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

Laura Asher, Abebaw Fekadu, Solomon Teferra, Mary De Silva, Soumitra Pathare, Charlotte Hanlon, Laura Asher, Abebaw Fekadu, Solomon Teferra, Mary De Silva, Soumitra Pathare, Charlotte Hanlon

Abstract

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.

Keywords: Community mental health services; Ethiopia; Human rights; Mental disorders; Physical restraint; Schizophrenia.

Conflict of interest statement

Authors’ information

Not applicable.

Ethics approval and consent to participate

Ethical approval was obtained from the Addis Ababa University College of Health Sciences Institutional Review Board (reference 039/13/PSY) and from the London School of Hygiene and Tropical Medicine Research Ethics Committee (reference 6408). Written informed consent, or a witnessed thumbprint for those who were illiterate, was obtained from all study participants. Prior to conducting the interviews with people with mental illness, capacity to consent to participation in the study was evaluated by a psychiatrist.

Consent for publication

Consent for publication was obtained from all participants.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Conceptual model of drivers and consequences of restraint

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