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Brooke-Sumner C, Rapiya B, Myers B, Petersen I, Hanlon C, Repper J, Asher L. COVID-19 experience of people with severe mental health conditions and families in South Africa. S Afr J Psychiatr 2024; 30:2207. [PMID: 38726327 PMCID: PMC11079365 DOI: 10.4102/sajpsychiatry.v30i0.2207] [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] [Received: 10/12/2023] [Accepted: 01/30/2024] [Indexed: 05/12/2024] Open
Abstract
Background People with severe mental health conditions, such as schizophrenia, and their family caregivers are underserved in low- and middle-income countries where structured psychosocial support in the community is often lacking. This can present challenges to recovery and for coping with additional strains, such as a pandemic. Aim This study explored the experiences and coping strategies of people with lived experience of a severe mental health condition, and family caregivers, in South Africa during the initial stages of the coronavirus disease 2019 (COVID-19) pandemic. Setting This qualitative study was conducted in the Nelson Mandela Bay District, Eastern Cape, South Africa, in the most restrictive period of the COVID-19 lockdown. Methods Telephonic qualitative interviews were conducted with people with lived experience (n = 14) and caregivers (n = 15). Audio recordings were transcribed and translated to English from isiXhosa. Thematic analysis was conducted with NVivo 12. Results Participants described negative impacts including increased material hardship, intensified social isolation and heightened anxiety, particularly among caregivers who had multiple caregiving responsibilities. Coping strategies included finding ways to not only get support from others but also give support, engaging in productive activities and taking care of physical health. The main limitation was inclusion only of people with access to a telephone. Conclusion Support needs for people with severe mental health conditions and their families should include opportunities for social interaction and sharing coping strategies as well as bolstering financial security. Contribution These findings indicate that current support for this vulnerable group is inadequate, and resource allocation for implementation of additional community-based, recovery-focused services for families must be prioritised.
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Affiliation(s)
- Carrie Brooke-Sumner
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Bongwekazi Rapiya
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Bronwyn Myers
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
- Curtin Enable Institute, Curtin University, Perth, Australia
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Inge Petersen
- Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Charlotte Hanlon
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Julie Repper
- West London and St George’s Mental Health NHS Trust, London, United Kingdom
- Implementing Recovery Through Organisational Change (IMROC), Nottingham, United Kingdom
| | - Laura Asher
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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J. van Rensburg A, Brooke-Sumner C. Intersectoral and multisectoral approaches to enable recovery for people with severe mental illness in low- and middle-income countries: A scoping review. Glob Ment Health (Camb) 2023; 10:e19. [PMID: 37854420 PMCID: PMC10579663 DOI: 10.1017/gmh.2023.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/20/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
The needs of people with severe mental illness are complex and require a range of services embedded in well-coordinated systems of care to enable recovery, promote well-being and optimise social integration. The concept of recovery is strongly rooted in the centrality of multi and intersectoral systems of care, and, while multi and -intersectoral dimensions of mental health systems have been highlighted in analyses focusing on high-income regions, little has been elaborated in terms of these approaches in the recovery of people with severe mental illness (SMI) in low- and middle-income countries (LMICs). The aim of this review was to identify and describe multi and intersectoral approaches underpinning community-based SMI recovery interventions in LMICs. A scoping review was carried out following the following steps: (1) Objectives for the review were developed and refined; (2) A systematic search of databases (EbscoHost, PubMed, Google Scholar) and previous reviews were undertaken from 2012 to 2022, where relevant papers were identified; (3) Papers with a focus on SMI and recovery, a specific description of an intervention, located in LMICs, with explicit linkages between sectors, and published in English, were selected for inclusion; (4) Data were extracted and charted and (5) Findings were analysed and reported thematically. Thirty-six papers were included for analysis, from 18 countries, including qualitative studies, trials, desktop and secondary data reviews and case studies. Examples of multi- and intersectoral action included collaboration between healthcare and community support systems, collaboration in providing supported housing and supportive community spaces for recovery, and linkages between biomedical and social spheres of care. Barriers included the dominance of mental health professions in delivering care, community-based stigmatising attitudes towards SMI. Multi- and intersectoral collaboration for SMI recovery requires investments in financing, education and coordination by a governing body.
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Affiliation(s)
| | - Carrie Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
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Dean L, Buechner H, Moffett B, Maritze M, Dalton LJ, Hanna JR, Rapa E, Stein A, Tollman S, Kahn K. Obstacles and facilitators to communicating with children about their parents' mental illness: a qualitative study in a sub-district of Mpumalanga, South Africa. BMC Psychiatry 2023; 23:78. [PMID: 36707793 PMCID: PMC9883085 DOI: 10.1186/s12888-023-04569-3] [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] [Received: 07/21/2022] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Given that common mental disorders are one of the leading causes of disease burden worldwide, it is likely that many children are growing up with a parent or other adult within their family who has anxiety or depression. Parents with a mental illness may not consider it appropriate to discuss their illness with their child, and consequently an absence of communication may lead to stigmatization, shame, misunderstanding their parents' symptoms, and even blaming themselves. There is a scarcity of research exploring the experiences and perceptions of healthcare professionals about communication with children of parents with mental illness in low-resource and African contexts. METHODS A qualitative study using semi-structured interviews with healthcare professionals (n = 15) was conducted within the Bushbuckridge sub-district of Mpumalanga Province, South Africa. Data were analysed using Thematic Analysis. RESULTS Four themes were identified relating to the obstacles around communication with children. These included: (1) finding an appropriate language to describe mental illness, as well as the prevailing cultural explanations of mental illness (2) the stigma associated with mental illness (3) the perceived role of children in society and (4) mental health services and staff skills. Two themes that addressed facilitators of communication about parental mental illness were identified: (1) the potential to increase mental health awareness amongst the broader community through social media, the internet, and general psychoeducation (2) healthcare professionals' concerns for the wellbeing and future mental health of patients' children, as well as their hopes for increased mental health awareness amongst future generations. CONCLUSIONS This study provides insight into healthcare professionals' attitudes and perceptions about talking to patients and families within their community about mental illness. The results provide recommendations about possible ways to promote sharing information about a parent's mental illness with children at an individual and community level. Future research should focus on the collaborative creation of culturally sensitive psychoeducational resources and evidence-based guidelines. This must be supported by systemic and organisational change in order for professionals to successfully facilitate conversations with patients who are parents, and their children.
