Development of a strategy to promote effective management of mental health care users in mental health establishments in Limpopo Province, South Africa

Abstract

Introduction and background Mental health is a state of well-being whereby individuals can realize their own capabilities, cope with normal stressful situations in life and work productively while contributing to their communities. The prevalence of mental health disorders is increasing in global populations, more especially so in low-income countries. Treatment of people with mental disorders is also very poor in most countries as many mental health care users are discharged prematurely from the mental health establishments before they have fully recovered due to lack of infrastructure and human resources to deal with mental health problems. Aim The study aimed to develop a strategy to promote effective management of mental health care users in mental health establishments in Limpopo Province, South Africa. Objectives The objectives of the study were to: explore the views and experiences of mental health care users related to the provision of care, treatment, rehabilitation, rights of mental health care users in the mental health care establishments in Limpopo Province; explore the views and experiences of mental health care providers caring for mental health care users in Limpopo Province; develop a strategy to promote management of mental health services in Limpopo Province and to develop a plan for piloting the developed strategy for managing mental health services in Limpopo Province. Methodology The study was guided by modified PRECEDE-PROCEED model. The study comprised of two phases, which were the needs assessment and development of a strategy. Phase 1 covered the needs assessment and was conducted in three stages. In the first two stages, the convergent mixed methods approach was used and ran concurrently (qualitative, quantitative) and the third stage was the integration of data. The study was conducted at 13 selected mental health establishments in the five districts of Limpopo Province. In the qualitative study of mixed method research, non-probability purposive sampling was used to select 34 mental health practitioners, and 19 stable mental health care users. An unstructured interview guide was used to conduct in-depth individual face-to-face interviews and trustworthiness was ensured throughout the study through the application of credibility, dependability, conformability and transferability. Data were analyzed using the eight steps of Tesch’s open-coding. In the quantitative approach of mixed method research, a convenient sampling was done to sample 339 respondents and a self-administered questionnaire was used to collect data whereby only 305 questionnaires were received. Validity and reliability measures were applied and ensured throughout the study. Data were analyzed using the Statistical Package for the Social Sciences, version 26.0. In the third stage, the integration of the results was done where both qualitative and quantitative data were merged using side-by-side comparison and interpretation of data done, followed by discussions. Phase 2 covered strategy development and the development of the plan to pilot the developed strategy. The diffusion of innovation theory was incorporated in the development of the strategy and, again, the PRECEDE-PROCEED model was used to address the plan to pilot the developed strategy. Ethical considerations were followed throughout the study. Results Six themes emerged from the qualitative data analysis and they were confirmed by statistical evaluation of quantitative data where a convergent parallel mixed method was noted. Six themes emerged, including structural-related challenges, inadequate management of mental health care users when admitted, improper application of safety measures in the wards, poor mental health care user support, insufficient knowledge regarding mental health care and strategies to improve the management of mental health care users. The strategy to improve the mental health services in the Limpopo Province was then developed with the stakeholders, who were the members of the district mental health forum. The strategy components included: increased knowledge and encourage a healthy attitude about mental health, improve social environment, improve and develop social skills of mental

health care users and improve self-efficacy to obtain and take treatment by mental health care users. Recommendations The recommendations were outlined, based on government, policymakers, education and practice, and further research. It is also recommended that the pilot and process evaluation of the developed strategy be carried out.