Johanita Strumpher

Help-seeking behaviour, barriers to care and experiences of care among persons with depression in Eastern Cape, South Africa

BACKGROUND Little is known about the help-seeking behaviour and barriers to care among people with depression in poor resource settings in Sub-Saharan Africa. METHODS This is a cross-sectional population-based study including 977 persons aged 18-40 living in the Eastern Cape Province in South Africa. The prevalence of depression was investigated with the help of a questionnaire (the Mini International Neuropsychiatric Interview). Several socio-economic variables, statements on help-seeking and perceptions of earlier mental health care were included. Data collection was performed from March to July 2012. RESULTS The prevalence of depression was 31.4%. People aged 18-29 and those with no or low incomes were less likely to seek help. Promotive factors for help-seeking included having social support and tuberculosis comorbidity. Of all people with depression in this sample, 57% did not seek health care at all even though they felt they needed it. Of the variety of barriers identified, those of most significance were related to stigma, lack of knowledge of their own illness and its treatability as well as financial constraints. LIMITATION Recall bias may be present and the people identified with depression were asked if they ever felt so emotionally troubled that they felt they should seek help; however, we do not know if they had depression at the time they referred to. CONCLUSIONS Depression is highly prevalent among young adults in the Eastern Cape Province, South Africa; however, many do not seek help. Health planners should increase mental health literacy in the communities and improve the competence of the health staff.

BARRIERS TO ACCESSING MENTAL HEALTH CARE IN THE EASTERN CAPE PROVINCE OF SOUTH AFRICA

The aim of this study was to explore and describe the perceptions of professional nurses concerning barriers to care for people with mental illness in the Eastern Cape Province, South Africa. The study was based on a qualitative, explorative and descriptive design. A total of nine professional nurses working in primary, secondary and tertiary health care facilities were purposively selected. Unstructured interviews were conducted to collect data. Participants’ responses were captured on an audio recorder and later transcribed verbatim. Participants’ responses were then analysed thematically. Two main themes and their related sub-themes were identified. The first theme concerns the perceptions of professional nurses regarding the societal barriers that may hinder people with mental illness from accessing and utilising mental health services. These barriers include socioeconomic hardships, lack of knowledge and insight, lack of family support, embedded cultural beliefs and practices and stigma. The second theme highlights the barriers that professional nurses perceive within the health care system that influence access and utilisation of mental health services. These barriers include inadequate support from stakeholders and leaders in the mental health sector and lack of financial, human and infrastructure resources. Professional nurses made recommendations to improve mental health care. Those of high priority included enhanced mental health literacy among members of the public and a need for mental health stakeholders and leaders to increase their support of the mental health sector in an effort to improve access to mental health care.

Can community volunteers work to trace patients defaulting from scheduled psychiatric clinic appointments

To the Editor: Mental illness is set to become the second largest source of economic and social burden worldwide by 2020.

Perceptions of mental healthcare professionals regarding inpatient therapy programmes for adolescents in the Eastern Cape, South Africa

Objectives The study aimed to explore and describe the perceptions of mental health professionals with experience working in psychiatric hospitals regarding inpatient therapy programmes for adolescents. Methods The study followed a qualitative, exploratory, descriptive and contextual design. The research population included various mental healthcare professionals with experience working at psychiatric hospitals in the Eastern Cape. Purposive sampling was utilised and semi-structured interviews were conducted. Teschs eight steps of data analysis were followed and Lincoln and Gubas model of trustworthiness was utilised. Results Two main themes emerged from the research. The first considered the unique skills and contributions of mental healthcare professionals to an adolescent programme. The second theme acknowledged the need for adolescent therapy programmes to be holistically structured in order to be effective. Conclusions The findings showed that inter-professional collaboration is an important aspect of successful inpatient adolescent therapy programmes. Such programmes benefit from the involvement of a wide variety of professionals. However, professionals who are part of a multi-professional team need to be suitably skilled and prepared to meet the needs of the adolescent. Professionals working in therapy programmes for adolescents should have certain personal attributes that make them suitable for working with adolescents. An adolescent inpatient therapy programme requires a team leader or a coordinator to lead the programme to ensure its success. Continuous assessment of each adolescent is essential. Therapy should take place in an adolescent-friendly environment and should be structured yet flexible. The involvement of the adolescents’ families is critical, and the programme should be designed with the family in mind. Group therapy is a major component of an adolescent therapy programme and individual therapy is also an important aspect of the programme. Finally, adolescents should only take part in the programme for a short time to avoid institutionalisation.

Overcrowding as a possible risk factor for inpatient suicide in a South African psychiatric hospital

About 4% of all suicides are estimated to occur while being an inpatient in a psychiatric facility. Staff generally assume that an inpatient suicide reflects a failure on their part to recognise the patient’s suicidal intent and whether it could have been prevented in any way. Inpatients who commit suicide do not seem to be a homogenous group, but some risk factors have been identified, including being young, single, male, unemployed, abusing substances, schizophrenia and personality- and affective disorders. Number of admissions in the previous month also appears to be a risk factor. When the numbers of inpatients are high, more violent incidents occu. Although literature presently do not suggest an association, overcrowding in psychiatric inpatient wards should be considered a risk factor for inpatient suicide.