The experiences of caregivers of mental health care users with schizophrenia in Upington, Northern Cape

Abstract

The process of deinstitutionalization in South Africa after 1994 have resulted in mental health services being decentralized to community level in an effort to integrate psychiatric care into primary health care services at community level, thus moving away from institutionalised and pharmacological treatment alone, to include environmental resources such as community-based clinics and hospitals as care providers for mental illness such as schizophrenia, which is at the centre of this study. Primary health care services alone were not affected by this shift, but the families of psychiatric patients, as well as the families were required to assume responsibility of care for psychiatric patients. A major concern with regards to deinstitutionalisation was the preparedness of families to resume this responsibility of care. Public health care in South Africa is characterised by a great divide between public –and private health care services with the minority of the country being served by the majority of health care professionals employed in the private health care system, thus contributing to disparities in health care and contributing to a lack of specialised human resources in the public health care system. Challenges such as lack of public awareness on mental health; stigma against mental health care users and families, and inequity between the provinces in the country with regards to the distribution of resources and services amongst others, are external factors contributing to the functioning of the family system and the burden experienced by those caring for family members diagnosed with mental illness. In addition to these environmental factors, families are also affected by mental illness as they have to adapt, learn new skills and coping mechanisms to deal with schizophrenia and care for their family member. The aim of the study was to explore the experiences of the caregivers of mental health care users with schizophrenia in the town of Upington in the Northern Cape. Research was qualitative in nature with a sample of eight participants – all of whom were responsible for caring for family members diagnosed with schizophrenia – drawn from different primary health care clinics in Upington. The findings of the study indicate that caregivers are experiencing challenges mainly related to factors external to the family system. These challenges cannot be attributed to a single factor, but to different environmental factors related to treatment, availability of support services and lack of awareness amongst others. The experiences of the caregivers with regards to their role are influenced more by external factors as previously mentioned, than by the patients they care for and their behaviour. The study concludes that caregivers are influenced and affected by different systems within their environment in which they function. It is also concluded that there is a lack of basic support, education and training services aimed at creating awareness on schizophrenia and developing caregiver skills to cope with the role of caregiver. The recommendation is made that community-based mental health care services are implemented to provide support to families living with mental illness, that community awareness is raised on schizophrenia to enable caregivers to cope in a more effective manner, resulting in improvement of family functioning and reducing caregiver burden.