It appears that few studies have attempted to evaluate task-based community-based PSR for schizophrenia requiring the integration of mental health services in Primary Health Care (PHC) in South Africa. Results: Results from this study showed that comprehensive mental health care that includes pharmacology and community-based strategies for schizophrenia is effective in.
INTRODUCTION
Introduction and background
However, two thirds of mortality among patients with schizophrenia can be attributed to natural causes of death (Auquier et al., 2007). Historically, patients with schizophrenia or severe mental illness were mainly treated in asylums or psychiatric hospitals.
Statement of the problem
Lack of adequate community-based mental health services has been associated with high rates of relapse and readmission to psychiatric hospitals in developing countries (Oyffe et al., 2009). In addition, in the context of a shortage of mental health specialists in South Africa, mental health interventions adopt task sharing.
Definition of terms
This chapter will also cover ways in which South Africa has benefited from decentralized mental health care. This chapter concludes by discussing the importance of training and supervision of non-specialist mental health care workers.
LITERATURE REVIEW
Introduction
This evolution discussion will include the institutional inpatient care model and the introduction of deinstitutionalization of psychiatric patients, as well as community-based mental health care in developed and developing countries. Mental health care in South Africa, which includes decentralization of mental health care services, will also be discussed.
Impact of schizophrenia
- Impact of schizophrenia on the individual
- Impact of schizophrenia on the family
- Impact of schizophrenia on the society
Patients with schizophrenia also experience exclusion from participating in community and family activities due to stigma (Balaji et al., 2012), and they are also exposed to various types of discrimination in mental health institutions (Solanki, Singh, Midha & Chugh, 2008). . Unfortunately, there are few decentralized and integrated CBR programs for schizophrenia patients and families in South Africa.
Evolution of schizophrenia treatment
Moral treatment
The reform of the asylum and the decline of moral therapy
Furthermore, moral therapy was impractical in understaffed state hospitals (Thornicroft & Tansella, 1999). The Mental Hygiene Movement emerged as a response to the dehumanizing conditions in state hospitals.
Deinstitutionalization
The deinstitutionalization of mental health care has been associated with a significant decline in the number of psychiatric hospital beds. By the mid-1960s, many patients in the United States had been transferred from psychiatric hospitals to community mental health centers.
Community/psychosocial management of schizophrenia
ICM has been found to be effective in reducing hospitalization and improving psychosocial disability in patients with schizophrenia. Research shows that psychoeducational interventions for schizophrenia are effective in addressing many of the psychosocial disturbances experienced by patients with schizophrenia.
Psychosocial rehabilitation in the LMIC context
The lack of CBR interventions in LMICs is also due to a shortage of mental health specialists, and this also contributes to the treatment gap (Iemmi et al., 2015). 2016) support the integration of mental health services into the PHC as this addresses the unmet needs of the population in LMICs. Strong community mental health services are a fundamental part of deinstitutionalization and preventing unnecessary hospital admissions.
Task-sharing
A study investigating the feasibility and acceptability of mental health care task sharing in the delivery of mental health services in LMICs examined the perceptions of primary health care providers (nurses, physicians, CHWs). This acceptance has the potential to significantly reduce the treatment gap and increase access to mental health services. The introduction of task sharing and integration of mental health services will reduce unnecessary referrals and increase access to mental health services at the PHC and community level (Mendenhall et al., 2014).
Psychosocial rehabilitation – the South African context
The South African government has made a significant effort to reform and improve access to mental health services. The MHCA was created to improve access to mental health care and to improve the human rights of mental health care users (Stein, 2014). A study by the Mental Health and Poverty Project shows that South Africa benefited from the decentralization of mental health care services (Lund et al., 2008).
Challenges with decentralization of mental heatlth care services in South Africa
Other studies suggesting the effectiveness of psychosocial interventions for schizophrenia in LMICs include family interventions in South. Furthermore, a Cochrane review that included five studies on community-based rehabilitation for schizophrenia indicated that task-sharing interventions lack robust evidence for schizophrenia in LMICs (Iemmi et al., 2015). Therefore, there is a need to research decentralized community-based PSR programs for schizophrenia delivered through task sharing in South Africa.
Theoretical approach: Complex interventions
This community-based PSR was delivered by Auxiliary Social Workers (ASW) in DKK District, North West Province (Brooke-Sumner et al., 2015). Furthermore, it allows the researcher to explore in detail parts of the intervention that were helpful and factors that contributed to the failure of the intervention. To achieve this process evaluation, semi-structured interviews were used to explore in detail aspects of PSR that were useful and contributed to the success of the intervention.
Conclusion
Understanding the processes of change is an important aspect of evaluation and focuses on exploring and investigating the ways in which the intervention was implemented. In addition, participants were asked to describe aspects of the programs that were not helpful and to suggest what could be done to optimize the intervention. This chapter also discussed the importance of task sharing in addressing the 75% mental health treatment gap in South Africa.
RESEARCH METHODOLOGY
Objectives of the study
Research questions
Research design and theoretical approach
Research site
Sample and sampling method
Data collection
Data analysis
Triangulation analysis can be used to achieve reliability and validity of research findings (Wong, 2014). This was done to ensure the accuracy, fairness and confirmation of the description and analysis of the research report (Wong, 2014). Additionally, to ensure data control, the research supervisor and the PRIME researcher checked the themes and coding.
