A psychosocial educational programme for caregivers of people diagnosed with bipolar disorder

Abstract

Bipolêre versteuring is ‘n kroniese, herhalende en ernstige siekte met ‘n voorkoms van 1 % wêreldwyd. Pasiënte kan psigoties word, selfmoordideasie hê en ook soms aggressief raak. Dikwels moet hulle gehospitaliseer word - ook teen hulle wil, want hulle mag soms geen insig toon nie. Pasiënte mag presenteer met ‘n ko-morbiede toestand, byvoorbeeld substansmisbruik of ‘n persoonlikheidsversteuring. Dit gebeur dikwels dat hulle nie hulle toegewysde rolle, byvoorbeeld dié van gade, broodwinner, ouer of volwasse kind, kan vervul nie. Versorgers van pasiënte gediagnoseer met bipolêre versteuring, word eweneens beïnvloed deur die siekte en die gepaardgaande stigma daarvan. Dit kan vir hulle baie moeilik wees wanneer hulle die verantwoordelikhede en rolle van die pasiënt moet oorneem. Beskou vanuit die oogpunt van ‘n ekologiese sisteemperspektief is die aard van hierdie impak op die maatskaplike funksionering van die versorgers relevant vir maatskaplike werk in die geestesgesondheidsveld. Die verkenning van hierdie impak en die ontwikkeling van ‘n intervensie om die impak aan te spreek het dus die rasionaal van hierdie studie gevorm.

Die geïntegreerde biopsigososiale model, binne ‘n ekologiese sisteem perspektief, word aangewend by die psigiatriese instelling waar die navorser werk. Hierdie benadering het dus ook gedien as die vertrekpunt vir die betrokke studie. Die gemengde-metode navorsingsbenadering is tydens hierdie studie benut ten einde ‘n uitgebreide analise van die navorsingsprobleem te verskaf. Die voorgenome studie het binne die kategorie van toegepaste navorsing geval, want die doel daarvan was om ‘n program te ontwikkel om hulp te verleen aan versorgers van individue gediagnoseer met bipolêre versteuring. Die navorser het haar navorsing gerig aan

die hand van Rothman en Thomas (1994) se intervensie ontwerp en ontwikkelingsmodel (D&D) deur gebruik te maak van kwalitatiewe en kwantitatiewe metodes. Na afloop van die analise van die kwalitatiewe data, is ‘n unieke psigo-maatskaplike opvoedkundige program, die SEE-SAW program, ontwikkel en toe geïmplementeer. Die konsep van balans versus wanbalans binne die sisteem is essensieel; die navorser se program het ten doel gehad om beter balans binne die sisteem van die pasiënt en versorger te bewerkstellig. Die gevolgtrekkings het duidelik getoon dat die versorger van die bipolêre pasiënt blootgestel is aan ‘n wye spectrum van behoeftes en uitdagings, maar dat intervensies soos die SEE-SAW program van groot waarde mag wees.

Bipolar disorder (BD) is a chronic, recurrent, serious illness that occurs in 1 % of people globally. Patients might become psychotic, suicidal and sometimes violent. They often need to be hospitalised, even against their will because they may have no insight. Patients may have a comorbid condition such as substance abuse or a personality disorder. They are frequently unable to fulfil their assigned roles of spouse, breadwinner, parent or adult child. Caregivers of patients diagnosed with BD are also affected by the illness and the associated stigma. It becomes very difficult for them when they have to take over the responsibilities and roles of the patient. The nature of this impact on the social functioning of the caregivers, understood from an ecological systems perspective, is relevant for social work in the mental health care field. Discovering more about this impact and developing an intervention to curb it therefore formed the rationale for this study. The integrated biopsychosocial model, within an ecological systems perspective, is being used at the psychiatric institution where the researcher works. This approach therefore also served as the point of departure from which this research was conducted. A mixed methods research approach was utilised to provide a comprehensive analysis of the research problem. The proposed study fell into the category of applied research, due to its aim of designing a programme to assist caregivers of people diagnosed with BD. The researcher directed the study according to Rothman and Thomas’s (1994) intervention design and development model (D&D), using qualitative and quantitative methods. After the analysis of the qualitative data a unique psychosocial educational programme, the SEE-SAW programme, was developed and then implemented. The concept of equilibrium versus disequilibrium in the system is central; the researcher’s programme therefore strove towards better equilibrium within the system of patient and caregiver. From the conclusions it is apparent that the caregiver of the BD patient is exposed to a wide spectrum of needs and challenges, but that interventions such as the SEE-SAW programme may be very helpful.