COMMUNITY-BASED PSYCHIATRIC SYSTEM AND MANAGEMENT OF SCHIZOPHRENIA IN SOUTHWESTERN NIGERIA

Abstract

Regimented treatment of People with Schizophrenia (PwS) in hospitals stigmatises and hinders their full recovery and makes their reintegration into the society difficult. Previous studies have focused mainly on the bio-medical model of management of PwS with little attention paid to the social dimension of its management. Community-based Psychiatric (CBP) Systems is a model of care that adopted de-institutionalisation of psychiatric care with global acceptance. This study, therefore, examined the social and community-based components (stigma, burdens and culture) of the management of people living with schizophrenia in southwestern Nigeria. Structural-Functionalist Theory and Health Belief Model provided the framework. The cross-sectional descriptive survey design was adopted. Southwestern Nigeria was purposively selected because the region is reputed for having the highest deployment of collaborative community-based psychotherapy in the country. Oyo, Ogun and Ekiti states with community-based psychiatry were purposively selected. One urban and one rural area with CBP facility with Mental Health Personnel (MHP) were purposively chosen from each State. Three hundred and twenty eight family caregivers of PwS across the six CBP facilities were proportionately selected in Ogun (120), Oyo (112) and Ekiti (96) States. A standardised WHO questionnaire was adapted to elicit information on socio-demographic characteristics, knowledge about schizophrenia, reaction to stigmatisation and stereotyping, utilisation and people’s satisfaction with CBP. Twenty four focus group discussion and 33 key informant interview sessions with selected community members and MHP were conducted respectively to complement information on the care and appropriateness of CBP services. Quantitative data were analysed using percentages, Chi-square and multi-nomial logit regression at p≤ 0.05, while qualitative data were content analysed. The mean age of primary caregivers was 40±20 years; respondents were mostly female (61.6%) and employed (60.3%). Caregivers’ knowledge about the etiology of schizophrenia due to mental affliction (20.7%) and that it is incurable (61.0%). The PwS were regarded as dangerous (30.5%) and perceived as failures (35.1%) but not considered suicidal (91.2%). About half (50.9%) claimed that health workers showed concern for PwS, 82.0% were satisfied with the care in the CBP, while 50.3% believed in the effectiveness of the treatment received from CBP. Patients stayed more with their mothers compared to the fathers (z=2.967), and individual who visit traditional healers before hospitalisation (z=1.87) were more likely to be stigmatised. Social acceptance (β=.19;t=3.20), perceived stability (β=.23;t=3.54), and social stigmatisation (β=-.17;-2.60) predicted the adequacy of community-based treatment [F7,320=9.60, R2 =.17]. Participants perceived PwS negatively, tracing schizophrenia to spiritual attack or punishment inflicted by humans. Social distance (avoidance) was the major reaction of people towards PwS and such category of people were regarded as weak, violent, worthless and uninformed. People believed in the effectiveness of CBP in addressing spiritual problems which are not within the realm of orthodox psychiatric therapy. The CBP services were also considered more humane, integrative and robust. The community-based psychiatric system was perceived to reduce stigmatisation and stereotyping; Therefore there is the need to create awareness and sensitisation about the curability of schizophrenia and increase the capacity of stakeholders in community-based psychiatric care in southwestern Nigeria.