1
|
Pigeon-Gagné É, Hassan G, Yaogo M, Saïas T. Discrimination and Social Exclusion of People Experiencing Mental Disorders in Burkina Faso: A Socio-anthropological Study. Cult Med Psychiatry 2024:10.1007/s11013-024-09860-w. [PMID: 39017776 DOI: 10.1007/s11013-024-09860-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 07/18/2024]
Abstract
Stigma has been pointed out as a barrier to mental healthcare in sub-Saharan Africa. Among the manifestations of stigma, the use of physical restraints is condemned as a form of violation of basic human rights. Research on this phenomenon is limited in West Africa and more particularly in Burkina Faso. This study explores the phenomenon of stigma of individuals experiencing mental disorders in Bobo-Dioulasso (Burkina Faso). As part of 8 months of socio-anthropological fieldwork, we interviewed 94 informants (7 focus groups and 25 individual interviews) to document exclusionary practices, their perceptions, and justifications. Exclusionary practices can be divided in five subgroups: ignoring, physically and sexually abusing, abandoning, banning, and restraining. Some practices were linked to a lack of financial and material resources, while others were justified by an inferior moral status. We observed differences in the type of exclusion experienced between men and women. Restrictive, abusive, and exclusionary measures are common in Bobo-Dioulasso. These practices can either be understood as part of families' adaptative strategies when dealing with chronic conditions, as part of security measures in the case of patients with aggressive behaviors, or as part of punitive measures when transgressions are committed. We conclude the article by addressing the tensions between local and global meanings of stigma.
Collapse
Affiliation(s)
| | - Ghayda Hassan
- Department of Psychology, Université de Québec à Montréal, Montreal, Canada
| | - Maurice Yaogo
- Université Catholique de l'Afrique de l'Ouest, Bobo-Dioulasso, Burkina Faso
| | - Thomas Saïas
- Department of Psychology, Université de Québec à Montréal, Montreal, Canada
| |
Collapse
|
2
|
Omigbodun OO, Ryan GK, Fasoranti B, Chibanda D, Esliker R, Sefasi A, Kakuma R, Shakespeare T, Eaton J. Reprioritising global mental health: psychoses in sub-Saharan Africa. Int J Ment Health Syst 2023; 17:6. [PMID: 36978186 PMCID: PMC10043866 DOI: 10.1186/s13033-023-00574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Arthur Kleinman's 2009 Lancet commentary described global mental health as a "moral failure of humanity", asserting that priorities should be based not on the epidemiological and utilitarian economic arguments that tend to favour common mental health conditions like mild to moderate depression and anxiety, but rather on the human rights of those in the most vulnerable situations and the suffering that they experience. Yet more than a decade later, people with severe mental health conditions like psychoses are still being left behind. Here, we add to Kleinman's appeal a critical review of the literature on psychoses in sub-Saharan Africa, highlighting contradictions between local evidence and global narratives surrounding the burden of disease, the outcomes of schizophrenia, and the economic costs of mental health conditions. We identify numerous instances where the lack of regionally representative data and other methodological shortcomings undermine the conclusions of international research carried out to inform decision-making. Our findings point to the need not only for more research on psychoses in sub-Saharan Africa, but also for more representation and leadership in the conduct of research and in international priority-setting more broadly-especially by people with lived experience from diverse backgrounds. This paper aims to encourage debate about how this chronically under-resourced field, as part of wider conversations in global mental health, can be reprioritised.
