Speaker
Description
Background: Patient abandonment in psychiatric wards is concerning, especially in resource-limited settings where the mental health workforce and bed capacity is inadequate. This results in congestion at the wards due to an increased number of discharge in patients, patient abscondment after long stays, staff burnout due to increased workload and a strain on the hospital budget. Contributing factors for patient abandonment include stigma surrounding mental illness; intensive caregiver burden and its effect on their quality of life; patients' impulsive, disorganized or disruptive behaviors that make caregiving challenging and their violent behavior compromising family safety; and socio-economic factors given the high cost of living and treatment costs. Systemic factors including lack of a well co-ordinated mental health care service in Kenya, and a community resource database threaten the success of re-integration efforts. Some of the patients lack identification documents, making home tracing and re-patriation challenging. This report thus highlights an emerging trend of patient abandonment at an acute psychiatric ward at a level 6 referral hospital in Kenya.
Objective: The broad objective is to highlight the challenge of patient abandonment, the management and home tracing of abandoned patients, re-integration back to the community and best practices and lessons learnt through the process.
Methods: Descriptive case reports done at Moi Teaching & Referral Hospital (MTRH). For inpatient management of patients with severe mental illness, MTRH has a psychiatric ward, a transitional skills training home, and an Alcohol and Drug Abuse Rehabilitation center with bed capacities of 80, 16 and 40 beds respectively. Outpatient services include the emergency mental health services and two outpatient clinics. Data was collected from patient records and supplemented from departmental case summaries of home tracing and repatriation.
Results: A summary of three patients who were abandoned by their families having given up hope of finding them. Two of the patients are male and had an average stay of seven years at the hospital while one is female and stayed for about one year. All were successfully reintegrated to the community after repatriation. Some of the interventions that worked included stay in the transitional home that provided structure and the services provided like skills training for economic empowerment, Illness Management and Recovery (IMR) for them to understand their illness, coping skills, and importance of medication; home tracing by social work team for re-integration; family psychoeducation and community sensitization at Barazas to reduce stigma and structured follow up post discharge for up to one year. Community focused strategies that worked included mentorship to nearby peripheral health facilities, and use of community resources like community health volunteers (CHVs).
Conclusion: Potential interventions for patient abandonment in psychiatric wards need to focus on community mental health as a possible solution. Transitional homes are beneficial in bridging the gap between psychiatric wards and community re-integration. A multi-sectoral approach is recommended to address this complex issue.
