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

[摘要] ENGLISH ABSTRACT: This dissertation explores care for people with psychosocial disabilities in a rural area in theEastern Cape province of South Africa.In Low and middle-income countries, including South Africa, the gap between the need formental health services and available services is critical. Reasons for this have been said to belack of priority at policy level, lack of equipment, personnel, and medication, and low mentalhealth literacy. As a result, the majority of people with psychosocial disabilities are notdiagnosed or treated. In order to close the gap between need and provision, there is a call formore community based mental health services, for task-shifting and a move towardsrecognising 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, butarguably also includes assistance with daily tasks, companionship, conversation and intimacy.Explanatory models for psychosocial disability are crucial in care seeking, diagnosis, treatmentand cure. As such, the theoretical points of departure for this dissertation are the concepts ofpsychosocial disability and care.The aim of this study was to explore practices, views, knowledge and experiences related tocare 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, butmethodologically different parts, namely a contextual part and a case study part. Theoverarching methodological principles are the same; they are both anchored within aqualitative, explorative research design.The dissertation has found that in the context of psychosocial disability in Madwaleni, care ismuch broader than health care, and about much more than curing illness or looking aftersomeone who is ill or dependent. In an attempt to improve mental health, and prevent, treatand cure mental disorder, it is essential to apply a broad definition of care. We need to rethinkhow we deliver mental health services, moving away from care as pacifying, to care asactivating. Care must be integrated into real-world settings. The global mental health literatureemphasises shifting the focus of mental health care from cure to promotion and prevention. Italso stresses the value of using an interdisciplinary team of lay and trained health workers fromthe professional, folk and popular sectors. This strategy needs to be complemented by otherstrategies, for example, integrating mental health into other projects focussing on sustainable livelihoods and development of infrastructure. The challenges are complex, as this small studyshows, but it is only by looking closely at local conditions that it is possible to develop culturallyand contextually appropriate interventions and make optimal use of local resources.

[发布机构] Stellenbosch University