Burden of Care in Mental Health Conditions

This time two years ago, I was in the hospital.

I had just suffered a mental breakdown and was on admission. I had been separated from my child and my husband had to shuttle between the hospital and the house daily. I recall he slept at the hospital every night for the three weeks+ I was on admission for.

During this period, I hallucinated, was violent, cursed and basically acted out. I recall being out of touch with reality, being so afraid and alone. I totally forgot that I had a daughter and part of what began my healing process was when my family agreed to bring her in every night to see me.

I am indeed thankful for my care-givers especially my husband. Everyone made sure I was okay always. There was a period I was addicted to playing the Game Ludo – all the nurses had to take turns to play with me during the day as I was always bored and restless!

It indeed isn’t easy being a patient neither is it easy being a care-giver. It takes a lot of commitment and love to keep at it.

Below is a write up by a Medical Officer at Happy Family Hospital, I hope it encourages you today.

***

Ifeanyi is a 31 year old male who has been visiting our hospital for the past 4 years. He was only 27 years old when he first visited. Before then, he was an Economics student in one of the tertiary institutions and he combined this with a part-time job to earn some income.

It all started when on a particular day he suddenly became agitated.

He ran out of his home singing at the top of his voice. It was impossible for him to be calmed down. He claimed he had been talking to Jesus and had a very important message to pass to his school’s management.

He was eventually admitted to the hospital and went home after 6 weeks of being on admission. A working diagnosis of acute psychotic illness was made on his first visit. He returned to the hospital 8 months later with a similar episode. After then his diagnosis was upgraded to bipolar affective disorder.

He has had many episodes of relapses and remissions since then.

All illness generally exerts a devastating effect on both the sick person and his immediate support system of care-givers. We cannot prevent falling ill sometimes. Still, nobody ever wishes to fall ill at any particular point in time. Also, nobody can accurately predict when he or she will be ill or otherwise. So it is something absolutely left to chance. When illness does happen, it is always expected that it resolves in a definite period of time. This enables the sick person to go back to his former role in the family or society.

Different illness conditions have different expected periods of resolution.

For instance, when someone is down with malaria, it is expected that after a few days of medical treatment, he should be up and doing. Let us look at other illnesses that can take quite a longer period of time to resolve – say, a fracture of the thigh bone. In such a case, the patient is restricted to the sick bed for say a period of weeks to months. But the good news is that after this period, he eventually gets up and gets about. He can be adjudged to have recovered.

Now let us look at other health conditions which unlike as in the two examples cited above, do not resolve in definite time frames.

Medically, these conditions are described as chronic health conditions. Let us take for example, two popularly known health conditions – diabetes and hypertension. In these conditions, the patient does not get to go free from the illness, but can only manage symptoms and hope that complications do not arise

Most mental health conditions also fall into these category of chronic health conditions. Schizophrenia for instance is not a condition that can be said to have resolved after any defined period of treatment.

The aim of management is to keep patient symptoms free and functional for greater part of his days as much as is possible. Same applies to bipolar disorders and personality disorders. In both situations, the sickness more or less remains with the patient for life. There may or may not be intervals of stable state after which the patient gets ill again.

Caring for people with chronic health conditions especially mental illness places enormous stress on the patient and the care-givers. This stress is both physical, psychological and financial. The care-givers for the purpose of this discourse is broadened to include both the patient relatives and members of the health care team seeing the patient.

The patient after long periods of multiple hospital admissions gets tired of going in and out of hospitals. Such patients easily fall prey to quacks and charlatans who promise them easy solutions to their problems that are not attainable. Some other times, they are also tempted to turn to religious bodies for solution to their problems since it seems to them that orthodox medicine has not been able to resolve their problem. Again, such patients are the ones that are most likely to stop taking prescribed drugs as they feel that the ones they have taken so far has not been helpful. Besides, prolonged periods of taking most drugs usually predisposes to unpalatable side effects.

The patient relatives also get demoralized and frustrated after prolonged periods of providing care, most times without any obvious dramatic results. At such times, care-giver apathy may surface. They tend to rationalize that having done their best for the ill person, maybe it is just best to leave him or her to her fate. Remember also, that the illness also always is a major drain on the finances of the patient relatives who in most cases are the ones footing the medical bills.

The medical personnels who are also part of the care-giving team are not immune to this process of care-giver apathy. The psychological burden of seeing a patient repeatedly and knowing that you have probably offered the best that you can for his condition with little or no changes in the status quo cannot be described in words. Patient and patient’s relatives drop the burden of the illness and their frustrations with it on your shoulders at every clinic visit. They justifiably expect you to wave a magic wand and make their problems disappear. From a doctor’s perspective, it is frustrating that we do not have all the answers yet, and sometimes the very best we can do for our patients is only but very little.

In summary, it is important that both the patient and the care-givers understand the prolonged nature of chronic health conditions right from the outset when treatment is commenced. There are always some psychological and financial burdens attached to chronic illnesses, and the aim of treatment is not always with intention to achieve cure, but rather to keep patient stable and functional. Understanding this will enable all units in the team to work towards a common goal and to encourage each other when the need arises. A chronic mental health condition does not warrant a total write off or abandonment of the ill individual.

Contributed by

Dr Anyim Nnamdi

Medical Officer (at Happy Family Hospital Ltd) with interest in Mental Health

www.happyfamilyhospital.com.ng

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6 thoughts on “Burden of Care in Mental Health Conditions

  1. MT says:

    Wow! 2 years..how time files, super glad you are so full of life, happy, funny and fun to be around. Thankful for all the great things God has done and is still doing in your life.

    Sincerely, going in and out of hospitals can be tiring, can doctors even take the patients through some emotional freedom techniques, at least to help manage relapsing and also encourage continued doctors visits. So it just does not stop at the doctor’s office.The patient can always remember the successful learning sessions etc..just saying

    btw,love the website look and feel 🙂

    Liked by 1 person

  2. Obi says:

    ‘It indeed isn’t easy being a patient neither is it easy being a care-giver. It takes a lot of commitment and love to keep at it’. what a Joy when a caregiver sees his patient get well. You guys are doing a great work @Happy family hospital.

    Liked by 1 person

  3. Linda says:

    Information is a very powerful tool in the healing process of every patient with a chronic disease. On their first visit to the hospital, they and their relatives should be properly informed about their health conditions and what to do to keep the patient stable and functional all through the days of his/her life. A nice write up! Thumbs up to the writer👍👍👍.

    Liked by 1 person

  4. obiora says:

    Insightful write up. Information determines who dies and who lives. This piece brings to bear the importance of information and its role in being able to manage expectations with respect to different illnesses.

    Like

  5. Davis Ngubor says:

    Caring for the chronically ill is very challenging; for the terminally ill is downright frustrating. But I think that it will help a great deal if we at our first contact with these patients we spend a lot of time and energy talking about the nature of the illness and adjusting the expectations of these patients and these relatives. We shld also encourage them to read about their illnesses. Nice write up Dr Anyim.

    Liked by 1 person

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