Shrink's Views

ramblings of an unknown psychiatrist

“I will pay in full for I promised to sell my land”

Posted by Dheeraj Kattula on April 29, 2009

He was sick from Makara Sankranthi season. He muttered to himself and beat his wife black and blue. He shouted obscenites and village people avoided him. He was suspicious of people harming him, so he kept aloof. He suspected hisown  father to have a realtion with his wife. That was the reason that he was so irritated with his father and aggressive over his wife.

His beliefs overwhelmed him and he wanted to die. His father brought him one evening and he had to be given chemical restraints (pychiatric medicines in form of injections )before he could be admited. Injections are not painless. His backside was aching continuously after he recieved few shots. He understood that the hospital staffs are supportive. They give injections but also him give ice packs and comforting words. He started taking oral medicines.

He responded within a week. His hallucinations came down and his delusions were loosing their grip on him. He beacme very loving towards his wife and father too. He wanted to live, have children, educate them and do well. Nearly two weeks from admission, it was time to get discharged. His father wanted to pay ‘full’. We offer people to pay prospectively too. A poor family becomes much poorer following a hospital admission. When we asked again he said he now had cash, so it was no problem. I asked him, how he got that cash. I could then smell the handia, the local rice beer from his breath. He said he promised off to sell 6 ghunt land for Rs 6000/- . This was to pay a bill of Rs 1800/- !!! When we did not mind it being paid in installments without interest !!! One could suspect the balance amount would run down his throat within a couple of weeks as alcohol. I told him to cancel off the deal and pay whatever he could from his own reserved. He had about Rs 1000/-. Rest was to be paid over 8 months as Rs 100/- per month.

What is the possibility that this family with a schizophrenia patient would default? Minute. The whole purpose of admission was to remit the symptoms AND educate the family on drug compliance issues. Basically driving home the fact that He will do well as long as he takes medicines. Can’t you see how medicines have helped within the last few days? If he stops medicines, he will be back to the way he was. At that time these medicines may not work. We will have to then go for costlier medicines.If you want to stop medicines for financial resons and you do it, you would end up spending more!’

There is less chance for a patient to leave psychiatric services here and go anywhere else as the over all costs are cheaper and quality of services provided are better. Quality measured in the ‘time spent with patient’ and ‘time spent with family’.So there is less chance of losing to the competition.

Occupational rehabilitation is encouraged so patient becomes economically productive in ways such that in the long run cost of treatment is seen as an investment in generating income to the family.

I hope to see this patient back after 20 days from now. I do not want to see him as a psychotic in patient again i.e. I wish treat him in the OP for rest of his life. I know I can only wish…

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