Background
Methods
Study setting
Indicators | Description of profession | Facility 1 | Facility 2 |
---|---|---|---|
Facility | Location | Kumasi Metropolis | Ejisu-Juaben District |
The minimum duration of rehabilitation | 9–18 months | – | |
MHPs | Total FTE staff | 13 | 6 |
Total FTE clinical staff | 2 | 3 | |
Non-Clinical staff | 11 | 3 | |
Rotational (Casual nurses) | Min 10 max 30 | Min 10 max 30 | |
Total peer-support staff | 5 | 3 | |
Consumer: FTE staff ratio | 3:1 | 9:1 | |
Consumers | Maximum occupancy (consumers) | 40 | 55 |
Physical Environment | Number of self-contained independent living units | None | None |
Number of shared halls and rooms for living | 22 | 6 | |
Total number of beds for consumers | 55 | – | |
Philosophy of care | Recovery-oriented | Yesa | Yesb |
Strengths-based | Yes | Yes | |
Designated rehabilitation focus | Yes | Yes | |
Voluntary engagement in rehabilitation | Yesc | Yesc | |
Individualized care planning | Yes | Yes | |
Transitional support | Yesd | Yesd | |
Role of peer support | Minimal support | Minimal support | |
Treatment and support | Cognitive Behavior Therapy (CBT) | Yes | Yes |
Living skills support and development | Yes | Yes | |
Structured leisure and physical activities | Yes | Yes | |
Social integration and economic empowerment | Yesf | Yesf | |
Evidence-based therapeutic group programs | Limited | Limited |
Research approach
Participants and sampling
Data collection
Data analysis
Results
Characteristics of participants
Variables | Facility 1 | Facility 2 | Total |
---|---|---|---|
Consumer participants | N (%) | N (%) | N (%) |
Gender | |||
Males | 5 (55.55) | 6 (60.00) | 11 (57.89) |
Female | 4 (45.55) | 4 (40.00) | 8 (41.10) |
Age | |||
20–30 | 4 (44.44) | – | 4 (21.05) |
31–40 | 1 (11.11) | 4 (40.00) | 4 (21.05) |
41–50 | 2 (22.22) | 2 (20.00) | 2 (10.52) |
51–60 | – | 2 (20.00) | 2 (10.52) |
61–70 | 2 (22.22) | 2 (20.00) | 2 (10.52) |
Mean:40, SD:12 | |||
Education | |||
Basic | 2 (22.22) | 4 (40.00) | 6 (31.57) |
SHS/technical and vocational | 3 (33.33) | 5 (50.00) | 8 (42.10) |
Tertiary | 4 (44.44) | 1 (10.00) | 5 (26.31) |
Marital status | |||
Single | 6 (66.66) | 5 (50.00) | 11 (57.89) |
Co-habitation | 1 (11.11) | – | 1 (5.26) |
Married | 2 (22.22) | 3 (30.00) | 5 (26.31) |
Separated | – | 1 (10.00) | 1 (5.26) |
Widow | – | 1 (10.00) | 1 (5.26) |
Occupation | |||
Unemployment | 2 (22.22) | 6 (60.00) | 8 (42.10) |
Self-employed | 3 (33.33) | 2 (20.00) | 5 (26.31) |
Government sector | 1 (11.11) | 1 (10.00) | 2 (10.52) |
Student | 2 (22.22) | – | 2 (10.52) |
Pastoral work | 1 (11.11) | 1 (10.00) | 2 (10.52) |
MHPs | |||
Profession | |||
Occupational therapist | 1 (50) | 1 (33.33) | 2 (40) |
Psychiatric nurses | 1 (50) | – | 1 (20) |
Psychiatrist/Prescriber | – | 1 (33.33) | 1 (20) |
Social worker | 1 (33.33) | 1 (20) | |
Gender | |||
Males | 1 (50) | 2 (66.67) | 3 (60) |
Females | 1 (50) | 1 (33.33) | 2 (40) |
Marital status | |||
Single | 1 (50) | 22 (66.67) | 3 (60) |
Married | 1 (50) | 1 (33.33) | 2 (40) |
Average years of working experience | 3 years |
Themes identified from the thematic analysis
Global themes | Organizing themes | Basic themes | Codes |
---|---|---|---|
Theme 1: Recovery services offered to consumers | Admission process to the residential facilities | Conducting MSE and PHA are used to assess mental and physical health of consumers respectively | Mental Status Examination (MSE) |
Physical Health Assessment (PHA) | |||
Treatment plan and goals setting | |||
Receiving a referral from a psychiatric facility can be used to start recovery services | Continuity of services | ||
Routine recovery activities and intervention | Planning daily recovery activities is key in achieving recovery | Personal self-care skills | |
Medication | |||
Time management skills | |||
Socialization (eg. playing games and watching television) | |||
Leisure and recreational activities | |||
Psycho-therapy | |||
Psycho-education | |||
Mindfulness-based interventions | |||
Physical health training | |||
Cognitive behaviour therapy | |||
Family therapy | |||
Consumers’ involvement in decision concerning recovery services | Respecting consumers rights in medication decision is key in achieving recovery | Consumers understand their rights | |
Temporarily seizing consumers autonomy | |||
