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2017 ; 13
(1
): 47
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"I cry every day and night, I have my son tied in chains": physical restraint of
people with schizophrenia in community settings in Ethiopia
#MMPMID28693614
Asher L
; Fekadu A
; Teferra S
; De Silva M
; Pathare S
; Hanlon C
Global Health
2017[Jul]; 13
(1
): 47
PMID28693614
show ga
BACKGROUND: A 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.
METHODS: A 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. RESULTS: Most 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. CONCLUSION: Restraint 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.