Perceptions and experiences associated with abscondment of service users with severe mental illnesses at Chainama Mental Hospital in Zambia

Shamayinda, Charles Mungenisa

Perceptions and experiences associated with abscondment of service users with severe mental illnesses at Chainama Mental Hospital in Zambia

Thesis / Dissertation

2023

Publisher

University of Cape Town

Department

Centre for Public Mental Health

Faculty

Faculty of Health Sciences

Abstract

Background: Research suggests that for some people living with severe mental illness, they have experiences that lead them to leave the hospital without permission. This affects service users adversely in terms of their mental and physical health, including an interruption to their treatment plans. Absconding can also create emotional distress such as fear, worry, and guilt among healthcare staff and family members. However, despite the serious consequences of abscondment, there are currently no studies available exploring the perceptions and experiences associated with abscondment of service users with severe mental illnesses in Zambia. Methods: The study was qualitative, exploratory, and descriptive in nature, using semi- structured, in-depth individual interviews with 20 participants. All interviews were audio-recorded with informed consent gained and took place in different wards, including male and female wards at the Chainama mental hospital. Service users recruited in the study were assessed as stable and competent to provide consent. Thematic analysis using the Nvivo 12 software package was employed to synthesise the findings. Data was thematically categorized, paying attention to prominent themes that addressed the study objectives while remaining open to new emerging themes in the data, and this procedure was repeated until no new themes appeared. Results: The main findings were: 1) routes and timing of absconding, such as jumping the fence, crawling through the ceiling board, and the main gate, often during meals and drug administration periods, which reduced nurses' and security officers' attentiveness; and 2) descriptions of the pressures that led them to abscond, including family responsibilities, boredom, fear of stigma, and in-patient violence. Most respondents attributed their absconding behaviours to the natural desire to provide for and be with their families and friends. They also complained about a lack of entertainment, which increased their boredom; 3) perception of hospital care, where the majority of respondents bemoaned the rundown hospital's physical infrastructure, describing it as being old, dilapidated, dirty, and generally unfit for human habitation, while others bemoaned the poor health worker-patient relationship and lack of service user involvement in their care as factors that motivated their desire for a hospital; and 4) experiences of absconding and forced return, where most service users expressed happiness after absconding and described their forced return as upsetting and disheartening.