How to Help Family Member With Mental Illness

• Research article
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• Published: xiv May 2016

The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: a qualitative urban based study in Dar es Salaam, Tanzania

BMC Psychiatry volume sixteen, Article number:146 (2016) Cite this commodity

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Abstract

Groundwork

Mental affliction may cause a variety of psychosocial issues such as decreased quality of life of the patient'south family members as well as increased social altitude for the patient and the family caring for the patient. Psychosocial challenges are enhanced by the stigma attached to mental affliction, which is a problem affecting not only the patient simply also the family as a whole. Coping mechanisms for dealing with mentally ill patients differ from 1 family to another for a diverseness of reasons.

The aim of the study was to decide the psychosocial problems of mental illness on the family including the coping strategies utilized past family unit members caring for a person with mental illness.

Method

A qualitative study was conducted, involving four focus group discussions and 2 in-depth interviews of family unit members who were caring for patient with mental illness at Temeke Municipality, Dar es Salaam. Purposive sampling process was used to select participants for the report. Audio-recorded interviews in Swahili were conducted with all written report participants. The recorded interview was transcribed and qualitative content thematic analysis was used to analyse the data.

Results

Financial constraints, lack of social support, disruption of family functioning, stigma, discrimination, and patients' disruptive behaviour emerged equally the principal themes in this report. Acceptance and religious practice emerged as the major coping strategies used by family members.

Determination

Familial care for a person with mental illness has its advantages, yet it has multiple social and psychological challenges. Coping strategies and skills are of import for the well-existence of the caregiver and the patient. Addressing these psychosocial challenges requires a collaborative approach betwixt the wellness care providers and government and then that the needs of the family unit caregivers and those of the patients can be addressed appropriately.

Background

Globally, it is estimated that 450 one thousand thousand people are affected by mental disorders at any one time. These include 121 million people with low, 24 million with schizophrenia and 37 million with dementia [ane]. Mental illness deemed for most 12.three % of the global burden of illness in 2001 and it is estimated that by 2020 unipolar depressive disorders will exist the second well-nigh important cause of disability [2]. The brunt of caring for mentally ill patients falls on the family members who provide all necessary support.

Evidence from developing countries is scarce; some countries bear witness a higher prevalence of psychiatric patients living with families. In Uganda for instance, the Uganda National Health Statistics (UNHS) of 2005/06 reports that of all households with disabled members, 58 % had at least one person with a mental disorder. To engagement, Tanzania lacks established statistics on families afflicted by mental illness.

Virtually mentally ill patients usually consult traditional healers and the reasons for not attending health facilities still remains unclear [iii]. Behavior regarding the cause of mental illness may be i of the reasons for non seeking healthcare. Well-nigh family members view mental illness not as disease, but as a curse; a product of both witchcraft and evil spirits of which the patient himself is counted equally the main contributor [4]. It is likely that mental illness is severely underreported resulting in many untreated patients. Withal, in all cases, family members bear much of the brunt of the patient'south mental illness and this affects them psychologically and socially [v].

Psychosocial problems

Mental affliction may cause a variety of psychosocial problems such as decreased quality of life for the patient'south family members, too every bit increased social distance for the patient and the family unit caring for the patient. The family unit members who intendance for relatives with mental illness report feeling stigmatized as a issue of their association with the mentally ill [six].

Persons with serious mental illnesses often engage in behaviours that are frightening, troublesome, disruptive, or at least abrasive, and many relatives are obliged to control, manage, or tolerate these behaviours [7]. Thus, psychiatric professionals ofttimes view the family members of a patient as people of support considering they can act as informants regarding the patient and they tin can deed as co-therapists at home [viii]. The family members need to be in an optimal social and psychological state. It is reported that reduced function of one family member contributes to the burden of other members and this in turn leads to other family unit members assuming a critical attitude towards the patient [9]. Such criticism can in some cases pb to a relapse of the patient'southward illness or to the family feeling overwhelmed by the patient'due south disruptive behaviour [6, 10].

