Challenges of Providing Home Care for a Family Member with Serious Chronic Mental Illness: A Qualitative Enquiry

Understanding Thai Community Nurses' Experiences of Caring for Psychiatric Patients in Primary Care Units: A Phenomenological Study

Background

Mental illness has been a significant public health challenge in Thailand, where there is a shortage of specialists. Consequently, community nurses (CNs) who are not specialists have been tasked with enhancing mental health outcomes in the primary care system of the country. This study aims to shed light on CNs' lived experiences of caring for psychiatric patients within the primary care units (PCUs).

Methods

A phenomenological research approach and in-depth interviews were conducted with nine CNs responsible for psychiatric patient care purposefully selected at nine PCUs in southern Thailand, including Nakhon Si Thammarat, Krabi, Phangnga, and Chumporn provinces, between March and December 2019. Data analysis was carried out using Colaizzi's method.

Results

The experiences of CNs were expressed through three main themes: "Confronting role expansion in long-term psychiatric care responsibilities," "Insecurity in role ambiguity," and "Duty of supportive caring for marginalized people."

Conclusion

Thai CNs face significant stress when providing care for psychiatric patients, grappling with their acknowledged lack of specialization and essential expertise in the field. Alongside the issue, they knew that supportive caring for marginalized people is their duty to humanity. Primary care systems must recognize CNs' vital role in enhancing psychiatric patient care. Comprehensive training empowers them, fostering confidence and enabling better connections and care management. This can lead to improved patient outcomes and overall care quality.

Burden of Care of Family Caregivers for People Diagnosed with Serious Mental Disorders in a Rural Health District in Kwa-Zulu-Natal, South Africa

An estimated 6% of the world population has serious mental illness, with one in four families having a member with some form of psychiatric disorder, who is mostly cared for by their relatives within a family setting. Although care-giving in a home setting is reported to be associated with significant mental distress, the burden of such distress is rarely measured. The purpose of this study was to quantify the burden of care among family caregivers of relatives with serious mental disorders, as well as to explore possible associations between the caregiver burden of care and a range of caregiver and Mental Health Care User (MHCU) variables in a rural district in Kwa-Zulu Natal, South Africa. The Zarit Burden Interview (ZBI) scale was used to collect data from 357 caregivers, and STATA 14 was used to analyze data. The ages of the sample ranged from 18 to 65 years, with a mean of 50.29, and the majority (86%) were female and unemployed (83%). The ZBI scores ranged from 8 to 85, with a mean of 41.59. The majority (91%) were found to be affected by family caregiver burden, which ranged from mild to severe. Using the Pearson Chi-square test of association (p = 0.05), variables that were significantly associated with the burden of care were clinically related (caregiver self-reported depression, MHCU diagnosis, recent relapse of the MHCU), socio-economic (caregiver family monthly income, MHCU disability grant status and MHCU employment status) and socio-demographic (MHCU gender and MHCU level of education). The prevalence of the burden of care is high and severe, and the scarcity of resources in families and communities contributes to the high burden of care in these rural communities.

Challenges to the provision of home care and support for people with severe mental illness: Experiences and perspectives of patients, caregivers, and healthcare providers in Dar es Salaam, Tanzania

A balance between hospital-based and community-based services is needed to effectively provide mental health services for people with mental illness. As an essential part of community mental health services, home-based care plays an important role in meeting patients' needs, and should, therefore, be appropriately provided. To achieve this, there is a need to understand the challenges faced and take relevant actions to address them. This study aimed to explore challenges to home care and support for people with mental illness in Temeke district, Dar es Salaam. We used a descriptive qualitative study approach to explore challenges to home care and support for people with mental illness among patients, their caregivers, and healthcare providers. The purposeful sampling method was used to recruit participants at Temeke hospital, data was collected using in-depth interviews and focus group discussions, and analysis was performed using a content analysis framework. Four main themes highlighting challenges encountered in the provision of home care and support for individuals with mental illness were revealed. They include poor understanding of mental illness, abandonment of patients' care responsibilities, disputes over preferred treatment, and lack of outreach services for mental health. Participants also provided suggestions to improve home care and support for people with mental illness. Home care for people with mental illness is affected by poor knowledge of the mental illness, social stigma, and lack of outreach visits. There is a need for the provision of health education regarding mental illness, stigma reduction programs, and funding and prioritization for outreach home visits to improve home care and support for people with mental illness. Further research is needed to determine the magnitude of these challenges and factors that can facilitate the provision of support in similar settings.

