Medication challenges for patients with severe mental illness: experience and views of patients, caregivers and mental health care workers in Dar es Salaam, Tanzania

Abstract

BackgroundManagement of patients with mental disorders is inadequate in the majority of low and middle income countries. The main treatment modality for patients with severe mental disorders in these countries is mainly pharmacological approach. Patients face many challenges in meeting medication needs. In this context, high percentages of individuals who have severe mental disorders are not treated. Regular and adequate supplies of appropriate, safe and affordable medications are some of the important aspects required for provision of quality mental health services. Psychotropic medications are an important component of holistic care that provides treatment options for those suffering from mental illnesses. In Tanzania, mental health services face many challenges including inadequate mental health care providers, infrastructure, and medication supply. Relapse is a common problem among patients attending mental health facilities. This study is aimed at exploring views and experiences of patients, caregivers and mental health care providers on the psychotropic medication in Dar es Salaam, TanzaniaMethodsA qualitative study was conducted, involving two focus group discussions with seven and nine caregivers in each group. Eleven in-depth interviews with four patients and seven mental health care providers at Temeke Municipality, Dar es Salaam, were conducted. Convenient sampling procedure was used to select participants for the study. Discussion and interview guides were used during data collection. Interviews were audio-recorded in Kiswahili with all study participants. The recorded interviews were transcribed and qualitative content thematic analysis was used to analyze data after translation.ResultsFour themes were identified. These include attitudes of patients towards psychotropic medication, availability of psychotropic medications, financial concerns towards psychotropic medications, and coverage of free treatment policy.ConclusionThe availability and affordability of psychotropic medications to patients are big problems. This was partly attributed to insufficient funds to support the budget of health facilities and technical challenges contributed by both the health facilities and other stakeholders. To improve mental health services in the country, it is important to ensure adequate supply of psychotropic medications in the health facilities. Access to psychotropic medications is essential in addressing the public health problem of untreated mental illnesses. These findings call for the government and other stakeholders to increase funding for essential psychotropic medications.

Working conditions in a mental health institution: An exploratory study of professional nurses in Limpopo province, South Africa

“…Another study conducted in a Tanzanian psychiatric hospital reported that there was a lack of essential drugs for MHCUs. The unavailability of the essential psychotropic drugs was attributed to poor procurement practices and budget cuts because of competing demands, which delayed steady supply of the medication (Iseselo & Ambikile 2017 :16). Similar findings were reported in Ghanaian mental health institutions, where rampant corruption and bureaucracies delayed the constant supply of medication (Oppong et al 2016 :28).…”

Key Barriers to the Provision and Utilization of Mental Health Services in Low-and Middle-Income Countries: A Scope Study

“…Past experience of treatment adverse effects, especially in medications and technology-based treatments, plays a deterrent role against utilization of MH services. Lack of adequate knowledge on necessity of continuous treatment and its possible adverse effects is a great challenge which dissuades patients from receiving care and decreases adherence to treatments (45,46). It is suggested that increasing patients' knowledge about different treatment choices and their potential side effects would be beneficial (23).…”

“…This problem is pertaining to the lack of information about various types of treatment and place of services(17,18,25,44,49).B-4-Treatment-related barriersB-4-1-Fear of treatment side effects: results of the study showed that patients' concern about side effects of available treatments has negative impact on utilization of MH services. Treatment side effects are mainly related to medications and technology-based interventions(18,23,45,46,48,49). B-4-2-Long-term nature of treatment: findings of the study indicated that long-term period of MH treatments is another barrier to the utilization of MH services.…”

Biopsychopharmacosocial approach to assess impact of social distancing and isolation on mental health in older adults

“…anti-psychotic medication, mood stabilisers). The implication of running out of these medications, for patients who rely on them to maintain psychiatric functioning is clear and has the potential to be a significant stressor for an individual (Iseselo and Ambikile, 2017). Similarly, for patients established on longterm analgesic agents or life sustaining medication used in chronic disease management it is likely that the pharmacy supply chain will remain a great stressor during any episode of isolation.…”