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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

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

Authors

LAURA ASHER LAURA.ASHER@NOTTINGHAM.AC.UK
Clinical Associate Professor

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.

Journal Article Type Article
Publication Date 2017-12
Journal Globalization and Health
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 13
Issue 1
Article Number 47
APA6 Citation Asher, L., Fekadu, A., Teferra, S., De Silva, M., Pathare, S., & Hanlon, C. (2017). “I cry every day and night, I have my son tied in chains”: physical restraint of people with schizophrenia in community settings in Ethiopia. Globalization and Health, 13(1), https://doi.org/10.1186/s12992-017-0273-1
DOI https://doi.org/10.1186/s12992-017-0273-1
Publisher URL https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-017-0273-1

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