11.2.4 Follow-up
Following your referral, the doctor at the higher health facility will examine the person with mental health problems, diagnose the nature of the illness and prescribe the appropriate treatment if necessary. After the treatment is initiated (Figure 11.3) it is essential to have follow-up visits to your clients and their family members to discuss how they are doing. Follow-up is important to achieve adherence to treatment and improve the overall outcome. If for any reason the patient discontinues the prescribed treatment, all your efforts and the efforts of the doctor and the family members will have been fruitless. Box 11.6 outlines some of the questions you should go through during the follow-up visits to a client who has been on prescribed medication.
Box 11.6 Questions to ask during follow-up
- Is the client taking their medicines regularly as prescribed?
- How much improvement has the client made?
- Has the client developed any side effects following the drug use?
- Has the client started working again?
- Has the client seen the doctor for follow-up and review?
Based on the information you collect during the follow-up visits, you may identify some continuing issues that need to be addressed. In the remainder of this section we will discuss how you can deal with some of the problems that are likely to arise during follow-up of clients who are taking medication.
Adverse effects of medication
Some of the people who take medication to treat their mental illnesses may experience unwanted effects (also known as adverse effects). Different types of medical drugs are used to treat different mental health problems, and some drugs may produce side effects that are unpleasant to the client. Some of these effects are mild, in which case you can reassure the patient; for example, when a client complains about dryness of the mouth, light-headedness or constipation, reassure them that it is temporary. Dryness of the mouth can be helped by taking more water. However, severe unwanted effects, such as unclear speech, walking unsteadily like a drunken person, stiffness of the limbs, or twitching of the tongue, mouth, neck, hands or legs can also occur in some people. A patient may also experience drooling of saliva or drowsiness. If any of these side effects occur you should refer the patient to the doctor immediately. Any necessary changes in the drug dosage will be carried out by the doctor.
When a person is very agitated they are often put on a high dose of medication. As they get better over time a lower dose is needed to adjust to the new situation. Because of the risk of relapse (return of the previous symptoms of mental illness), the drugs should not be stopped suddenly. Similarly, people who are very sad and depressed and receive drugs to treat their problems should not suddenly stop their treatment when they start to feel better. Instead the drugs should be reduced gradually and then stopped, always in consultation with the doctor, to avoid relapse.
Making sure your client takes their medication
For a very ill or unmanageable person, one member of the household should be made responsible to make sure that the patient takes their medication. A neighbour or any other individual in the village who is close to the patient could also be given this responsibility. If the family is taking less interest in treating the person with mental illness, or if the family mainly has faith in traditional cultural methods of treatments talk to them repeatedly to convince them to (also) accept modern treatments for the patient. Geographical distance, financial difficulties and absence of a family member to accompany the patient to the health centre can also be reasons for not starting or continuing medication. You can solve these problems by mobilising other help, such as another person from the same village. In some cases, you could collect the drugs from the doctor yourself and deliver them to your client directly.
A person with mental health problems who shows improvement over time is the best example for others. Use these examples to demonstrate the value of modern treatment to other people with mental health problems and to the people in your community in general.
11.2.3 Referral