Supporting people diagnosed with schizophrenia living in the community and their caregivers: the Ghanaian perspective

The transition from hospital-based to community-based mental health services in Ghana has
faced significant obstacles due to insufficient resources and a lack of social support for both service users and their caregivers. Schizophrenia is recognised as one of the top 20 disease burdens globally, and mental disorders are major contributors to disability. Although the overall incidence of schizophrenia is low, its impacts on service users, families, and society are profound. The ramifications of schizophrenia often include social isolation, feelings of worthlessness, and a diminished social status, stemming from the individual's inability to fulfil socially defined roles.

Despite existing research, there is a notable gap in the literature concerning schizophrenia and the support available to affected individuals and their families within Ghana's community mental health services. Consequently, this study aims to explore the support mechanisms in place for individuals diagnosed with schizophrenia and their caregivers living in Ghana. This exploration focuses on the perceived meaning of support for service users, the nature of professional care provided to community mental health service users, the experiences of nurses working in the community mental health setting, the challenges facing community mental health services, and the appropriateness of services offered to caregivers.

Methodology: This study employed a qualitative approach, utilising interpretative phenomenological analysis (IPA) aided by the conceptual frameworks of the ecological model for health promotion (EMHP) and ladder of citizen participation. A purposive sample of 10 community service users diagnosed with schizophrenia, 21 caregivers of these individuals, and six community mental health nurses was recruited. Participants shared their lived experiences regarding the support of service users and their caregivers through in-depth interviews. The interviews were audio recorded and subsequently transcribed for thematic analysis.

Findings: The findings indicate that support for service users encompasses three dimensions: general, physical, and psychological. Furthermore, professional support was identified to consist of care reviews, assessments of service user needs, health promotion initiatives, access to medication and treatment, and counselling. Within the experiences of nurses providing care in community mental health settings, the study revealed numerous challenges, including a lack of free psychotropic medication for service users, inconsistent staff training, stigmatising attitudes toward mental disorders, and transportation difficulties for mental health nurses. Additionally, the services available to caregivers were often inadequate or non-existent, rendering them unsuitable.

To address these issues, the study recommends several actions, including policy reform to improve caregiver assessment processes, provision of free psychotropic medication, enhancement of caregiver group support, transportation provisions for nurses, establishment of resource centres, implementation of proactive mental health crisis teams, and a review of education and training for nurses.

Conclusion: The burden of caregiving on caregivers is significant. Recognising the significant burden placed on families in caregiving, gaining a deep understanding of the real challenges faced by service users and their relatives will enhance the quality of care they receive. Therefore, it is crucial to proactively identify and address the needs of both service users and their caregivers to ensure they receive the necessary and appropriate support. Introducing a social dimension into community mental healthcare will be crucial in mobilising resources within the community to enhance the wellbeing of service users and their relatives. This approach will also strengthen the delivery of community healthcare services by actively involving both service users and their caregivers, contributing to the overall rehabilitation of community mental health. The study recommends a comprehensive policy planning and implementation that emphasises resource allocation for health supplies, staff training, and caregiver group support. This innovative approach has the potential to inspire a review and establishment of community mental healthcare services that are truly effective and suitable for the context of Ghana, with implications potentially extendable to other similar nations in Africa.