Relapse among MHCUs after a Short-Term Admission in an Acute Psychiatric Unit: Primary Caregivers’ Perspective
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Design and Setting
2.2. Study Population and Sampling Procedure
2.3. Data Collection Tool
2.4. Data Collection Procedure
2.5. Data Analysis
2.6. Trustworthiness
2.7. Ethical Considerations
3. Findings
3.1. Demographic Characteristics of Participants
3.2. Findings That Emerged from Data Analysis
3.2.1. Misconception about the Self-Mental Health Condition
Denial of Mental Health Condition
“The problem is that the MHCU does not think that he needs the medication. He thinks he is not mentally ill. I tried to force him to take the mental health tablets but refused and reported that he will take only tablets for headaches”.(P3, 38 years old sister)
Perceived Cured
“She told me that she feels better and that there is no need to take the medication anymore”.(P13, 44 years old mother)
“My son believes that he is fine, and no longer sick. We were so happy to see him in that state, and I did not even bother to ask him about his medication. But I have observed that he is not taking the medication as instructed anymore”.(P15, 61 years old father)
“He does not take his medication anymore, because he says he is okay. I do not know if I can get people who can talk to him about the medication so that he can understand his medical condition. We always talk to him about medication, but he undermines me. He says I must tell those who are mentally ill to take their medication, not him”.(P2, 59 years old grandmother)
3.2.2. Barriers to Supervision
Refusal of Direct Observation Treatment Support by Caregivers
“He refused to be given treatment by me, indicating that he will take it on his own time. Two weeks later, I started to suspect that something was wrong. I went to count his pills the time he went out, only to find that he still had a lot of supplies. I observed that where he was supposed to take two per day, he was taking one tablet instead”.(P9. 49 years old aunt)
“I am scared to remind him to take his medication because he gets angry and becomes verbally aggressive whenever I remind him. He swears at me, saying why I treat him like a child. So, I let him keep his medication, I am sure he does not take it the way they told us at the hospital because his behaviour has changed”.(P3, 38 years old aunt)
“He does not want us to get involved in his medication. He locks his room and fights with us when we ask if he took his medication. I think he undermines me because I am a woman. Sometimes he looks well, and the other time looks like he has relapsed. I wish I had a male person in the house who would force him to take treatment”.(P6, 53 years old mother)
Leaving Alone after Discharge
“I think this time after discharge, I will insist that he comes to my place. There is no one in his parents’ place as all are deceased..... I thought he will be able to manage his condition since he is an adult and I was mistaken”.(P16, 65 years old grandfather)
“I think it was the biggest problem to leave him alone. Even though we suggested that he must come and stay with us. He would come for one week and later return to his place. Some weeks later the neighbours would call to inform us that he relapsed again”.(P4, 50 years old uncle)
3.2.3. The Perceived Belief about Mental Illness
Thought of Witchcraft
“My mother thinks she is sick because one in the family has bewitched her. She does not want to talk about the condition or treatment. I think this increases her stress level because she is always angry and bitter”.(P11, 24-year-old daughter)
“People thought that psychotic patients are witches. With this myth, some MHCUs avoid their clinic follow-up visit for treatment collection because they are afraid of going public with that stigma attached to them”.(P17, 27 years old sister)
Seeking Alternative Therapy
“My sister was taken to the “Sangoma” by my aunt after she was discharged from the hospital. She was told to use the traditional medicine to bathe with to remove the dark cloud hanging on her”.(P14, 38 years old brother)
“My daughter refuses to take medication, as she says that the pastor in the church thinks she has “demons” [evil spirits]. She says the pastor prayed for her and instructed her to stop taking the medication”.(P16, 58 years old mother)
3.2.4. Change in Mental Health Treatment
“They changed his injection and also added tablets. Since he was put on the new injection, his re-admissions are frequent. When he was on the previous one, he used to stay for a year without re-admission. He was used to it”.(P1, 59 years old grandmother)
“She was taking the pink tablets for almost three years now. The problem started when the hospital ran out of pink tablets. They gave her white tablets in a box, unlike the previous one, which was in sachets. Those tablets work the same way, but she says hers are pink, not white. She believes they gave her the wrong tablets, and she does not take them”.(P8, 60 years old grandmother)
3.2.5. Exposure to Behaviour That Aggravates the Mental Health Condition
“It does not help to drink alcohol while one is on treatment because that alcohol dilutes the tablets. Sometimes he comes home late at night and gets drunk. I cannot force him to take medication”.(P7, 59 years old grandfather)
“He wakes up early in the morning and goes to his friends. They smoke dagga the whole day. Once he is intoxicated with dagga, he does not listen to anybody. I am afraid of him because he is aggressive. Hence most days he missed the treatment”.(P5, 47 years old mother)
“Alcohol use makes him stop taking treatment. If you dare tell him about medication, he will swear at you with vulgar words. He takes treatment whenever he likes. I just keep quiet and let him do as he pleases”.(P6, 53 years old father)
“I do not know what we can do to make him take his treatment because that is the only thing that can save him from relapsing. If he can stop drinking this ‘mahafhe’ (home-brewed liquor), I believe everything would be fine. Liquor is the main problem”.(P10, 49 years old mother)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Sub-Category | Frequency |
---|---|---|
Gender | Female | 12 |
Male | 6 | |
Age category in years | 20–39 | 4 |
40–49 | 5 | |
50–60 | 7 | |
61 and above | 2 | |
* Marital status | Ever married | 13 |
Never married | 5 | |
* Education status | * Ever attended school | 15 |
Never attended school | 3 | |
Household income | Less than 1000 | 4 |
1000 to 5000 | 11 | |
5001 and above | 3 | |
Relationship with the MHCU | Mother | 9 |
Father | 2 | |
* Sibling | 3 | |
* Relative | 4 | |
Living in the same household with the MHCU | Yes | 11 |
no | 7 |
Themes | Sub-Themes |
---|---|
Misconception about the self-mental health condition |
|
Barriers to supervision |
|
The perceived belief of mental health illness |
|
Change in mental health treatment | |
Exposure to behaviour that aggravates the mental health condition |
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Raluthaga, N.; Shilubane, H.N.; Lowane, M.P. Relapse among MHCUs after a Short-Term Admission in an Acute Psychiatric Unit: Primary Caregivers’ Perspective. Int. J. Environ. Res. Public Health 2023, 20, 1384. https://doi.org/10.3390/ijerph20021384
Raluthaga N, Shilubane HN, Lowane MP. Relapse among MHCUs after a Short-Term Admission in an Acute Psychiatric Unit: Primary Caregivers’ Perspective. International Journal of Environmental Research and Public Health. 2023; 20(2):1384. https://doi.org/10.3390/ijerph20021384
Chicago/Turabian StyleRaluthaga, Nelson, Hilda N. Shilubane, and Mygirl Pearl Lowane. 2023. "Relapse among MHCUs after a Short-Term Admission in an Acute Psychiatric Unit: Primary Caregivers’ Perspective" International Journal of Environmental Research and Public Health 20, no. 2: 1384. https://doi.org/10.3390/ijerph20021384