How To Handle A Violent Mentally -Ill Patient

This is one of the most important, yet neglected aspects in the care of the mentally ill. There are countless approaches in handling the violent mentally ill emanating from faulty paradigms. We have procedures like chanting incantations, prayers to cast out the devils that have taken possession of the patient. Exorcism as a practice of driving out evil spirits from the violent mentally ill 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. In the medieval times, the human body was viewed as the container of the eternal soul, which provided the link between bodily therapies and healing of mental illness. Apart from prayers, some were starved and flogged to harass the devil within. Trephining was an ancient practice based on the belief that mental illness was caused by the evil spirit lodged in the head and that they would be able to escape if a hole were cut in the skulls of the possessed person. The era of witch-hunt was characterised by accusing the mentally ill of eating children, staging sexual orgies and other violent behaviours. It is estimated that from the middle of the 15th century to the end of the 17th, about 100,000 people were executed as witches. The practice of hospitalising the mentally ill is a very old one, usually called madhouses. These institutions were only a little better than prisons. Allderidge describes the conditions in one English madhouse around 1815 this way: ‘Part of the accommodation consisted of six cells about 9×5 inches wide, opening to a passage which, in turn, looked out on to pigsty and dung- heap. The walls were unplastered, damp greenstone; there was no light or ventilation except when the cell doors were opened; the cells were floored only with bare earth. “The patients were chained to beds consisting of long boxes raised from the ground and filled with straw. “Of the 14 male patients, only one was not confined in irons. In London’s Bethlehem hospital, patients lay holding in chains while the curious public bought tickets to see them ‘perform’. “In other hospitals, patients were chained, caged, starved, preyed upon by rats, left for years lying naked in their own excrements and displayed in their misery for the amusement of the public. “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 19th 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. 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 harming 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 policemen who can, at least, use the handcuffs safely. The principle of the handcuff is demobilisation 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 setback to the synergy between the orthodox medical practice and traditional, spiritual approach is largely in the management of the violent patient. Most spiritual and traditional 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. Source:punch