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'No one bothers about the confused people': Care for people with psychosocial disabilities in rural South Africa

Braathen, Stine Hellum (2016-12)

Thesis (PhD)--Stellenbosch University, 2016.

Thesis

ENGLISH ABSTRACT: This dissertation explores care for people with psychosocial disabilities in a rural area in the Eastern Cape province of South Africa. In Low and middle-income countries, including South Africa, the gap between the need for mental health services and available services is critical. Reasons for this have been said to be lack of priority at policy level, lack of equipment, personnel, and medication, and low mental health literacy. As a result, the majority of people with psychosocial disabilities are not diagnosed or treated. In order to close the gap between need and provision, there is a call for more community based mental health services, for task-shifting and a move towards recognising medical pluralism. There is lack of evidence on family and community care, traditional systems of healing and medical pluralism. Care is often reduced to health care, but arguably also includes assistance with daily tasks, companionship, conversation and intimacy. Explanatory models for psychosocial disability are crucial in care seeking, diagnosis, treatment and cure. As such, the theoretical points of departure for this dissertation are the concepts of psychosocial disability and care. The aim of this study was to explore practices, views, knowledge and experiences related to care for people with psychosocial disabilities living in a rural, South African context. To do this, a qualitative methodology was deemed suitable. The study is divided into two linked, but methodologically different parts, namely a contextual part and a case study part. The overarching methodological principles are the same; they are both anchored within a qualitative, explorative research design. The dissertation has found that in the context of psychosocial disability in Madwaleni, care is much broader than health care, and about much more than curing illness or looking after someone who is ill or dependent. In an attempt to improve mental health, and prevent, treat and cure mental disorder, it is essential to apply a broad definition of care. We need to rethink how we deliver mental health services, moving away from care as pacifying, to care as activating. Care must be integrated into real-world settings. The global mental health literature emphasises shifting the focus of mental health care from cure to promotion and prevention. It also stresses the value of using an interdisciplinary team of lay and trained health workers from the professional, folk and popular sectors. This strategy needs to be complemented by other strategies, for example, integrating mental health into other projects focussing on sustainable livelihoods and development of infrastructure. The challenges are complex, as this small study shows, but it is only by looking closely at local conditions that it is possible to develop culturally and contextually appropriate interventions and make optimal use of local resources.

AFRIKAANSE OPSOMMING: Hierdie verhandeling ondersoek sorgverskaffing aan persone met psigososiale gestremdhede in ’n landelike gebied van die Oos-Kaapprovinsie, Suid-Afrika. In lae- en middelinkomstelande, waaronder Suid-Afrika, is die gaping tussen die behoefte aan geestesgesondheidsdienste en die diensaanbod kritiek. ’n Gebrek aan beleidsvoorrang, ’n tekort aan toerusting, personeel en medisyne, sowel as lae geestesgesondheidsgeletterdheid word as redes hiervoor aangevoer. Gevolglik word die meeste mense met psigososiale gestremdhede nie gediagnoseer of behandel nie. Om hierdie gaping tussen vraag en aanbod te oorbrug, is daar ’n oproep om meer gemeenskapsgebaseerde geestesgesondheidsdienste, taakoordrag en ’n verskuiwing na die erkenning van mediese pluralisme. Daar bestaan weinig bewyse in verband met familie- en gemeenskapsorg, tradisionele genesingstelsels en mediese pluralisme. Onder ‘sorg’ word dikwels gesondheidsorg verstaan, maar dit sluit stellig ook bystand met daaglikse take, kameraadskap, gesprek en intimiteit in. Verklarende modelle van psigososiale gestremdheid is noodsaaklik in die soeke na sorg, diagnose, behandeling en genesing. Daarom is die teoretiese uitgangspunte vir hierdie verhandeling die konsepte van psigososiale gestremdheid en sorg. Die doel van hierdie studie is om praktyke, sienings, kennis en ervarings met betrekking tot die versorging van mense met psigososiale gestremdhede in ’n landelike, Suid-Afrikaanse omgewing te ondersoek. Hiervoor word ’n kwalitatiewe metodologie as gepas beskou. Die studie word in twee verbandhoudende dog metodologies verskillende afdelings ingedeel, naamlik ’n kontekstuele afdeling en ’n gevallestudieafdeling. Die oorkoepelende metodologiese beginsels is dieselfde; albei afdelings is in ’n kwalitatiewe, ondersoekende navorsingsontwerp veranker. Die verhandeling bevind dat sorg, in die konteks van psigososiale gestremdheid in Madwaleni, veel verder as gesondheidsorg strek, en ook oor veel meer handel as die genesing van siekte of die versorging van iemand wat siek of afhanklik is. In ’n poging om geestesgesondheid te verbeter en geestesteuring te voorkom, te behandel en te genees, is dit noodsaaklik om ’n breë omskrywing van sorg toe te pas. Ons moet nuut dink oor hoe ons geestesgesondheidsdienste lewer, en wegbeweeg van die gedagte van sorg wat kalmeer tot sorg wat aktiveer. Sorg moet by die omstandighede van die werklike wêreld geïntegreer word. Wêreldliteratuur oor geestesgesondheid onderstreep die belang van ’n klemverskuiwing in geestesgesondheidsorg van genesing tot bevordering en voorkoming. Dit beklemtoon ook die waarde van ’n interdissiplinêre span leke- en opgeleide gesondheidswerkers uit die professionele, volks- en populêre sektore. Hierdie strategie moet aangevul word met ander strategieë, soos die integrasie van geestesgesondheid by ander projekte met die oog op ’n volhoubare bestaan en die ontwikkeling van infrastruktuur. Die uitdagings is kompleks, soos hierdie beperkte studie toon, maar slegs deur plaaslike omstandighede indringend te bestudeer, kan ons kultureel en kontekstueel gepaste intervensies ontwikkel en plaaslike hulpbronne optimaal benut.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/100234
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