Table 2 Summary of barriers experienced by people with SMD
| Â | Engaged | Disengaged | Non-Engaged |
|---|---|---|---|
Poverty | Difficulty to maintain ongoing access to treatment (not being able to cover cost of treatment) | Difficulty to maintain ongoing access to treatment | Inability to initiate treatment due to lack of money for direct and indirect costs of treatment |
Difficulty to obtain poverty certificate | Difficulty to obtain poverty certificate | Lack of social support (inability to reciprocate) | |
The pressure to maintain dignity | |||
Concealing poverty | |||
Medication-related barriers | Unreliable medication supplies | The belief that holy water and modern medication should be mutually exclusive | Â |
Medication side-effects | Intolerable medication side-effects | ||
Lack of some medications | |||
Ineffective medications | |||
Long-term care | Medication-side-effects from prolonged use | Stigma of long-term engagement with care | Presence of other co-morbid illnesses |
Declining social support over years | Looking for cure | Having physical disability | |
Presence of other co-morbid illnesses | Low personal autonomy | Having severe functional impairment | |
Presence of other co-morbid illnesses | |||
The nature of SMD | The challenge from co-morbid alcohol use | The challenge from co-morbid alcohol use | The challenge from co-morbid alcohol use |
Wish to discontinue treatment to use alcohol (although engaged) | Lack of help for families when service users are uncooperative | Severity of the illness | |
Spontaneous improvement | Premature discontinuation of medication to use alcohol | Not wanting treatment | |
Violence towards others |