Depression is a common mental disorder, characterised by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities.

People with depression normally have several of the following: a loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide.​

Many things can cause depression.  Some of these are biological.  Examples of biological causes of depression include chemical imbalances in the brain, which may be caused by events in the person’s life, such as a car accident in which someone’s brain is injured. 

Other things that cause Depression are environmental.  Stressful life changes or events can trigger depression in some people.  

​Example of environmental causes of depression include major stress such as the death of a loved one, divorce and financial problems.  Men and women of all ages, races, and economic levels can have a depression. 

Early signs  of Depression 
  • Agitation, restlessness, and irritability 
  • Dramatic change in appetite, often with weight gain or loss 
  • Extreme difficulty concentrating 
  • Fatigue and lack of energy 
  • Feeling of hopelessness and helplessness or anger and discouragement 
  • Sudden use or increase in use of alcohol or illegal substances 
  • Feelings of worthlessness, self-hate, and inappropriate guilt 
  • Inactivity and withdrawal from usual activities, a loss of interest or pleasure in activities that were once enjoyed 
  • Trouble sleeping or excessive sleeping 

Signs of a full-blown Depression    
  • Psychotic symptoms, such as hallucinations and delusions.  These symptoms may focus on themes of guilt, inadequacy, or disease. 
  • ​​Thoughts of death or suicide 


  1. The first level of entry for a person indicating the signs and symptoms of a mental health patient should be your local clinic.
  2. The client has to go to the Help Desk at the clinic where they will receive a registration number.
  3. The client will then be seen by a clinic administrative clerk, who will open a clinic file. 
  4. The clerk will then send the client to a Primary Health Care Professional Nurse who will conduct a full medical evaluation and mental health status.
  5. The nurse based on the assessment results will conclude that the client needs medication then refer the client to the Primary Health Care Medical Officer who will do further assessments and prescribe the relevant medication if necessary.
  6. The client will then go to the clinic’s pharmacy area where medication would be prescribed with detailed instructions of usage - drug advice, medical reaction and arranged period of usage.  After 14 days, they are required back to the clinic for re-evaluation. 
  7. If no improvement is noted, the doctor will refer the client to a team of Mental Health Practitioners for further evaluation.  The team consists of a Psychiatric Nurse Medical Officer, Psychiatrist, Psychologist, Social Worker, Dietician, Occupational Therapist or any other professional practitioner will form part of the team.
  8. The client will sign a consent form at the psychiatric section and may be seen by all practitioners or by specific practioner dependent on the assessment history of the client.   
  9. Treatment will be explained as a long-term process and the client’s family or significant other will also be involved in the treatment process.
  10. On the advice of the Mental Health Practitioners team, the client will be referred to the Casualty Ward of their nearest District Hospital for a third phase of assessment if and when necessary - At this point Mental Health forms as set out in the Mental Health Care Act Regulations:- 

    1. ​​Two (2) forms by different medical practitioners’ and other team members that indicate the health status of client
    2. A third form signed by the head of the Establishment (The CEO of the hospital) acknowledges that he/she agree with the findings of the practitioners and that the client can be admitted.
    3. In the ward further two (2) documents will be completed by other two medical practitioners:
      • ​​at the end of the 72 hour assessment the user may either be discharged or referred furth​er  ​​for assessment care treatment and rehabilitation  for a longer period in a designated psychiatric ward at the hospital
      • if no improvement in progress of health status the user can be further referred to so specialist hospital for further in-depth assessment care treatment and rehabilitation.
      • If no improvement by the client the specialist hospital may refer the user to a contracted care facility for further long-term care treatment and rehabilitation. 

  11. If the specialist hospital concurs that the user has improved to a satisfactory extent, they then will be discharge under the care of their family or significant other.
  12. A social worker can assist the client’s caretaker(s) to commit the user to a Mental Health Non-Governmental Organisation either as a Day Care User or in a 24 hour Center, if his/her condition deteriorates or doesn’t improve after being discharged or whilst in the hospital’s care.First form completed by referring family member of friend or significant other.

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