At times, hallucinating patients will threaten to rape a health worker, while some actually beat up nurses.
“There's a patient who locked the door to one of the dorm rooms and said he wanted to sleep with the nurse that day,” a female nurse at Gilgil Level 4 Hospital in Nakuru county said.
“She lied to him that she would go get ready and then come back. He allowed her to leave. She was traumatised and she had to get psychological help,” the nurse said.
The nurse spoke to medics from Eldoret’s Moi Teaching and Referral Hospital who visited 14 mental health facilities in public hospitals to explore the safety-related incidents there.
Nearly all health workers in those units, mostly nurses, reported being insulted or beaten up by aggressive patients.
They also mentioned a recurring shortage of fast-acting psychotropic drugs that can quickly calm aggressive patients.
“There was a patient who was very aggressive. We had tried medication and they were not responding. He slapped the two nurses and they ran away,” a nurse in Nyeri said.
But some health workers said they also beat up patients.
A female nurse at Kakamega Level 5 Hospital said she was provoked when a young patient took her glasses and smashed them on the floor.
“So I was provoked and I felt that I should punish the patient. I took the patient in the strong room and gave him some beating. He is a student and I told him not to repeat such a thing again,” she said.
This study, led by Kamaru Edith and Robert Kiptoo of MTRH, is the first in Kenya to document safety incidents in mental health facilities in Kenya.
There are at least 13 Levels 4, 5 and 6 hospitals in Kenya offering mental health care and psychiatric services.
The MTRH medics said despite the incidents, mental health facilities should not be assumed to be dangerous places.
The incidents reported range from verbal threats, stalking, physical assault, sexual harassment and rape.
“These incidents have the potential to cause both physical and psychological harm to patients and healthcare workers,” the MTRH authors said in their report published last Saturday by the 'BMC Health Services Research' journal.
They said the incidents may contribute to low morale among staff, high rates of sick leave and high staff turnover and leave staff. They may contribute to negative feelings such as guilt, self-blame and insecurity in dealing with patients or even feelings of failure in their professional work.
The qualitative descriptive study was carried out between December 2019 and February 2020. It included 28 mental health staff across 14 mental health units in 13 hospitals.
“There were 359 healthcare providers in the 13 facilities assessed. The majority of them were nurses (56 per cent),” the authors said.
Other authors are MRTH CEO Wilson Aruasa, Florence Jaguga, Felicita Wangechi, Saina Chelagat and Francis Ogaro.
Their report is titled 'Incidents related to safety in mental health facilities in Kenya'.
Healthcare workers attributed the safety incidents to poor infrastructure, limited human resources and inadequate medication to calm down agitated patients.
They suggested improved surveillance systems, hiring more specialised healthcare workers and providing adequate supplies such as short-acting injectable psychotropics.
According to the World Health Organization, the Kenyan situation is not isolated because as much as 38 per cent of health workers globally suffer physical violence at some point in their careers. Most violence is perpetrated by patients and visitors.
“Violence against health workers is unacceptable. It has not only a negative impact on the psychological and physical well-being of health care staff, but also affects their job motivation,” WHO says.
(Edited b V. Graham)