Theme 2: Expectation regarding the personal recovery process | Psychiatric medication (management of condition) | Adherence to psychiatric medication improve the recovery process | Becoming sober |
Reducing aggression | |||
Improving meaningful conversation | |||
Reducing degree of illness | |||
Economic empowerment | Participating in normative life is key in recovery services | Expecting employment opportunities (eg. vocational training) | |
Independent living | Attaining independent living | Regaining self-care and daily living skills | |
Attracting respect | |||
Moving around independently | |||
Social inclusion (integration) | Gaining social inclusion | Integration into families and communities | |
Making a meaningful contribution to families and society | |||
Participating in religious activities | |||
Social interaction (eg. entertainments) | |||
Theme 3: Challenges in achieving personal recovery | Systemic or management-related challenges | Set-backs affecting implementation of recovery services | Limited funds |
Infrastructure | |||
Poor feeding | |||
Limited medication supply | |||
Limited family support | |||
Inadequate MHPs | |||
Consumer challenges | Consumers faced individual challenges | Dealing with unreasonable behaviour | |
Uncooperativeness | |||
Non-adherence to medications |
Theme 1: recovery services offered to consumers
“The first thing is that you have to do Mental Status Examination to know what treatment plan you have for them. Secondly, when you draw the treatment plan you have to involve the family because they can give you the correct information on the consumer. So we first do the mental status examination and if the person has been to a different hospital, we write the medications down, and we also write if the family have a history of mental illness” (MHP 4; Psychiatrist, Facility 2).
“A nurse gave me treatment. The nurse tied my hand and took a sample of my blood [physical health assessment]. And they said only males are at where they took me. So I was brought here in the evening by car” (Consumer 14, Facility 2).
“When I arrived, they hold something which has been typed on paper. They looked on that to give me treatment. There was one nurse called Awurama [name]. She took care of me the first 3 months I came here n went back home” (Consumer 13, Facility 2).
“Initiation comes from the first point of contact, which is the psychiatric hospital or facilities they were. When they come, they come and continue with their medication, except that the person is not responding to that treatment or we need to reduce it for their improvement” (MHP 1; Mental Health Nurse, Facility 1).
“When we wake up every day, we do household chores, like scrubbing the toilet and mopping the tiles. Afterwards, we, eat breakfast prepared by the caterers of the facility, eat lunch in the afternoon and evening supper, then sleep if you want to, if not you can rest or watch TV chat with others and take medicine” (Consumer 16, Facility 2).
“I brush my teeth, have my bath and ease myself. If the matron is not around, I read my magazine till the time the matron will call us to come for our food (porridge) … I will be awake at around 10 am and eat. I will go back to the room and if no one is disturbing I will lie down on the floor and exercise myself because I am a sportswoman” (Consumer 13, Facility 2).
“In the morning when we wake up, we bath and dress up after that we go for our meals and later the bell rings for us to take our medicine so, after the medicine, we are all sent to bed. Sometimes we don’t even sleep we just seat there idle till evening or lunch” (Consumer 9, Facility 1).
“Every Monday we do group psychotherapy. We try to educate the psychotic patient. For the addicts, on Tuesdays, we choose one particular disease or a condition like malaria and talk about it. So after their breakfast, we gather them and talk. Sometimes we put them into groups and we share amongst ourselves. Also, for the drug addict, we do conflict management and coping skills for them. We have so many programs that we do” (MHP 3; Occupational Therapist, Facility 2).
“The cognitive behaviour therapy is to change the mindset. We believe if you change your thinking, it should change your behaviour., we have a deeper task which is one on one to look at things that have influenced you and your believes about taking the drugs or something and then we try and help you reconstruct it” (MHP 1; Mental Health Nurse, Facility 1).
