of the insane. London: Weidenfield and Nicolson, 1987.
Swartz S. The great asylum laundry. Ch 10 in Topp, Moran and Andrews: Madness Architecture and the Built Environment. Routledge 2007.

16. “The Asylum” Francesco Goya -1792

17.  Fight, flight and freeze

18. FIGHT, FLIGHT, FREEZE APPROACH
 Rapid recruitment of defence
mechanisms, unconscious AND
conscious
 Conceptual awareness
(categorical)
 Evaluative processing
(dichotomous)
 Cognitive enhancement
(narrative)
 Quick decisions – clear outcomes -
highly effective - short term
 Allostasis, less resilience, negative
disposition
 Limbic
 Attentional monitoring
 Non-conceptual awareness
 Non-evaluative
 Present moment sensory
awareness
 Intentional
 Sustained
 Homeostasis, resilience,
positive disposition
 Allows for creativity -
limitless possibility!
 Prefrontal

19. Peter Senge “The Fifth Discipline”

22.  “a deeply personal, unique process of changing
one’s attitudes, values, feelings, goals, skills
and/or roles. It is a way of living a
satisfying,hopeful, and contributing life even
with limitations caused by illness. Recovery
involves the development of new meaning and
purpose in one’s life as one grows beyond the
catastrophic effects of mental illness.”

23. Internal Conditions
 Hope
 Healing
 Empowerment
 Connection
External Conditions
 Human Rights
 A positive culture of
healing
 Recovery Oriented
Services

24. The essence of spring.

25.  Bridging the divide between a mental health
institution and deeply scarred surrounding
community by designing a mental health centre of
the future.
 In essence the concept of Spring is brought to life
through healing people and the environment.

26. The first green psychiatric hospital in Africa
 Efficient water use
 Minimal carbon footprint
 Waste recycling
 Produce gardens
 Green consciousness: Enviro-mental health
 Green therapies
 Cultural festival
 A place of beauty
 From stigmatized patient to green ambassador

29. Note: In all photographs where the identity of a mental healthcare user may be revealed, the informed consent of participants
has been secured.

31. BIKO
“The oneness of
community is at
the heart of our
culture.”
I write what I like.
Bowerdean Press
1978

32. Thank you
To view material from this talk visit
www.sacap.edu.za/events
Like our Facebook Page
Follow us on Twitter @SACAP
#PsychologyFest