Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa

Abstract

Although treatment default by psychiatric patients or mental health care users is a global challenge, this behavior is reported to be higher in South Africa. The Manguzi District Hospital in rural Kwa-Zulu Natal Province, South Africa, experiences high rates of treatment default by psychiatric patients. The objective of this study was to determine the reasons for treatment defaulting at Manguzi Hospital, KwaZulu-Natal Province, South Africa. An explorative qualitative design, using in-depth interviews, was conducted with mental health care users who had defaulted out-patient psychiatric treatment. Twenty-one mental health care users were interviewed before data saturation was reached. Nvivo version 11 was used to analyze the qualitative data. Major themes that emerged confirmed that social factors are key contributions to treatment defaulting, and these include denial of the mental disorders; belief that they are cured; lack of, or disintegration of social support; preference for traditional medicine; and flaws in the health care system. Social determinants of treatment outcomes for mental disorders require tailor-made support systems for patients in these rural communities, which include increase in health literacy and attention to the cultural understanding of mental disorders.

Relapse among MHCUs after a Short-Term Admission in an Acute Psychiatric Unit: Primary Caregivers’ Perspective

“…The findings agree with [24], who found that family members often struggle to persuade MHCUs to take treatment as they have difficulty acknowledging that they are mentally ill. This was supported by a study conducted by [2], which highlighted that denial of mental health conditions and perceived cure is very much common among MHCUs who have poor health literacy regarding their condition, hence it results in poor health outcomes. Supervision of MHCUs is of particular concern because it affects the rate of early relapse after discharge from the hospital.…”

“…Several factors were observed by the primary caregivers as the main reasons for MHCUs to redevelop psychiatric symptoms after being stabilised in hospitalisation. Although several studies have investigated factors associated with the occurrence of psychiatric symptoms after discharge, few studies have examined whether misconception about self mental health conditions is the cause of relapse among MHCUs [1,2,7,23]. Denial and perceived cure by MHCUs are the major barriers to complying with treatment.…”

“…Mental illness in South Africa was found to be highest in the African region, with the highest prevalence of chronic mental disorders among mental healthcare users (MH-CUs) [1,2]. Many MHCUs are treated as voluntary or involuntary inpatients in the hospital setting before being discharged to a primary health care or home environment [3].…”

“…Despite all the challenges, South Africa has taken initiative to strengthen its mental health system, by improving the Mental Health Care Act 17 of 2002 [1,15] which proclaims that MHCUs can be treated in communities and homes and is called deinstitutionalization of mental healthcare program [1,2,15]. Many mental healthcare users require a substantial amount of help from primary caregivers.…”