Social back up is important for the wellbeing of the family afflicted past mental disease. A research finding reveals that families should assume major roles in supporting relatives with mental illness; and collaborative plans should include strategies to help family members and consumers in dealing with stigma [11]. There is a relationship betwixt caregivers' social back up and stigma associated with relative with mental disease. For instance, in a study investigating the links between stigma, depressive symptoms and coping amongst caregivers, it was found that stigma may erode the morale of family caregivers and result in withdrawal from potential supporters [12]. This statement supports the situation of families affected by mental disease in Tanzania as many families with mentally sick members hide the patient to avert stigma and beingness socially discriminated. Information technology is not known what psychosocial bug affect family unit members caring for their relative with mental affliction in Tanzania.

Family coping and adaptation

Coping differs from one family to some other for a diversity of reasons. In developed countries, some researchers have emphasized coping every bit a key concept for the report of adaptation and mental health [thirteen, 14]. However, the effects of age, elapsing of illness, living arrangements and other contextual factors on the coping styles of family caregivers, and on the recovery or rehabilitation of persons with mental illness are important factors to be considered [14].

In this case, family caregivers have to learn and empathise the patient's characteristics and behaviour. Coping with symptoms such every bit delusions, hallucinations, inappropriate behaviours, and violence may frequently require lengthy, circuitous, and pitiful negotiations. Over-burdened caregivers employ less effective coping strategies, report more frequent physical and mental health problems and use services more oft [15].

In the Tanzanian context, still, information technology is unclear how family unit members cope with the mental disease of their relatives.

Information technology is important to know how the family struggles to cope with the stressful situation and then as to be able to help the family unit with mental illness. This written report examined the psychosocial problems and coping strategies of families living with a person with mental illness within Temeke Municipality, Dar es Salaam.

Methods

Study design

The study used an explorative qualitative approach. Information was obtained from individual families living with mentally sick persons regarding the issues and coping strategies utilized.

Setting

The study was conducted in Dar es Salaam, which is the largest commercial city in Tanzania. The urban center has a population of more than four meg and has diverse socio-cultural characteristics equally a result of significant rural to urban migration. This region consists of a mixture of tribes mainly from southern Tanzania.

Sample size and sampling procedure

14 participants were recruited using purposive sampling on the clinic days at Temeke Municipal Infirmary in the Outpatient Clinic of Mental Health and Drug Abuse. Family members escorting the patient with mental disease to the clinic and who met the criteria were asked to participate in the study. Temeke Municipal Hospital does not admit psychiatric patients; therefore those patients who need access are referred to Muhimbili National Hospital, which is also situated within Dar es Salaam. Sampling was done to the point at which no new information was obtained from participants and redundancy was accomplished, referred to every bit data saturation. During the interview nosotros identified ii participants who seemed to exist reserved, and were not active participants. Nosotros interviewed them separately after the Focus Group Discussions in club to obtain their views and experiences.

Selection criteria

Participants were selected according to the following criteria:

1. one.

   Caregiver living with relative who had been suffering from mental illness for more than than half dozen months.

2. two.

   Caregiver is eighteen years or older

3. 3.

   Caregiver is the main caretaker.

He/she was explained briefly the nature of the written report before being asked to participate. All who agreed to participate were asked to provide contact data to make up one's mind on an advisable twenty-four hours for the interview.

Upstanding approval

Ethical clearance was obtained from the Muhimbili University of Health and Centrolineal Sciences Ethics and Publication Committee. Further permission and blessing was obtained from the Temeke Municipal Medical Officer in charge. Before the interview started, the informants were given a full explanation of the information collection process. Each participant was fully informed and understood the nature of the report and voluntarily agreed to participate. The written consent form was read, understood, and signed by the participants. Those who were not able to write were requested to provide verbal consent. However, all were able to read and write and therefore signed the consent class. Participants were informed that they could go along to utilise the health service as usual. Confidentiality was guaranteed by maintaining anonymity of all caregivers who participated in the written report. Freedom to withdraw from the report at any time was ensured.

