GOVERNMENT has introduced a strict diet for psychiatric patients at the National Psychiatric Referral Hospital, aimed at curbing prevalence of non-communicable diseases (NCDs).
However, nurses at the hospital have raised alarm that this could have adverse effects for patients, and could lead to more cases of violent behaviour.
Their concern is that this revised diet for patients would most likely lead to an increase in violent confrontations, injuries and could potentially lead to deaths within the institution.
The new diet was introduced as part of government’s efforts to reduce the prevalence of non-communicable diseases (NCDs) among psychiatric patients, amid concerns that many gain excessive weight after admission because they eat five meals a day while engaging in little or no physical activity.
While the nurses acknowledge the importance of tackling NCDs, they argue that the policy fails to consider the unique needs of psychiatric patients, many of whom take medication that significantly increases their appetite.
“Our concern is that patients have fought before and some have died. In one incident, a patient who died was found to have suffered a head injury,” the nurses said.
They explained that healthcare workers are often required to account for how such injuries occur, even though fights can break out within seconds.
According to the nurses, violence has become more pronounced since the reduced food portions were introduced. They said healthcare workers had observed a growing trend of patients with intellectual disabilities who naturally eat slowly, having their meals snatched by other patients with stronger appetites who finish eating quickly before forcefully taking food from others.
“This pattern has been reported to hospital authorities because we fear it could have fatal consequences,” they said.
The nurses said the incidents occur even in the presence of healthcare workers because everything happens so quickly that there is often little opportunity to intervene.
They noted that the situation particularly disadvantages intellectually disabled patients, who cannot be separated from other patients because of limited space at the hospital. Each ward has only two secure rooms reserved for newly admitted patients who are still violent.
Patients with intellectual disabilities cannot be confined because they are generally not violent, while those grabbing food also cannot be isolated because their behaviour is driven by hunger rather than aggression.
“The new diet has dangerous repercussions for our patients. The only ones who are better off are those whose families regularly visit and bring them food,” the nurses said.
They further questioned government’s conclusion that patients develop NCDs while admitted to the institution. Although they acknowledged that some patients do develop such conditions during their stay, they argued that no proper baseline assessment was conducted before the new programme was introduced.
“When patients arrive, especially those who are violent, they are not immediately screened for these diseases. They are only tested after they have stabilised. Simply finding an illness after admission does not mean it developed here or that our previous diet caused it,” they said.
The nurses also criticised the implementation of the programme, saying it began as a pilot implementation about a year ago, but they were never provided with its findings.
“We waited for the pilot implementation results but received no feedback. Instead, we were simply informed that this would become the new diet because other hospitals were implementing similar reduced portions,” the nurses said.
They maintained that psychiatric hospitals cannot be compared with general hospitals because psychiatric medication often stimulates appetite, while many patients are admitted underweight and require adequate nutrition to recover physically.
“The diet is not working for our patients. Many are taking longer to recover physically, while some who were admitted underweight have still not improved,” they said.
The nurses said the hospital had always monitored patients’ weight and, where medication contributed to excessive weight gain, doctors would change the medication to better manage the condition.
They further alleged that the reduced diet appeared to be more about cutting government expenditure than improving patient health.
“What we think is that government is trying to cut expenditure on patients’ food, but it will be at the expense of our patients. This new diet will increase injuries and possibly deaths within the institution,” they said.
The nurses also criticised the absence of baseline data collection and the lack of communication on the outcomes of the pilot, saying these shortcomings make it impossible to determine whether the new dietary programme was achieving its intended objectives.