Relapse among MHCUs after a Short-Term Admission in an Acute Psychiatric Unit: Primary Caregivers' Perspective

South Africa has taken initiative to strengthen its mental health system, by improving the Mental Health Care Act 17 of 2002 which proclaims that mental healthcare users (MHCUs) can be treated in communities and homes. Due to short-term hospitalisations for acute MHCUs and advocacy for community-based care, families play a significant role in providing care to severe mental healthcare users. The objective of the study was to explore primary caregivers' perspective regarding the relapse of MHCUs following a short-term admission in acute psychiatric units. A qualitative explorative design was used. In-depth individual interviews were conducted with 18 primary caregivers whose family members were readmitted to four hospitals with units designated for acute MHCUs in Limpopo. NVivo computer software version 11 was used to analyse data. The findings are that MHCUs deny the mental health condition. Mental illness is considered a short illness that can be cured, which shows misconceptions about self-mental health conditions. Refusal of direct observed treatment support also emerged; hence, it is difficult for caregivers to identify if the patient is taking the correct doses or not taking the medication at all. Perceived wrong beliefs about mental illness can affect the patient's desire to seek proper management and it can be damaging in many ways. Drugs and alcohol abuse makes MHCUs display disruptive behaviours and contribute to treatment non-adherence resulting in caregivers becoming reluctant to be around them. In conclusion, mixing traditional and faith-based mental healthcare practices as reported by primary caregivers can mean that tailor-fabricated culture-specific mental healthcare is required.

Promoting Psychosocial Health of Family Caregivers of Patients with Chronic Mental Disorders: A Review of Challenges and Strategies

The present study aimed to investigate the mental and social health challenges of family caregivers of the patients with chronic mental disorders (CMD) and strategies which can be helpful in this regard. This study is a narrative review conducted in PubMed, Web of Science, Scopus, Elsevier, Google Scholar, Proquest, Magiran, and Sid databases where keywords such as Family caregiver, Chronic Mental disorder, Health Promotion, Program, Psychosocial, Support, Challenge, and Problem were searched in both Persian and English. A total of 5,745 published documents were found and were screened based on inclusion and exclusion criteria. Finally, 64 studies were found which had examined the related challenges, needs and strategies. According to the results, information deficits, needs for support, community participation deficits, and psychological suffering were recognized as challenges of family caregivers of these patients. Moreover, empowerments programs for the enhancement of the knowledge and skills of caregivers and peer-centered support programs were used to improve the level of mental and social health of family caregivers of these patients. Psychosocial problems and challenges that family caregivers of the patients with CMD face affect their health, satisfaction and quality of life. Using a collaborative approach, mental health service providers and government systems can help improve the psychosocial health of caregivers. The related managers and policymakers can reduce the emotional and psychological burden of families and promote their psychosocial health through developing a comprehensive program including practical objectives and strategies and taking into account the challenges that exist for caregivers in caring for patients with CMD.

Psychiatric patients' experience in receiving services provided by non-specialist community nurses, southern Thailand

BACKGROUND

Psychiatric problems have been a growing and significant public health challenge. Community-based psychiatric services have been shown to contribute to the improvement of health and social-related outcomes, but with limited specialists in this field. Consequently, Thailand has integrated these services into the primary care system delivered by community nurses working in primary care units (PCUs).

AIM

To describe the experiences of psychiatric patients in receiving services provided by non-specialist community nurses.

METHOD

A phenomenological approach was used. Eleven psychiatric patients with 10 major depressive disorders and 1 with schizophrenia were interviewed. The results were evaluated using thematic content analysis.

RESULTS

The results revealed two main themes as barriers and facilitators experienced in receiving services from community nurses.

CONCLUSION

Community-based services should be concerned about developing psychiatric nursing competency for community nurses to extend basic services to patients in communities and to assist family members.

Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa

Although treatment default by psychiatric patients or mental health care users is a global challenge, this behavior is reported to be higher in South Africa. The Manguzi District Hospital in rural Kwa-Zulu Natal Province, South Africa, experiences high rates of treatment default by psychiatric patients. The objective of this study was to determine the reasons for treatment defaulting at Manguzi Hospital, KwaZulu-Natal Province, South Africa. An explorative qualitative design, using in-depth interviews, was conducted with mental health care users who had defaulted out-patient psychiatric treatment. Twenty-one mental health care users were interviewed before data saturation was reached. Nvivo version 11 was used to analyze the qualitative data. Major themes that emerged confirmed that social factors are key contributions to treatment defaulting, and these include denial of the mental disorders; belief that they are cured; lack of, or disintegration of social support; preference for traditional medicine; and flaws in the health care system. Social determinants of treatment outcomes for mental disorders require tailor-made support systems for patients in these rural communities, which include increase in health literacy and attention to the cultural understanding of mental disorders.