RESUMEN
Background: Studies in the past have shown the effect of mental illness on marriage in persons with severe mental illnesses (SMIs). Primary care and family physicians have a major role in addressing marriage-associated dilemmas in their life. Methods: The literature search was conducted from databases such as PubMed, ProQuest, EBSCO, Scopus, and Google Scholar for understanding the context and the problem in-depth for bringing out the narrative-review based framework for addressing the dilemmas. Results: Marriage rates in persons with SMI are high in Eastern countries. Marriage in persons with SMI enhances social support and prevents the stigma of being unmarried. Disability, unemployment, stigma, and disclosure-related issues are barriers to getting desirable alliances. Evidence based interventions are available to reduce the associated distress to an extent. Conclusion: Published peer-reviewed literature has pointed out that marriage plays a significant role in the life of persons with SMI and their families, especially in Asian countries where marriage is an important social institution. It can have a positive impact or can lead to relapse, marital conflicts, and divorce based on contextual and clinical factors. Hence, there is a need to come up with tailor-made interventions to address marriage-related expectations in persons with SMI.
RESUMEN
BACKGROUND: Treatment gap causes significant loss to individuals, families, societies and the nation. Treatment adherence enhancement is a major challenge in psychiatric disorders. Globally, the community mental health services are obligated to minimize the treatment and adherence gap. In recent years' retrospective studies are gaining importance to measure the trend of mental health service utilization, cost effectiveness, resources allocation and similar aspects. AIM: To explore the treatment adherence pattern of persons with neuropsychiatric illness from a rural community mental health centre. METHOD: Five hundred and ninety-six medical records of persons with neuropsychiatric disorders who registered for outpatient treatment between 2015 and 2017 at Sakalawara Rural mental health centre of National Institute of Mental Health and Neuro Sciences, Bangalore, India, were reviewed to understand their adherence pattern. RESULTS: Out of 596 patients, 68 (11.4%) were referred to tertiary care mental health and District Mental Health Programme (DMHP) services. Out of the remaining 528 patients, 29.7% were regular to mental health services over a period of 12 months and above; majority of the patients (36.2%) dropped out of their treatment after their first contact and 34.1% discontinued their follow up visits over a period of first week to 12 months. CONCLUSION: Community based mental health centres too face challenges of and problems related to treatment non-adherence. Persons with neuropsychiatric disorders require continuity of care through regular home visits, out-reach services and innovative methods which will enhance treatment adherence.
Asunto(s)
Hospitales Psiquiátricos , Trastornos Mentales , Centros Comunitarios de Salud Mental , Humanos , India , Trastornos Mentales/terapia , Estudios Retrospectivos , Población Rural , Cumplimiento y Adherencia al TratamientoRESUMEN
Identification, enrollment, and retention in treatment are challenging processes in mental health care. The present paper highlights the challenges in tracing and reenrolling non-adherent persons with mental illness for treatment in a rural community mental health center. Unclear address, phone numbers not in use, relocation from the given address, no further contact details etc. are the barriers to trace and make the home visits. A detailed review of the medical record, having a network with the village informal health care workers and groups, utilizing peer group support, etc., are the facilitators for tracing the treatment non-adherent persons in the community.