Table 3 Factors perceived to increase the likelihood of exposure to traumatic events

Homelessness

Descriptions of or concerns about living without shelter

“R: I will take care of her until I die if I can. If I can’t, I would just let her go to the streets. I: Where would she go when you leave her? R: She would go on the street talking to random people. She would greet people she does not even know and talk to them haphazardly. She may suggest to go with them. She is a typical crazy woman except we kept her at home this far.”—Caregiver #5, Daughter of a woman living with SMI

“I: Have you ever been homeless? R: I had an experience of homelessness when I was young. That was so many years ago. I sometimes feel like that was what caused me the mental illness.”—Person Living with SMI #1, Male

Wandering off

Descriptions of or concerns about leaving home without notice to family or friends

“I: Is the medical treatment good for ****? Is the medicine good? R: Yes. It had helped him recover. I: What changes did you see after he started taking the medicine? What are some of the changes? R: He had recovered very much. But like I told you, I stopped it. I: OK. What are some of the changes you saw? R: Before, he disappeared in the bus station a lot of times. He went up to Kella He went to Kella on foot and someone brought him to me. He has also went to Awash many times, he had disappeared and I have seen many troubles… because his mind is not right. I: Now since he started the medicine R: He is fine. He sits at home. He does not go anywhere else.”—Caregiver #9, Mother of a man living with SMI

“R: I brought her here recently and she had an injection. I paid 150 birr [$6.70 USD] then we had a relief for 5 days. She was so calm. I don’t know, maybe the medication made her feel tired. We were so happy and thanked God. But now she started the urge to go again. She just wants to go somewhere. When she wants to go wandering around, she does not know even that she has to come home in the evenings.”—Caregiver #5, Daughter of a woman living with SMI

Aggression by a person with SMI

Descriptions of or concerns about a person with SMI being violent or aggressive to others

“R: In addition to money, I also need someone who can help me handle him when he is ill. Handling him all by myself is not easy. He cooperates when he is better but sometimes managing him gets really tough. He does not sit at home stable. That was how my mother left him. He sometimes tries to beat people. He may try to slaughter someone. He does not try to attack me but he was very violent towards my brother.”—Caregiver #15, Child of a man living with SMI

“I: Does he try to harm others or break things? R: Previously he used to break things and beat people. He is not aggressive anymore. I: So why did you have to lock him in? R: We do not keep him in a padlock. We just close the door from outside. He could have gone outside if he wants it but he sleeps mostly. There are no people coming to visit him. He used to insult people when we leave the window open but he is quiet these days. He is tired mostly. He may have other health problems we do not know. We just think of his mental illness but I suspect that he may have another illness.” Caregiver #6, Sister of a man living with SMI

“I: How do you see the treatment in general? R: It is good. If it wasn’t for the tablets, I wouldn’t have been able to function. I would have entered into fights with people when they say nasty things to me. The medication adds patience to people.”—Person living SMI #4, Female

“I: Is he violent? R: He used to be very violent. Now he is calm. The only time he gets violent now is if we try to have him treated, wash his body or change his clothes. His body has layers of stain but we can’t do anything about it. We are just here to sit and observe.”—Caregiver #14, Wife of a man living with SMI

Psychiatric Illness

Descriptions of or concerns about psychiatric symptoms

“R: It is only mental illness. The illness made him talkative. He leaves the house during the dark and wanders around. He talks aimlessly. He is aggressive at times and doesn’t listen to us at all. He walks around talking nonsense. He doesn’t listen to us. I: How long has it been? R: It is about four years now. R2: It has been long. He talks through the night and keeps on talking during the day. The illness makes him wander around a lot for no reason. He talks to everyone on the street.”—Caregiver #1, Mother of a male living with SMI

“R: It is a difficult situation to explain. It first started when I was drinking from river water directly just like the animals. After the illness, some weird thoughts crept into my mind. I started to think like I am related to Mengistu Hailemariam or Meles Zenawi. I started to feel like I am Jesus Christ. I felt like I am God. I became quite irritable and started saying rude words to people. I try to make peace with them when my illness goes away. I insult people when I am ill. I don’t remember some of the issues I said to people. the treatment has helped me a lot. I tried the holy water but it did not heal me. It might have worked for other people but that wasn’t the case for me.”—Caregiver #12, Father of a man living with SMI (secondarily a person living with SMI)

“R: When it first started, he said there is something burning in his head. He said his mind is burning and started crying non-stop. Then we took him to Meskelo district where there is treatment. We put him in chain and took him there via Zway because it wasn’t accessible from our side.”—Caregiver #14, Wife of a man living with SMI

