Closing the mental healthcare gaps that leave hundreds behind

Embedding mental healthcare into the country’s public health system is crucial to ensure that South Africans living with severe mental health conditions (SMHC) are not left behind after being discharged from psychiatric facilities.

That was the conclusion of Fadia Gamieldien, a PhD candidate in the University of Cape Town’s (UCT) Department of Psychiatry, whose research examined the barriers that hinder personal recovery for those living with SMHCs, like bipolar mood disorder, severe depression and schizophrenia, especially after their discharge from psychiatric facilities.

“While a form of integration is seen as a way of making mental health part of general health, the system is still too focused on clinical recovery (medication adherence and symptom reduction). The current system fails to include interventions that support MHSUs [Mental Health Service Users] to meet their personal recovery goals,” she said.

The result, she cautioned, was that the perspectives of MHSUs on their personal recovery were not prioritised, diminishing how they find meaning and purpose in life beyond their diagnosis.

Currently, the public health system requires that MHSUs collect their medication from the nearest primary healthcare facility after being discharged. Despite a desperate need, they are however offered very little psychosocial support by trained mental health professionals to manage their reintegration into their communities, and facilitate their path to recovery.

Research snapshot

For her research, Gamieldien, who currently works as a senior clinical educator in the Division of Occupational Therapy in the Department of Health and Rehabilitation Sciences, interviewed MHSUs previously diagnosed with SMHCs, who had been discharged after spending a significant time in acute psychiatric facilities.

Their responses revealed that clinical recovery dominates mental healthcare, limiting delivery of much-needed interventions that facilities are willing to offer as part of their packages of care.

Gamieldien’s research-gathering process followed a mixed-method approach, comprising a scoping review to examine available literature on how recovery is conceptualised by stakeholders in low- and middle-income countries; a qualitative, descriptive study design that included semi-structured interviews and focus group discussions with mental healthcare service providers and non-profit organisations (NPOs); and interviews with several male MHSUs and their caregivers, all from the Western Cape, to hear first-hand accounts of their recovery process.

She also conducted a review of the feasibility and psychometric properties of the Recovery Assessment Scale (RAS), one of the most commonly used recovery measures in recovery-orientated practice for people with mental health conditions.

“Recovery only really starts after their discharge … and we need to ensure that they receive proper care and support.”

“MHSUs and their caregivers indicated that long-term relational and psychosocial support, including community-based services outside the hospital setting, is vital for their recovery and for their reintegration into communities. Recovery only really starts after their discharge, not while they are admitted into hospital, and we need to ensure that they receive proper care and support to further aid this crucial process,” Gamieldien said.

NPOs a guiding light

Her research showed further that mental-health-focused NPOs were a guiding light for people with mental health conditions, their programmes playing a fundamental role in MHSUs’ recovery process. These initiatives provided access to psychosocial support, as well as a range of skills development programmes and projects aimed at building interpersonal and communications skills, to facilitate and aid recovery.

According to research participants, these programmes provide a safe space and allow room for capacity building and meaningful engagement. A further important benefit was that these NPO interventions have the capacity to identify and manage potential relapses, they said.

“Thanks to these initiatives, one of my groups indicated that the last time someone had a relapse was about 10 years ago, and 20 years ago respectively. So, these services are so beneficial to MHSUs. But they are not routinely available and accessible as part of the community’s rehabilitation services. Many communities don’t have them, and this is how hundreds of service users fall by the wayside,” Gamieldien warned.

Cinderella of healthcare

It’s no secret, she added, that mental healthcare is referred to as the ‘Cinderella’ of healthcare, a situation that needs to change. Her research sheds some much-needed light on gaps in the system, showcasing exactly how MHSUs and their caregivers experience care following discharge, and providing insights into what is needed beyond healthcare facilities.

“The COVID-19 pandemic reminded us that mental health is community wealth and should be everyone’s business. As health practitioners, we must collaborate with people who have lived experience of SMHCs in order for us to rethink and redevelop a system that suits everyone’s needs,” Gamieldien said.

“We continue to learn from and with MHSUs, who are experts through their own lived experience.”

Her findings also challenged the conventional definitions of recovery, she said, highlighting the need to co-create person-centred, contextually relevant, community-based recovery-focused services. She hoped her work would influence stakeholders involved in mental health policy development and implementation to reexamine the current system, with a view to providing additional support measures for MHSUs after their discharge from psychiatric facilities.

“We continue to learn from and with MHSUs, who are experts through their own lived experience. I hope this research fosters co-creation of relevant community-based services built from the ground up. By raising awareness of the value of personal recovery, I hope to contribute to developing recovery-focused mental health services within communities in our country, to offer the long-term relational support so vital for personal recovery from severe mental health conditions,” she said.