Collapse
Affiliation(s)
- O O Omigbodun
- Department of Psychiatry and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, 200212, Oyo State, Nigeria
| | - G K Ryan
- Department of Population Health, London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, Keppel Street, London, WC1E 7HT, UK.
| | - B Fasoranti
- Department of Psychiatry and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, 200212, Oyo State, Nigeria
| | - D Chibanda
- Department of Population Health, London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, Keppel Street, London, WC1E 7HT, UK
- Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - R Esliker
- Mental Health Department, University of Makeni, Lunsar-Makeni Highway, Makeni, Sierra Leone
| | - A Sefasi
- Department of Mental Health, Kamuzu University of Health Sciences, P/Bag 360, Blantyre, Malawi
| | - R Kakuma
- Department of Population Health, London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, Keppel Street, London, WC1E 7HT, UK
| | - T Shakespeare
- Department of Population Health, London School of Hygiene and Tropical Medicine, International Centre for Evidence in Disability, Keppel Street, London, WC1E 7HT, UK
| | - J Eaton
- Department of Population Health, London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, Keppel Street, London, WC1E 7HT, UK
- CBM Global Disability Inclusion, Dr.-Werner-Freyberg-Straβe 7, 69514, Laudenbach, Germany
| |
Collapse
|
3
|
Thein KZK, Herberholz C, Sandar WP, Yadanar. Caring for persons with drug use disorders in the Yangon Region, Myanmar: Socioeconomic and psychological burden, coping strategies and barriers to coping. PLoS One 2021; 16:e0258183. [PMID: 34618846 PMCID: PMC8496800 DOI: 10.1371/journal.pone.0258183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/22/2021] [Indexed: 11/19/2022] Open
Abstract
Drug use disorder (DUD) is a serious health condition that imposes a heavy burden on the persons who have a drug addiction experience and their families, especially in countries, such as Myanmar, where few formal support mechanisms are in place and repressive drug laws exacerbate the situation. Yet, in Myanmar, little is known about how informal caregivers are affected. This qualitative study aims at exploring the socioeconomic and psychological burden that informal caregivers in Myanmar encounter, coping strategies they employ, as well as barriers to coping they face. Thirty primary informal caregivers were chosen purposively from a mental health hospital in Yangon for in-depth interviews. The recorded interviews were transcribed and the data were analysed using framework analysis. The results revealed that financial constraint, income loss, social limitation and negative impact on family cohesion are important dimensions of socioeconomic burden, whereas sadness, anger, helplessness, worry, fear and guilt are the main psychological distress factors encountered by caregivers of persons with DUD. Key coping strategies employed by caregivers include religious coping, financial coping, acceptance and planning. Moreover, perceived stigma towards persons with DUD and their caregivers was very high and caregivers received hardly any social support, inter alia because of the country's drug law which reinforces stigma and discrimination. Neither the government nor any other organization in Myanmar provided financial support to the caregivers. The results of this study showed that caring for persons with DUD has devastating effects on caregivers and their families. While the 2018 National Drug Control Policy can potentially help alleviate the burden on substance users and their families, further amendments of the existing drug law are urgently needed. Moreover, strengthening prevention and harm reduction approaches, improving treatment and rehabilitation services, as well as stigma-reducing educational campaigns should be considered a priority.
Collapse
Affiliation(s)
| | - Chantal Herberholz
- Centre of Excellence for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok, Thailand
| | - Win Pa Sandar
- Department of Health Behaviour and Communication, University of Public Health, Latha Township, Yangon, Myanmar
| | - Yadanar
- Department of Health Policy and Management, University of Public Health, Latha Township, Yangon, Myanmar
| |
Collapse
|
4
|
Booysen D, Mahe-Poyo P, Grant R. The experiences and perceptions of mental health service provision at a primary health centre in the Eastern Cape. S Afr J Psychiatr 2021; 27:1641. [PMID: 34522437 PMCID: PMC8424744 DOI: 10.4102/sajpsychiatry.v27i0.1641] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Since 1994, the South African healthcare system has undergone several changes to meet the needs of contemporary South Africa. Yet the state of mental healthcare, especially in low-resource areas, remains in a precarious state. Aim This study aimed to explore how persons diagnosed with a mental disorder experience and perceive mental health services in a low-resource community in the Eastern Cape, South Africa. Setting The study was conducted at a primary care clinic in a low resource community setting in the Eastern Cape, South Africa. Method Semi-structured interviews were conducted with eight participants diagnosed with mental illness who had been accessing treatment for at least the past 6 months from a primary health clinic. Thematic analysis was used to analyse and identify pertinent themes. Results The following themes emerged from the data: (1) perceptions of mental disorders – role of culture, (2) experiences of having mental disorders – loss of employment, (3) problem of stigma – social rejection and labelling, (4) experience of distress – sadness and frustration and (5) challenges in accessing treatment – transport fee and shortage of staff. Conclusion This study yielded several lived experiences and perceptions in relation to participants’ feelings, opinions and interpretations of persons living with mental disorders and accessing mental health treatment in their local context. Future interventions should consider provision of more extensive professional help in the form of counsellors and social workers at the clinics, more efficient service delivery and future interventions regarding stigma should incorporate community members into the learning process.