Alcohol or drug misuse

Descriptions of or concerns about alcohol misuse

“R: He will stop taking the medicine saying he is fine and wants to go to social settings with other people. Then he goes out and drinks with other people. I: Would being on medication prevent him from being in social settings? R: What do I know? I: Or are majorities of his friends those who like alcohol? R: His friends won’t even pick him up say he fell. They don’t want him to be well and healthy. They want him to be laughed at or to die. They want him to be left on the street. I have kept quiet not to fight with all his friends. I just receive him whether he is drunk and brought to home by other people or he walks himself. He was not well even last night. I was trying to remind you about the illness when I noticed some symptoms but he is fooling me. I just have to be tolerant. What more can I do? I: So in your opinion Mr ****’s problem is mainly alcohol? R: Yes.”—Caregiver #16, Wife of a man living with SMI

“R: Yes. We do not drink coffee with our neighbors. Nobody comes to our house because they are scared of him. For example, the woman he had beaten the other day has never returned to our house. We do not go our neighbors’ house either because he might follow us if we go to them. For some unavoidable social gatherings, we have to wait until he goes somewhere so we can go to them for a brief stay or one of us has to stay behind with him. He would go to people’s houses and sit outside demanding for food and drinks. He would go and ask for arakie [a local spirit drink] if he smells people making it. He would use force to get what he wants. We feel ashamed of his deeds but he does not feel that way.”—Caregiver #8, Father of a man living with SMI

R: “My children do not want to come close to him because he beats them. Other people also do not want to help me because he might get violent towards them. Currently, there is someone who is holding his both hands behind so we can cut his clothes and dress him up with another clean cloth. From all our neighbors, there is only one person who is helping me with that. We do not have anyone else as people are scared of him. Even when he beats me and when I cry out for help, nobody would come to rescue me. My children would run away to protect themselves. He would hit people with anything he could find. He will throw things on us. He would go even crazy when he chews khat. He wants to slaughter people when he chews khat. People give him khat knowing that he is mentally ill. He would be violent towards us every day he chews khat.”—Caregiver #14, Wife of a man living with SMI

“I: Does he drink? R: He does. He chases me out of the house when he drinks alcohol. He insults me really bad. He drinks mostly around paydays. Around that time, he chases people on the street and throws stones at people. His colleagues tell me to advise him not to drink but he does not listen to me. I meet his colleagues when I go to receive his salary. The office decided to pay me (the custody 100 birr) instead because he is not well and not giving me. They threaten me that they will stop his salary because he is bothering them at work. My mother used to receive his payment before but now I go to receive his payment. They do not want to talk to him. They pass that responsibility to me instead. That is worrisome for me. I try to sit him down and talk to him but he said he would even stop the job. I tried to tell him that he needs the money. He would listen to me and apologize when he is feeling better.”—Caregiver #15, Child of a man living with SMI

Public nudity

Descriptions of or concerns about being naked in public

“I: Who was helping you around the time you heard that your father walked naked? R: There are two men in town. They came to school and called me from class to tell me that my father tore away his clothes and is walking naked. I was so disturbed when I saw him. We brought him home and they clothed him.”—Caregiver #15, Child of a man living with SMI

Medication non-adherence

Descriptions of or concerns about medication non-adherence

“It is a known fact. The illness is going to come back. I will bring him medications then. You know we see the difference in just two days. I am willing to get him his refills tomorrow but he won’t take it. He is not a child. I can’t beat him to take his medication. I can only advise him.”—Caregiver #16, Wife of a man living with SMI

“It has been four months since he stopped taking the medication. He stopped taking the tablets because he said the tablets are making him weak. He started fighting with his mother. He has never been anywhere else after he started the treatment.”—Caregiver #12, Father of a man living with SMI (secondarily a person living with SMI)

“R: Once he provided all information correct. The doctor asked him different questions and he was correct in answering. Then the doctor prescribed him medications. He returned to his uncle’s house with tablets. He was chained there. He felt better with the tablets. I stayed with him for five years. Two of my children were born after he got mentally ill. Later, he refused to see me. He chased me out. I went to my mother’s house with my children and stayed there for nine years. Caring for him was tiresome for me. All his brothers are also tired. We took him to different holy water places. There is nothing left that we could do. It has been seven years since we stopped everything we do to help him. He has not been on medication ever since. He refused all medications. Recently we heard that there is treatment at the health center. We rented a cart to get him there. We had to pay 80 birr. My two sons were trying to help him board. He beat them both and escaped. My son passed out and that shifted our focus.”—Caregiver #14, Wife of a man living with SMI