This aspect of the care of the mentally ill has become very important because of the likely increase in the incidence of new cases as a consequence of economic recession. Some of the new cases may get very violent which could put the relatives in a difficult situation as they may not know the necessary steps to take. We have procedures like chanting incantations, prayers to cast out the devils that have taken possession of the patient so that they can be disarmed. Exorcism as a preferred method cuts across Christianity, Islam and the African traditional religion especially for the violent ones. This also makes them more prone to inhuman interventions that can shorten their lives. Apart from prayers, some are starved and flogged to take the demons out. The practice of hospitalizing the mentally ill is a very old one usually called mad houses. These institutions were only a little better than prisons. The patients were chained to beds consisting of long boxes raised from the ground and filled with straw. Violent patients were restricted by the use of strait jackets where the patient is tied both legs and hands to an immobile chair and a nineteenth century crib specially designed to hold violent patient lying down. This description is interesting as it may depict some situation in present day Nigeria where the mentally ill patients are being held especially in some of our traditional and spiritual healer’s home. There are specific professional criteria that orthodox mental health practitioners follow in managing violent patients for the safety of the patients, caregivers and the public. In developed countries where community mental health practice is well developed; this effort is directed to the community mental health workers. However in Nigeria, the general public needs to be aware that the violent mentally ill should be handled cautiously with the aim of protecting them, caregivers and the public from harm.
There are certain signs of possible violence such as unnecessary anger, refusal to take instructions, argumentativeness, hoarding dangerous weapons with threats of having certain individuals, disturbed sleep pattern with restlessness. It is advisable to seek help from medical practitioners on how the patients can be safely brought to the hospital for care. When this is not immediately available; some individuals use the Nigeria police force officers who can at least use the hand cuffs safely. The principle of the hand cuff is demobilization when the balance is affected and extra hands involved. The use of chains and ropes should be totally discouraged because there are reports of associated damage to the use of limbs. Wounds arising from holding patients down with chains often get infected and responsible for the death of most patients. Some untrained individuals also administer some drugs and concoctions to put the patient to sleep which may eventually kill the patient. The value of the synergy between the orthodox medical practice and traditional, spiritual approach is largely in the management of the violent patient. Most spiritual and traditional health workers view the violence and aggression as due to spirit possession hence the use of beating, iron chains, starvation, and some concoctions that often contribute to the death of such patients. Even the public manhandling of such patients emanate from using this wrong concept instead of professional, safe handling of these violent patients for care.
Every community has a health worker that could be contacted when a patient is deemed potentially violent. Dangerous materials like knife, hammer, cutlass, forks and others should be taken away from the place where a perceived violent patient is staying. A car is preferred to a bicycle or motorcycle to avoid accidents and even in the car, the patient should be held by two persons at the back seat. It is usually safer, cheaper and more rewarding when taken to the orthodox medical practitioners where appropriate attention or referral can be done.
Dr Adeoye Oyewole
adeoyewole2000@yahoo.com
+2348034905808(Whatsapp only)
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