Collapse
Affiliation(s)
- Duane Booysen
- Department of Psychology, Faculty of Humanities, Rhodes University, Grahamstown, South Africa
| | - Phumeza Mahe-Poyo
- Department of Psychology, Faculty of Humanities, Rhodes University, Grahamstown, South Africa
| | | |
Collapse
|
5
|
Young LS, Flannigan R. My sibling's mental illness: An interpretative phenomenological analysis of experiences of having an adult sibling with a mental illness in semi-rural South Africa. S Afr J Psychiatr 2021; 27:1585. [PMID: 34192079 PMCID: PMC8182449 DOI: 10.4102/sajpsychiatry.v27i0.1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 04/07/2021] [Indexed: 11/01/2022] Open
Abstract
Background When there is a lack of resources in the community to support deinstitutionalisation, the siblings of an individual with a mental illness are the ones who are the most affected and vulnerable. Nevertheless, sibling care work is still largely unacknowledged in the mental health sector in low- and middle-income countries. Aim This article describes and interprets the lived experiences of 'black' isiXhosa-speaking individuals having a sibling with a mental illness, to shed light on how mental health professionals might support and sustain the involvement of individuals in the treatment and care of their sibling. Setting The study was conducted in a semi-rural town in the Eastern Cape of South Africa. Methods The study employed a qualitative research design using interpretative phenomenological analysis as the research method. Semi-structured interviews were conducted and analysed. Results The findings present interview extracts which give voice to participants' experiences of financial burden, social burden and stigma, and of engaging with psychiatric treatment while providing care for their mentally ill sibling. Findings also highlight the positive aspects of caring for a sibling with a mental illness. Conclusion This study specifically highlights the gendered nature of care work and siblings' increased understanding of mental illness by virtue of their relationship with their brother or sister, thereby possibly pointing to sibling relationships as valuable relational resources for challenging stigma. The study findings suggest that calls for greater cooperation between healing belief systems should include dialogue with western religious belief systems alongside traditional healing belief systems.
Collapse
Affiliation(s)
- Lisa Saville Young
- Department of Psychology, Faculty of Humanities, Rhodes University, Grahamstown, South Africa
| | - Raylene Flannigan
- Department of Psychology, Faculty of Humanities, Rhodes University, Grahamstown, South Africa.,Department of Health, Fort England Psychiatric Hospital, Grahamstown, South Africa
| |
Collapse
|
6
|
Gloria O, Osafo J, Goldmann E, Parikh NS, Nonvignon J, Kretchy IMA. The experiences of providing caregiving for patients with schizophrenia in the Ghanaian context. Arch Psychiatr Nurs 2018; 32:815-822. [PMID: 30454622 DOI: 10.1016/j.apnu.2018.06.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/23/2018] [Accepted: 06/02/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Odue Gloria
- Department of Psychology, School of Social Science, University of Ghana, Ghana
| | - Joseph Osafo
- Department of Psychology, School of Social Science, University of Ghana, Ghana; Centre for Suicide and Violence Research, Ghana.
| | - Emily Goldmann
- Department of Epidemiology, College of Global Public Health, New York University, United States.
| | - Nina S Parikh
- College of Global Public Health, New York University, United States.
| | - Justice Nonvignon
- Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, University of Ghana, Ghana.
| | - Irene M A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Ghana.
