Commentary
By Donald Conteh, Manager, London Greenwich Mental Health Nurse Practitioner Team and Associate Dual Diagnosis Lecturer, Greenwich University.
This week, Sierra Leone and other 191 Nations in Planet Earth celebrate the World Mental Health Day which was declared by the UN as a means to raise awareness and promote mental health.
However, as we celebrate this world event, some of our fellow citizens in recognised care institutions and informal care settings live with chains on their ankles, reminiscent of the slave trade. This barbaric method of restraint is not only physical and emotional abuse on their lives but a delay to their mental health recovery.
Restraints – time limited— are usually used for the protection of patients and others in circumstances when medication and verbal therapies are insufficient and as a last resort to control potentially violent patients. Please note that violence is the result of high level of emotions in a person. This is what happens in this situation when the emotion of the mentally ill patients has been provoked by being chained on the ankle.
Restraint was never discovered by scientific research but rather originated in primitive societies as a response to the danger posed by mentally deranged persons. We are now in the 21st Century with advances in psychiatry and the availability of psycho-pharmacotherapy and psychological interventions. So, why the use of chains on our mentally ill-family, vulnerable Sierra Leoneans and non-crime convicted citizens by persons who should help, support and treat their illness?
Mechanical restraint including the use of chains are used in most care settings because of perceive patient danger to self or others; to prevent patients from absconding or wandering; to control patient violent behaviour; to substitute for inadequate staffing; inadvertently as a means of punishing the patient when staff are angered or to allow staff to administer medication to the patient.
The mental health policy of March 2010 (first Mental Health Policy in Sierra Leone) reported that the Kissy Psychiatric Hospital which is 183 years old have two trained psychiatric nurses but 400 patient beds. Also, that there is lack of trained personnel and other resources needed for the management of an effective mental health service. Again, that the last supply of psychotropic medication was in 2005. The motive behind mechanical restraint of mentally-ill patients in most cases is not for the patient safety and that of the staff but rather due to lack of resources and skilled-staff.
Mentally-ill patients experience feeling of distress and disenabling effect which impact on their day-to-day ability to normal functioning. Therefore, this group of patients are vulnerable citizens in our communities and society. They rely on others for help, support and treatment so as to regain their mental well-being and again be meaningful to our society. But what are our actions on them? REFLECT.
. Unfortunately some patients may be experiencing mental illness that is drug-induced psychosis as a result of the use of illicit drugs and/ or alcohol to drown their sorrow. We must not dismiss the trauma of the 11 years rebel war and that some of our fellow citizens are now using illicit drugs to cope with their distress but those with genes sensitive to those substances may experience mental illness. The aggression exhibited by some mentally-ill patients may be the cause of transference whereby the patient’s mind replay experiences of trauma and would deem their carer as the abuser.
A patient with mental illness may experience paranoia, suspiciousness, hallucination and persecutory delusion and thus feel a threat on his/her life and existence. The patient may live with high level of emotion requiring professional care and treatment. Thus there is no further need to escalate an unstable emotion. Also, the effect of illicit drug intoxication and withdrawal may cause distressing physical and psychological symptoms which would affect the behaviour of the person and deem dangerous to others.
Our fellow citizens with mental illness require effective rapid tranquiller medication, trained staff in the prevention and management of violent and aggression, skilled staff in de-escalation techniques, availability of safe and soothing seclusion rooms in psychiatric settings and collaborative working between mental health service and the police rather than the use of CHAINS. Carl Rogers, an influential American psychologist and author of the client-centred therapy reported that when a therapist provide unconditional positive regards, empathy and genuineness then there is proven result of change in the patient’s mental health.
With President Koroma’s clarion call for attitudinal change, I believe it is also time for a change in our attitude to vulnerable persons in our society and re-examine our clinical practice in order to promote and provide quality care to Sierra Leoneans. The recent MDG award to the HIV/AIDS Directorate should be seen as an example in our Health Service. Our mental health Institutions and drug-rehabilitation centre are in dire straits of resources and skilled staff and urgently need the support of the Sierra Leone Government and UN agencies in Freetown. In re-branding the image of our country, we must equally think of the pathetic situation of those in mental health care settings.
DON’T WRITE THEM OFF. IT COULD BE YOU AND/OR YOUR FAMILY.
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