Ethical considerations
To ensure reliability and validity, and consistency and rigor of the study, the research protocol and interview guide (Appendix A) were developed to ensure that this study could be replicated by another researcher. The research protocol included research questions and objectives that are consistent, and fieldworkers remained focused during data collection to ensure that responses were consistent with the research questions and objectives. Further, participants were informed that interview transcripts would be viewed by PRIME researchers and pseudonyms would be used in place of personally identifiable information when direct quotes were used to illustrate some of the arguments.
Introduction
Change in feelings and thoughts
Most helpful aspects of the intervention
Participants reported a change in their risk-taking behavior after participating in the intervention.
Economic improvement
- Generating income
- Budgeting
Some participants reported that they were unable to budget before participating in the intervention. The session focusing on explaining schizophrenia was mentioned as an important aspect of the intervention. The following quotes emphasize the importance of understanding schizophrenia as a useful aspect of intervention.
Skills gained
Some of the patients with schizophrenia reported improvement in personal hygiene after participating in the PSR intervention.
Treatment adherence
Aspects of the intervention that could be improved
Family and community
The data showed that there was a difference in the ways in which community and family members treated some of the patients with schizophrenia. They treat me like a normal person and they don't call me crazy; they see that I have changed. Thirteen of sixteen participants reported that the intervention was accepted, and they cited various reasons for this acceptance.
Perceptions of patients with schizophrenia toward facilitators
PSR as a good way to support people with schizophrenia
Recommending the PSR programme
Another underlying theme that emerged was that patients with schizophrenia enjoyed participating in the PSR program and were not happy that it had ended. Fifteen of the sixteen participants reported that they would like to continue participating in the PSR intervention.
Conclusion
Introduction
Change in feelings and thoughts
The study therefore adds to the body of evidence on collaborative community-based PSR for schizophrenia in South Africa. The intervention improved their self-esteem and enabled patients to see themselves as normal human beings in their communities. 2014) postulates that joint task intervention that includes sessions on internalized stigma improves patients' self-esteem and self-concept and leads to reductions in suicidal thoughts and negative thinking.
Most helpful aspects of the intervention
- Problem solving skills and social improvement
- Economic improvement
- Reducing risky behaviour
- Treatment adherence
Several studies show that risk-taking is very common among patients with schizophrenia (Reddy et al., 2014). Several studies have reported a comorbidity of schizophrenia and substance abuse among patients with schizophrenia (Green & Brown, 2006; Thoma & Daum, 2013). Substance use among patients with schizophrenia is a major public health problem that requires mental health specialists.
Aspect of the PSR that could be improved
This finding is consistent with previous research that reveals that people from lower SES have low levels of mental health literacy (Bruwer et al., 2011). This study indicates a lack of mental health literacy among the people of lower socioeconomic status (which were the participants in this study) and suggests that psychoeducation is useful for people suffering from schizophrenia. Research findings from this study show that mental health literacy can be improved through community-based PSR programs.
Perception of patients with schizophrenia toward facilitators
This finding is consistent with previous research studies suggesting the effectiveness of task-shared community-based interventions for patients with schizophrenia in developing countries (Botha et al., 2010; Chatterjee et al., 2003; Chien et al., 2013). It should be noted that few studies have reported the effectiveness of task-sharing interventions for schizophrenia in developing countries. Therefore, this study contributes to the growing body of evidence showing the effectiveness of task sharing in improving treatment adherence, improving social skills, and reducing stigma.
Family and community changes
- Improved understanding of schizophrenia amongst family and community members
- PSR programme can reduce stigma
- Roles and activities
- Personal hygiene
As suggested above, family and community interventions should be included in PSR programs offered to patients with schizophrenia. The acceptability of the program is revealed by the reduction of the stigma surrounding schizophrenia and the involvement of patients with schizophrenia in family and community activities. Additionally, PSR programs involving family members should emphasize the involvement of persons with schizophrenia in family and community activities.
PSR as a good way to supporting people with schizophrenia
Participants indicated that the community-based PSR program was helpful in supporting individuals suffering from schizophrenia. Part of the study involved exploring whether participants would recommend the PSR program to other people in their community. All participants reported that they would recommend the PSR program to other community and family members diagnosed with schizophrenia.
Conclusion
It emerged that the participants would recommend the PSR program because other people suffering from schizophrenia need to understand their illness and the importance of following the treatment. Furthermore, the results illustrate the positive impact the PSR program had on patients with schizophrenia and the importance of promoting mental health. The PSR program played a crucial role in reducing risk-taking behavior, improving socialization skills and personal hygiene among patients with schizophrenia.
Conclusion
This study indicates that division of labor is likely to be effective when facilitators are well trained, supported and supervised. The findings of this study also suggest that community-based PSR can help reduce mental illness stigma. In addition, a study examining the impact of a prolonged stay in psychiatric hospitals reveals that poor living conditions worsen psychiatric symptoms (Breakey, 1996).
Limitations of the study
Goffman (1961) argued that institutionalized psychiatric patients experience mortification of the self and that psychiatric hospitals create closed systems that separate patients from their communities; as a result, they have limited access to the outside world.
Recommendations for future interventions
However, facilitators delivering task-shared interventions need proper training and supervision to provide effective PSR interventions. Fourth, community-based PSR interventions should include family interventions that will help family members cope and cope with the affected individual.
Recommendations for future research
Closing the mental health treatment gap in South Africa: A review of costs and cost-effectiveness. Planning district mental health services in South Africa: a situational analysis of a rural site. Task sharing psychosocial interventions in public mental health: A review of the evidence in the South African context.
If you would like to participate in a study to evaluate the outcomes of integrated mental health care, you will receive a copy of this information sheet. During the interview, you will be asked a number of questions about your mental health and your use and experience of health services at this clinic.