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW The aim was to synthesize recent evidence on schizophrenia illness experience and outcomes and models of care in low and middle-income countries (LMICs). RECENT FINDINGS There is a plurality of explanatory models for psychosis and increasing evidence that context influences experiences of stigma. People with schizophrenia in LMICs are vulnerable to food insecurity, violence and physical health problems, in addition to unmet needs for mental healthcare. Family support may help to improve outcomes if present, but caregivers may be overwhelmed by the challenges faced. Despite efforts to increase availability, evidence-based care remains inaccessible to many people with schizophrenia. Non-randomized evaluations in South Africa and Mexico indicate that psychosocial support groups for people with schizophrenia and caregivers may be acceptable and useful. Randomized controlled trials in Pakistan and China show that culturally adapted cognitive-behavioural therapy can reduce symptom severity. There is emerging evidence that alternative medicine, such as Tai Chi, may be beneficial, but to date most studies are of low quality. The challenges of biomedical-traditional provider collaborations have been highlighted. Evaluations of integrated mental healthcare in primary care are underway and promise to provide vital information about how to scale-up quality care. SUMMARY Acceptable and effective responses to schizophrenia in LMICs should be cognisant of both cultural context and universal concerns. Efforts to enhance the quality of family support should be central to models of care.
Collapse
|
8
|
Sibeko G, Temmingh H, Mall S, Williams-Ashman P, Thornicroft G, Susser ES, Lund C, Stein DJ, Milligan PD. Improving adherence in mental health service users with severe mental illness in South Africa: a pilot randomized controlled trial of a treatment partner and text message intervention vs. treatment as usual. BMC Res Notes 2017; 10:584. [PMID: 29121999 PMCID: PMC5679373 DOI: 10.1186/s13104-017-2915-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/03/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives Medication non-adherence is a significant problem in treatment of severe mental disorders and is associated with poor clinical outcomes and increased demand on services. Task-shifting interventions incorporating mobile health may improve adherence in mental health service users in low- and middle-income countries. Seventy-seven participants were recruited from a psychiatric hospital in Cape Town, with 42 randomized to receive the intervention and 35 to treatment as usual. Intervention pairs underwent treatment-partner contracting and psychoeducation, and received monthly text message reminders of clinic appointments. Primary outcomes were intervention acceptability and feasibility. Secondary outcome for efficacy were adherence to clinic visit; relapse; quality of life; symptomatic relief and medication adherence. Results Treatment partner and psychoeducation components were acceptable and feasible. The text message component was acceptable but not feasible in its current form. Efficacy outcomes favoured the intervention but did not reach statistical significance. A treatment-partner intervention is acceptable and feasible in a low- and middle-income setting. Work is needed to ensure that additional components of such interventions are tailored to the local context. Appropriately powered efficacy studies are needed. Trial Registration PACTR PACTR201610001830190, Registered 21 October 2016 (Retrospectively registered) Electronic supplementary material The online version of this article (10.1186/s13104-017-2915-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Henk Temmingh
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sumaya Mall
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Peter Williams-Ashman
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ezra S Susser
- Columbia University Mailman School of Public Health, New York State Psychiatric Institute, New York, USA
| | - Crick Lund
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Peter D Milligan
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
9
|
Onwumere J, Kuipers E. Caregiving roles: when will they be routinely recognized and supported? J Ment Health 2017; 26:95-97. [DOI: 10.1080/09638237.2017.1301649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Juliana Onwumere
- Psychology Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Elizabeth Kuipers
- Psychology Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| |
Collapse
|