Schizophrenia: How costly misunderstanding the nature of mental illness can be to a patient

Last month, The Associated Press, a news agency, reported that a North Carolina inmate with mental illness who died of thirst was held in solitary confinement for 35 days and cited twice for flooding his cell. Citing prison records, the wire said inmate Michael Anthony Kerr was found unresponsive in the back of a van March 12 after being driven three hours from Alexander Correctional Institution in Taylorsville to a mental hospital at Central Prison in Raleigh. An autopsy result, released earlier last week, says the 54-year-old inmate, who had schizophrenia, died of dehydration. The report also said he was receiving no treatment for the symptoms of his mental illness. Public records released to The Associated Press show Kerr was placed in ‘administrative segregation’ on February 5. The status means an inmate is confined to a solitary cell for such reasons as ‘to preserve order where other methods of control have failed.’ In the following weeks, records show Kerr was cited nine times by correctional officers for violating prison rules, including disobeying orders and ‘lock tampering.’ Inmates in the state prison system are often cited for lock tampering after repeatedly banging on the steel doors of their cells. On February 21 and again on February 24, records show Kerr was cited for intentionally flooding his cell. The following day, records show Kerr was moved to ‘disciplinary segregation,’ another form of solitary confinement employed as punishment that inmates commonly refer to as being in ‘The Hole.’ His condition was completely misunderstood by prison authorities. Throughout history, the disorder we now know as schizophrenia has been a source of bewilderment. Those suffering from the illness once were thought to be possessed by demons and were feared, tormented, exiled or locked up forever. “In spite of advances in the understanding of its causes, course and treatment, schizophrenia continues to confound both health professionals and the public,” says PsychCentral, an online mental health resource centre. “It is easier for the average person to cope with the idea of cancer than it is to understand the odd behavior, hallucinations or strange ideas of the person with schizophrenia.” As with many mental disorders, the causes of schizophrenia are poorly understood. Friends and family commonly are shocked, afraid or angry when they learn of the diagnosis. People often imagine a person with schizophrenia as being more violent or out-of-control than a person who has another kind of serious mental illness. But these kinds of prejudices and misperceptions can be readily corrected. “Expectations become more realistic as schizophrenia is better understood as a disorder that requires ongoing treatment. Demystification of the illness, along with recent insights from neuroscience and neuropsychology, gives new hope for finding more effective treatments for an illness that previously carried a grave prognosis,” says PsychCentral. Schizophrenia is characterised by a broad range of unusual behaviors that cause profound disruption in the lives of people suffering from the condition, as well as in the lives of the people around them. Schizophrenia strikes without regard to gender, race, social class or culture. Every October 10, the World Mental Health Day is observed, with the overall objective of raising awareness of mental health issues around the world and mobilising efforts in support of mental health. The Day provides an opportunity for all stakeholders working on mental health issues to talk about their work, and what more needs to be done to make mental health care a reality for people worldwide. The theme for this yeas is “Living with schizophrenia.” The focus of the World Health Organisation will be living a healthy life with schizophrenia. According to Jean Damascene Iyamuremye, the in-charge of mental healthcare development at Rwanda Biomedical Centre (RBC), an event to mark the day locally will be held in Musanze District, Northern Province. Iyamuremye says creating awareness about mental illness with be the dominant factor. Local statistics Statistics from Ndera neuro-psychiatric hospital show that the number of people consulting for mental illnesses increased by 26 per cent between 2012 and 2013. The data gathered from the hospital and its two affiliate clinics; Caraes-Butare and Ikizere Centre in Huye and Kicukiro districts, respectively, indicate that they increased from 39,069 in 2012 to 49,161 in 2013. Epilepsy and Schizophrenia were found to have the biggest occurrence, with 29.7 per cent and 19.6 per cent, respectively. Schizophrenia is a mental disorder often characterised by abnormal social behavior and failure to recognise what is real. Common symptoms include false beliefs, unclear or confused thinking, auditory hallucinations, reduced social engagement and emotional expression, and inactivity. Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain. The report from the hospital adds that mental illness cases were higher in adult females with 44 per cent, compared to 40 per cent in adult males, and 16 per cent in children. The conditions are commonest in the age bracket of 18 and 35. It adds that April of every year usually registers the biggest number of patients, courtesy of genocide related trauma, for instance the same month last year registered 5,137, a huge number compared to months like February the same year where only 2770patients were registered. The report, however, points out that mortality of mental patients reduced from 27 in 2012, to 24 last year. Did you know... The onset of schizophrenia in most people is a gradual deterioration that occurs in early adulthood -- usually in a persons early 20s. Loved ones and friends may spot early warning signs long before the primary symptoms of schizophrenia occur. During this initial pre-onset phase, a person may seem without goals in their life, becoming increasingly eccentric and unmotivated. They may isolate themselves and remove themselves from family situations and friends. They may stop engaging in other activities that they also used to enjoy, such as hobbies or volunteering. Warning signs include: • Social isolation and withdrawal • Irrational, bizarre or odd statements or beliefs • Increased paranoia • Becoming emotionless • Hostility or suspiciousness • Increasing reliance on drugs or alcohol (in an attempt to self-medicate) • Lack of motivation • Speaking in a strange manner unlike themselves • Inappropriate laughter • Insomnia or oversleeping • Deterioration in personal appearance and hygiene Efforts in place According to Jean Michel Iyamuremye, the director of nursing at Ndera neuro-psychiatric hospital, the hospital has been on an aggressive sensitisation campaign about mental illnesses. Iyamuremye said a team from the hospital makes periodic visits to different parts of the country, lecturing local leaders and the general population on potential causes, signs, symptoms and prevention measures of the ailments. The facility helps in grooming future mental health specialists. For instance, it provides internship to more than 300 students from various higher education institutions countrywide every year. Iyamuremye said they send experts to all the district hospitals at least twice a month to not only train local medics, but also identify existing challenges then help craft measures. At the national level, training of medical personnel and community based health workers has been intensified as far as identifying and handling mentally sick patients is concerned. For instance, 500 nurses in various health centres were trained last year, and over 15,000 community-based health workers between February and March. Challenges Iyamuremye said many patients at the hospital do not have known relatives, yet one is needed to give an account of a patient’s original behaviour so as to help with diagnosis. “Many of them are brought here by law enforcement officers after being picked from the streets. David Uwayezu, a psychiatrist with Spenna Clinic in Kimironko, cites stigma as a general challenge that mental patients face. There are only six psychiatrists countrywide and Ndera is the only one-stop centre for mental health.