“Apart from the normal routine activities, bathing, prayers, playing games, taking their medication, watching TV and having leisure time, we wanted to add occupation therapy and vocational training to fully reintegrate them into the community. But that has not been successful due to inadequate funds” (MHP 1; Mental Health Nurse, Facility 1).
Consumers’ involvement in the decision concerning recovery services
The MHPs felt that respecting consumers’ rights and involvement in decision concerning their lives are key in achieving personal recovery. These perspectives align with the principles of recovery-oriented practices, which support consensus in developing recovery goals and plan.“Most of them have insight so they are involved … Some of them know [the reactions of the medicine] because they have insight. Some of them also do not have insight so you have to put them on the start and then see their way forward” (MHP 5; Social Worker, Facility 2).
“ … a patient who has psychosis for the first time has no insight so he cannot make any decision. The law put it in this way that, at that particular moment, decision is going to be made for him. We decide because they can cause injury to themselves and others. So to take them out of the danger, their autonomy has to be seized temporary” (MHP 3; Occupational Therapist, Facility 2).
Expectation regarding the personal recovery process
“It’s helpful because without the medication we cannot stay with them (achieve personal recovery). We live with them based on the treatment. We believe that when they take medication, they become sober so we believe in the medication” (MHP 5; Social Worker, Facility 2).
“After the patient [we] is given medication, about one month, you would realize that the degree of the illness has reduced to the extent that you can have a meaningful conversation with him and he can do everything properly” (Consumer 4, Facility 1).
“As I am taking my treatment, to the glory of God, I will be better and well treated. I will be going home. And after that, I will be coming here for my treatment and when I go home I can start working. It will help me to abstain from wee [marijuana] smoking” (Consumer 2, Facility 2).
“Yes to go home and help them plant the maize because a season like June, July, August and September is very good at planting foodstuffs as compared to other months. (Consumer 11, Facility 2).
“Well, when I leave this place, I know how to sew clothes. I know how to sew clothes so when I leave this place, my aim is either to travel [go abroad] or be able to set up a shop where I would be able to work” (Consumer 4, Facility 1)
“I want to get well so I will go home and work … I want to be a hairdresser. I don’t know how to fix the wig but I can do other things” (Consumer 9, Facility 1)
“They use to do a lot of things but the turnover was poor because people [consumers] will produce a lower [substandard] product and they will sell at a lower cost. Liquid soap, for instance, the cost [market price] was around GHC 1[less than $1] but the people were selling it at the market place for 50p. So we were running at a loss, unless we get some support we can’t start again or invest in that vocational activity” (MHP 1; Mental Health Nurse, Facility 1).
“We expect that they can work for themselves and they will never depend on somebody. We are expecting that, after the rehabilitation, they can use the things that they learn from here to go out there to manage their lives without depending on somebody” (MHP 5; Social Worker, Facility 2).
“What I came here to seek … I have achieved it. I can go outside. I go to church at Grace Baptist every Sunday. Every Sunday I take a car from this place to Grace Baptist. So even on the days when I do not go anywhere, I can go out and take a walk. If I was still smoking the wee [marijuana], would I have been able to do all this? That’s why I was saying that, as I stay here, all that I wanted to achieve. I have achieved” (Consumer 4, Facility 1).
“That people will go to their home safe and sound and can interact with their family members normally, and participate in social life” (MHP 1; Mental Health Nurse, Facility 1).
“In their community, we do a community visit, so we go to them … I see them in their community often and also those who are working, we go to their workplaces. Some of them were working before their condition, so we try and go to their workplaces and see how they are working” (MHP 5; Social Worker, Facility 2).
“Apart from the medications to give them sound mind, recreational therapy has an impact on their socialization. When they play the game together, they love each other and are happy so relating with others in the society will not be a big issue anymore” (MHP 1; Mental Health Nurse, Facility 1).
Challenges in achieving personal recovery
“The major problems we have are feeding and drugs. Because our perception [about mental illness] is wrong, people do not even know they have to support their wards [consumers]. When they [family carers] bring them, they will never come back. We cannot live with them without giving them medication, so we use the little money we have to buy them medicine” (MHP 5; Social Worker, Facility 2).
“Here the feeding is poor, where we sleep is also not comfortable. If you should go to my room, I am a neat person, so I can keep it tidy. But if you should go to some of the places where the other patients sleep, there isn’t even light there, bedbugs … and when we talk about feeding, we can eat some kinds of rice” (Consumer 4, Facility 1)
“They don’t have that much money to cook foods as you would have at home. They can’t make it for you as you would have it at home” (Consumer 4, Facility 1)