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Affiliation(s)
- Lucy Dean
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Hadassah Buechner
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Bianca Moffett
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Meriam Maritze
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise J. Dalton
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jeffrey R. Hanna
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Alan Stein
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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de Wet A, Pretorius C. From darkness to light: Barriers and facilitators to mental health recovery in the South African context. Int J Soc Psychiatry 2022; 68:82-89. [PMID: 33307927 DOI: 10.1177/0020764020981126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND South Africa is a low and middle income country facing many challenges in public mental health care and implementation of recovery. AIMS To contribute to what barriers and facilitators to recovery might be for service users in South Africa, from the perspective of service users, carers and service providers from three psychiatric hospitals in the Western Cape province. METHOD Interviews and focus groups were conducted with service users, carers and service providers. Interviews and focus groups were transcribed and analysed using atlas.ti software and reflexive thematic analysis, from the bottom up. RESULTS The barriers, environment, family, public mental health services, stigma and service users' attitude or behaviour generated, were found to be the most salient. The facilitators to recovery generated were support, family or friends, service providers, structure and empowerment. The need for support was identified as an underlying component to all these themes. CONCLUSION Barriers and facilitators to recovery seemed to have both intrapersonal and external sources that intersect at times. Recovery needs to be supported at an individual level, especially through an under-utilised resource such as peer support work, but in conjunction with the development of recovery-enabling environments in services and communities in South Africa.
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Affiliation(s)
- Anneliese de Wet
- Psychology Department, Stellenbosch University, Matieland, Western Cape, South Africa
| | - Chrisma Pretorius
- Psychology Department, Stellenbosch University, Matieland, Western Cape, South Africa
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Process Evaluation of a Pilot Intervention for Psychosocial Rehabilitation for Service Users with Schizophrenia in North West Province, South Africa. Community Ment Health J 2018; 54:1089-1096. [PMID: 30094739 DOI: 10.1007/s10597-018-0318-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
This study investigated a non-specialist delivered programme for psychosocial rehabilitation for service users with schizophrenia in a low-resource South African setting. Forty-four service users with schizophrenia living in the community, receiving ongoing medication through primary care, participated in a structured support group. Quantitative measures (WHODAS 12 item, Brief Psychiatric Rating Scale and Internalized Stigma of Mental Illness Inventory) were assessed at baseline and 12 months. Sixteen service users were interviewed on their experiences. WHODAS data showed a small reduction. ISMI assessment showed a statistically significant reduction. Qualitative data revealed: improved self-esteem and increased illness knowledge, reduced risk taking, reduced social isolation and improved pro-social behavior, improved financial management and engagement in income generation activities as well as improved acceptance by the community. This study provides preliminary evidence on the benefits of this programme that warrant further study incorporating experimental methods.
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Brooke-Sumner C, Lund C, Petersen I. Bridging the gap: investigating challenges and way forward for intersectoral provision of psychosocial rehabilitation in South Africa. Int J Ment Health Syst 2016; 10:21. [PMID: 26962328 PMCID: PMC4784432 DOI: 10.1186/s13033-016-0042-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intersectoral collaboration between government sectors such as Health and Social Development and non-governmental organisations (NGOs) in communities is crucial for provision of psychosocial rehabilitation (PSR) for those with severe mental illness. This study aims to provide recommendations for strengthening such intersectoral collaboration in South Africa and with relevance to other low and middle income countries (LMIC), particularly African countries. METHODS Twenty-four in-depth semi-structured interviews were conducted with 16 key informants from the South African Department of Health, two key informants from the Department of Social Development, four key informants from the NGO sector and one key informant from a service user organisation at national level. Framework analysis was conducted with NVivo 10 software. RESULTS Challenges to intersectoral work identified were lack of communication between sectors, problems delineating roles, and each sector's perception of lack of support from other sectors. Participant-identified strategies for addressing these challenges included improving communication between sectors, promoting leadership from all levels and formalising intersectoral relationships through appropriate written agreements; as well as ensuring that the available resources for PSR are effectively re-directed to district level. CONCLUSIONS This study has outlined several directions for progress to address challenges for intersectoral working for PSR in South Africa. These may be of relevance to other LMIC, particularly those in Africa. Political will and a long-term view will be necessary to realise these strategies.
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Affiliation(s)
- Carrie Brooke-Sumner
- />School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa
| | - Crick Lund
- />Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Inge Petersen
- />School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa
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