“I cry every day and night, I have my son tied in chains”: physical restraint of people with schizophrenia in community settings in Ethiopia

Abstract

BackgroundA primary rationale for scaling up mental health services in low and middle-income countries is to address human rights violations, including physical restraint in community settings. The voices of those with intimate experiences of restraint, in particular people with mental illness and their families, are rarely heard. The aim of this study was to understand the experiences of, and reasons for, restraint of people with schizophrenia in community settings in rural Ethiopia in order to develop constructive and scalable interventions.MethodsA qualitative study was conducted, involving 15 in-depth interviews and 5 focus group discussions (n = 35) with a purposive sample of people with schizophrenia, their caregivers, community leaders and primary and community health workers in rural Ethiopia. Thematic analysis was used.ResultsMost of the participants with schizophrenia and their caregivers had personal experience of the practice of restraint. The main explanations given for restraint were to protect the individual or the community, and to facilitate transportation to health facilities. These reasons were underpinned by a lack of care options, and the consequent heavy family burden and a sense of powerlessness amongst caregivers. Whilst there was pervasive stigma towards people with schizophrenia, lack of awareness about mental illness was not a primary reason for restraint. All types of participants cited increasing access to treatment as the most effective way to reduce the incidence of restraint.ConclusionRestraint in community settings in rural Ethiopia entails the violation of various human rights, but the underlying human rights issue is one of lack of access to treatment. The scale up of accessible and affordable mental health care may go some way to address the issue of restraint.Trial registration Clinicaltrials.gov NCT02160249 Registered 3rd June 2014.

Factors related to pasung on people with mental illness

“…The following are the factors related to pasung on people with mental illness. around their neighborhood and destroying the properties, the traditional or medical medication drop out (2,4,5,11,12). Violent behavior and properti destruction done by people with mental illness are the main factors on the act of pasung by family towards people with mental illness (2,11,12).…”

“…around their neighborhood and destroying the properties, the traditional or medical medication drop out (2,4,5,11,12). Violent behavior and properti destruction done by people with mental illness are the main factors on the act of pasung by family towards people with mental illness (2,11,12). The violent behavior mainly triggered by medication drop out (2,11,13).…”

“…Violent behavior and properti destruction done by people with mental illness are the main factors on the act of pasung by family towards people with mental illness (2,11,12). The violent behavior mainly triggered by medication drop out (2,11,13). These commonly caused by financial issues and the unaccessible health provider from home of people with mental illness.…”

“…Factors originated from community includes stigma and discrimination against people with mental illness causing the increased family burden (4)(5)(6)12). Society stigma against people with mental illness and family become the highest cause of pasung (2,5,9). Stigma causes people with mental illness and family felt discriminated and decide on alternative treatment instead of mental health services (1).…”

Trauma exposure, depression, suicidal ideation, and alcohol use in people with severe mental disorder in Ethiopia

“…This hypothesis aligns with a qualitative study in Sodo District that found that the primary reason for restraint was to protect the individual with mental illness or to protect the community from the individual. This was particularly true when access to treatment was limited or nonexistent [51].…”