Information collection

4 focus group discussions (FGD) and 2 in-depth interviews were carried out due to the fact that more than detailed information was needed in order to go the psychosocial problems and coping strategies of families caring for patients with mental illness. Data were nerveless through audio-taped interviews, which lasted for 55 to 60 min for focus groups discussions and 30 to 45 min for in-depth interviews. Four FGDs were conducted at the hospital. Each FGD consisted of 3–four members. The aim was to go at least 6–8 people merely information technology was not possible for a variety of reasons including bug with transportation At that place was no categorization of the group participants. Both sexes were mixed during the interview and they were from dissimilar areas of the Dar es Salaam region. The in-depth interviews were conducted in the participants' dwelling house environments. This provided an opportunity for the researcher to observe the living situation of the caregiver and the patient. The participants in this category were identified during the interview as those who were not actively sharing their views in the group discussions. They were then asked to participate in an interview in their dwelling environment.

Information collection was guided by the post-obit five structured questions.

1. one.

   What is the experience of caring for your mentally ill relative?

2. 2.

   What issues do you face when caring for the mentally ill relative?

3. iii.

   How practice other relatives assist you to care for the mentally ill relative?

4. 4.

   What are the attitudes and views of the people effectually you concerning caring for a person with mental illness?

5. 5.

   How do you cope with such problems?

The structured questions were followed past specific probing questions in gild to obtain more data or clarification. The discussions and interviews were conducted in Kiswahili, the national language which was easily understood by all informants. During group discussions, the principal investigator moderated the discussion while a enquiry banana was taking notes, operating the audio recorders and taking intendance of any interruptions. Observations of non-exact reactions were collected during and after the discussion. Field notes were composite with the recorded data during analysis.

Data analysis

Content thematic analysis was used in order to gain a deeper and clearer understanding and a formation of themes. Audiotaped focus grouping discussions and in-depth interviews were transcribed verbatim in the original Kiswahili language. The principal investigator transcribed the audiotaped information by typing directly into the computer using the Microsoft Word program. This helped the researcher to correlate the tone of the informants in the sentence with the feelings and emotions, which were of importance to the analysis. In the process of transcription, the informants' words were captured as closely every bit possible. To brand certain that the data were transcribed correctly, the transcripts were checked against the audiotape and then reviewed past a person who was also expert in Kiswahili. Interview notes and ideas were jotted down and the transcripts were read several times and then that the researcher could be immersed in the data.

The unit of analysis was the themes expressed in the text about social and psychological issues found in families caring for persons with mental illness. Iterative reading of the interview transcripts was done. Pens, highlighters and memos were used during analysis. Different colours were used to highlight the patterns in the text, which corresponded to the preconceived category derived from the report objectives. In both margins of the hard copies of the transcripts, the patterns were jotted downward in a crystallised meaning (condensed significant) which were then transferred to a different sail of newspaper for further analysis. Memos were used to summarize the patterns of the condensed meaning earlier transferring to the principal canvas. To identify the source of data in the memo and in the text, identification numbers of informants were used when transferring the condensed meaning to the master canvas, so that the source could be hands traced and accessed. On this sheet of paper, coding schemes were developed with the abstracted categories and themes. Different categories, condensed pregnant units, or codes were compared for underlying meanings and relationship at the interpretation level, which formed the themes (Tabular array 1).

Table one Some excerpts of coding scheme resulted in theme germination

Full size table

Field notes were also analysed separately whereby the patterns and categories were compared to those from the FGDs and in-depth interviews.

