Abstract
BackgroundGrowing interest in strategies regarding early intervention for psychosis has led to a parallel interest in understanding help-seeking behavior, especially in low- and middle-income countries (LMICs). Nevertheless, few LMIC studies have examined individuals with psychosis in non-urban, non-hospital settings. Using the perspective of formal and informal community service providers, we aimed to uncover descriptions of people with psychosis in a rural South African community and illuminate the potential complexities of their help-seeking journeys.MethodsWe conducted a qualitative study of 40 key informant interviews and seven focus groups with stakeholders (traditional leaders, traditional healers, religious leaders, health care nurses, heads of non-governmental organizations, schoolteachers, community caregivers) in a rural Zulu community (Vulindlela). Thematic analysis of the data was performed using the inductive analysis approach.ResultsInterviewees discussed 32 individuals with probable psychosis in their community and provided rich descriptions of their symptoms. A complex picture of help-seeking behavior, primarily involving informal mental health service providers, emerged. Over half of the reported cases had no contact with formal health services in the course of their help-seeking journey; while more than two-thirds never attended a hospital and only 1 in 8 accessed a psychiatric hospital.ConclusionsOur results highlight the important role of informal care providers in LMICs as well as the need for more research on mental illness and local providers in non-hospital contexts. Community stakeholders can contribute to a fuller understanding of these issues, thereby assisting in the creation of appropriate and effective mental health interventions for rural South African communities like Vulindlela.
Highlights
Growing interest in strategies regarding early intervention for psychosis has led to a parallel interest in understanding help-seeking behavior, especially in low- and middle-income countries (LMICs)
In recent years, growing interest in strategies aimed at early intervention for individuals with incipient psychosis has led to a parallel interest in understanding help-seeking behavior, especially in low- and middle-income countries (LMICs)
Following Gater and colleagues’ stance, one might argue that most studies on help-seeking behavior have only been able to describe partial “treatment maps” since they assume that (a) all individuals seeking care access formal health services and (b) hospitalization is the final destination in the treatment journey
Summary
Growing interest in strategies regarding early intervention for psychosis has led to a parallel interest in understanding help-seeking behavior, especially in low- and middle-income countries (LMICs). Following Gater and colleagues’ stance, one might argue that most studies on help-seeking behavior have only been able to describe partial “treatment maps” since they assume that (a) all individuals seeking care access formal health services and (b) hospitalization is the final destination in the treatment journey. This is erroneous in some settings, but even more problematic in a number of LMICs where formal health resources—especially in relation to mental health—are limited and often inaccessible [21,22,23], and many people utilize informal healthcare. The authors point out that choices and decisions regarding which practitioner/s to consult are made for a host of reasons including those related to belief or preference as well as “structural health service failures.” the issue of help-seeking behavior is closely tied to the issue of causal beliefs and understandings of illness; any attempt to unravel the complexities of help-seeking behaviors should include an engagement with the beliefs that underlie and guide behavioral choices
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