Ensuring compliance to treatment of the mentally ill

Ensuring compliance to treatment of the mentally ill

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For many centuries, people viewed mental illness as a mysterious attack from the supernatural. The cause, they believed, bordered on spiritual possession in the blood, fluids and other parts of the body. This actually formed the basis of many barbaric methods of healing, such as bleeding so that the spirit in the blood can come out or purging so that those in the body in the form of fluids can be discharged.

At a time, some felt that the spirit was hidden inside the brain, which informed the many surgical procedures in the skull to let out the spirits. In some cases, the patients were physically beaten to exorcise the spirits from the body and, in extreme cases, they were burnt. Several restrainers were constructed ranging from wooden cupboards, iron bars and jackets to effectively demobilise a violent patient.

Several “mad houses” with dehumanising conditions sprang up, especially during the medieval period. There was also the time of the witch-hunt when several mentally, ill people were framed up as preaching heresy against the church and were banished. Several methods of exorcism in Africa and particularly in Nigeria had existed in this period also.

However, much improvement was recorded when patients were taken care of in decent and compassionate atmospheres, especially during the renaissance. Mental illness can manifest as disturbance of emotion, which could be as anxiety disorder where the emotion of fear and apprehension remain at the centre. Some may have problems with the mood and present with undue sadness, feelings of hopelessness and worthlessness, which could lead to suicidal ideations. When the mood is unduly elated, there is associated hyperactivity, ideas rushing through the mind, feelings of possessing special powers associated with social and sexual indiscretion as it occurs in a manic episode.

There could also be problems with the capacity to remember, especially in old age where folks may miss their way in the house, wander away from familiar environment and may not recognise friends and family members as it is in dementia. A patient could hear voices of unseen individuals discussing him among two or more persons or running commentaries on his actions.

This particular illness may be associated with experiences that show that unspoken thoughts are known or a feeling that thoughts are inserted by an external agent or thought blockade as it is in schizophrenia. There are many other such groups of disorders of the mind serious enough to cause personal distress, make the patient behave out of keeping with the prevailing practices of that society.

One of the most important discoveries of the 20th century is that of the antipsychotic drug–chlorpromazine that effectively eliminated hearing of voices of unseen individuals and other psychiatric symptoms .As of today, there is actually no mental illness that does not have a therapy.

Through the birth of the discipline of psychiatry, a gamut of pharmacotherapeutic agents, ranging from tablets, capsules and injectables, are available for the remission of symptoms of mental illness with minimal side effects. Where drugs alone may not be enough or are not immediately indicated, we have several psychotherapeutic approaches that have proved effective in restoring patients back to normal at a personal and social level.

There are empirical and anecdotal reports that show that these interventions are effective and useful for the recovery of the mind. However, despite the efficacy of these interventions, several factors hinder patients from gaining access to these resources. Poverty is very central, where a patient cannot afford the medication and sustain procurement for a long period, which could be solved if the NHIS can include mental illness as one of its principal areas rather than classifying it as a chronic disease.

Closely linked to this is ignorance, which does not spare our educated ones, who still believe that spiritual forces cause mental illnesses and hence medication is not effective. This ignorance comes from the concept of the sick role, which determines causation, course and time limit of effective intervention.

Another myth is that our drugs only suppress but does not cure. This negates the practical experience that stops the hearing of voices in patients and can drastically improve or stabilise moods as the case may be. The side effects are not life-threatening and drugs exist that can take care of them when they occur. The gains of the initial contact with orthodox care are linked to the long-term compliance to the prescribed medication through follow-up visits at the clinic.



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