Abstract
Although treatment default by psychiatric patients or mental health care users is a global challenge, this behavior is reported to be higher in South Africa. The Manguzi District Hospital in rural Kwa-Zulu Natal Province, South Africa, experiences high rates of treatment default by psychiatric patients. The objective of this study was to determine the reasons for treatment defaulting at Manguzi Hospital, KwaZulu-Natal Province, South Africa. An explorative qualitative design, using in-depth interviews, was conducted with mental health care users who had defaulted out-patient psychiatric treatment. Twenty-one mental health care users were interviewed before data saturation was reached. Nvivo version 11 was used to analyze the qualitative data. Major themes that emerged confirmed that social factors are key contributions to treatment defaulting, and these include denial of the mental disorders; belief that they are cured; lack of, or disintegration of social support; preference for traditional medicine; and flaws in the health care system. Social determinants of treatment outcomes for mental disorders require tailor-made support systems for patients in these rural communities, which include increase in health literacy and attention to the cultural understanding of mental disorders.
Highlights
IntroductionAdherence to treatment is key to the successful management of chronic mental disorders and in the absence of this, relapse is frequent, which compromises the treatment outcomes [6]
This theme refers to the collapse of the social system which provided support to enable and encourage the patient to adhere to treatment appointments, which was followed by treatment default after the support failed or was withdrawn
This study found that the failing or withdrawal of social support leads to treatment defaulting, whether such support comes from friends, spouse, or relatives [19]
Summary
Adherence to treatment is key to the successful management of chronic mental disorders and in the absence of this, relapse is frequent, which compromises the treatment outcomes [6]. Regular scheduled attendance at health facilities is necessary to enable treatment assessments because this is associated with positive treatment outcomes. Treatment defaulting often leads to relapse, which may need hospital re-admission to stabilize the patient before being discharged home as an out-patient. Many chronic mental disorders allow for patients to be treated at home, combined with periodic assessment of their condition and reissue of medication. A break in this process, which often results from treatment default, is a challenge in many health systems, and needs attention if the intended treatment outcomes are to be achieved
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