Abstract
BackgroundIn many parts of South Africa there is little support for people with psychosocial disability caused by schizophrenia, beyond provision of psychotropic medications. Appropriate community-based psychosocial rehabilitation interventions are a crucial element of mental health service development.ObjectivesThis study aimed to use an explanatory model of illness framework to document experiences of illness, disability and recovery amongst service users with schizophrenia and their caregivers in a poorly resourced area in the North West Province. Data were used to provide recommendations for a contextually appropriate non-specialist facilitated group psychosocial rehabilitation intervention.MethodEighteen in-depth individual interviews were conducted: nine with schizophrenia service users and nine with caregivers. Interviews were conducted by two trained field researchers; both clinical psychologists fluent in the first language of participants. All interviews were recorded, translated and transcribed. Data were thematically analysed using NVivo 9.ResultsParticipants linked the illness to witchcraft, poverty and stress. Family conflict was recognised in the course of the illness, causing stress and challenges for emotional well-being. Knowledge of diagnosis and biomedical treatment was minimal. Key factors recognised by service users as promoting recovery were the ability to work, and the support of traditional healers and religious structures.ConclusionBased on the findings of this study, a group psychosocial rehabilitation intervention emerged as a recommendation, with the incorporation of psycho-education, adherence support, coping skills, and opportunities for income generation and productive activity. The importance of also enlisting the support of religious leaders and traditional healers in supporting recovery is emphasised.
Highlights
Schizophrenia can be a chronic, highly disabling mental illness
In the absence of nationally representative epidemiological studies, annual schizophrenia prevalence has been estimated at 1% in one South African province (Western Cape) (Kleintjes et al 2006)
This study aimed to document experiences and perceptions of illness, disability and recovery amongst service users with schizophrenia and caregivers, with the aim of informing a contextually appropriate community-based psychosocial intervention that could be facilitated by non-specialists within a resource-constrained setting
Summary
Schizophrenia can be a chronic, highly disabling mental illness. In the absence of nationally representative epidemiological studies, annual schizophrenia prevalence has been estimated at 1% in one South African province (Western Cape) (Kleintjes et al 2006). Psychosocial rehabilitation (PSR) helps people with schizophrenia on the journey of recovery by helping them gain skills and access resources that improve their capacity to live fulfilling and productive lives (Anthony & Farkas 2009). In many parts of South Africa there is, little support beyond provision of psychotropic medications, which are relatively widely available within primary health services (Lund et al 2010). In many parts of South Africa there is little support for people with psychosocial disability caused by schizophrenia, beyond provision of psychotropic medications. Appropriate community-based psychosocial rehabilitation interventions are a crucial element of mental health service development
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