The two lists of categories were generated and compared and adjustments were fabricated to the words used in the labelling of the categories. Transcripts were read again alongside with the list of the categories to ensure that the interviews had been transcribed. All the transcripts were so coded according to the list of categories and the coded sections of the transcripts were collected so sorted. Verbatim examples were used as evidence for each theme and categories.

Results

Characteristics of informants

A full of 14 family caregivers (informants), whose age ranged from 35 to 60 years, were interviewed. Five informants were men and 9 were female. Four informants identified as Christian and ten identified equally Muslim. Most of the informants had gone to primary school and a few had received secondary level education. Five informants were housewives, that is, they were married with no source of income except that of their husbands while five participants were petty traders' i.e. were doing pocket-sized business organisation (Table two).

Table ii Characteristics of informants

Full size table

Characteristics of patients

The informants who participated were caring for ill relatives with different types of mental affliction including schizophrenia, bipolar disorders, autistic disorders and epilepsy with psychosis. The duration of relatives' disease ranged from 7 months to 27 years. All the caregivers were living with the patient in the same household and nigh of them were parents.

Themes identified

After analysis, seven main themes emerged from the data.

Fiscal constraints

Financial constraints were a business concern for almost all participants. They said they had limited time to piece of work in order to earn money considering most of their time was spent caring for their relative. The amount of coin earned from limited working time was used to help care for the relative, such equally buying charabanc fare to the hospital, purchasing medications, and other activities for the patient.

Cost for transport

Nigh informants expressed concerns about fiscal strain acquired by increased cost for patient care, which was coupled with decreased working hours. Most of the participants were living a considerable distance from the hospital, they had to travel either past taxi or by public transport for patient follow-upwards. This caused most caregivers to take multiple financial crises with the small amount of money they had. For psychotic patients, some used to take taxi only the easiest and nearly accessible transport was public buses (daladala). The most of import business concern was how to go the coin for the transport. Some failed completely to come to the hospital for more than ii or more months and other caregivers sometimes used their other relatives to collect the medication at the clinic equally reported by ane of the respondents caring for her elder sister with schizophrenia:

"Like that day I sent my brother-in-law, and told him; accept this patient's register book because you are going there, I don't have the bus fare for going to the infirmary just to collect the medicine." (46 year quondam sister).

Toll for medication

In addition to cost of transportation, it was revealed that shortage of medicine in the infirmary compromised the treatment system of the patient. Medication was expressed as a major contributor to a patient'due south comeback. For example, the informants whose ill relative used more ii types of medication were rarely getting the 2d medication from the infirmary and consequently had to purchase it in private pharmacies. Equally a result of lack of coin, they used only one blazon of medication due to the carer's inability to buy the second drug. This was reported by an informant caring for his son with schizophrenia:

"……and when y'all come up the adjacent calendar month, you are told; again, we don't have this type of drug, so yous are given the simply one, okay! Then the patient uses the one type of drug considering no money to buy the second drug." (58 years old male parent).

The psychotropic medications are unremarkably provided free of charge by the government hospital. However, not all are available in the government pharmacies and thus patients demand to buy from private pharmacies. In this case patients reported that drugs were so expensive that those who managed to buy them had to sacrifice other household needs so that the patient could get the drug to foreclose the disruptive behaviour:

"My principal trouble is money to buy the drug. They (doctors) have changed the medication, just imagine, a unmarried monthly dose now costs forty thousand shillings (40,000/=) and she uses three dissimilar types of drugs……we ought to abandon other household issues to buy the medication because if she does not apply the drugs for 2 or three consecutive days, you lot find that no peace at home". (51 years old female parent).

This theme occurred even in patients using one type of drug. Some informants expressed that even if the patient had i type of drug which was not available at the hospital, the patient had to expect until they get the coin to buy it. This was expressed every bit a causative risk factor for frequent relapse of patients' symptoms as a event of inappropriate dosage regimen.

The informants expressed that their relative's disruptive behaviour needed to be prevented by regular employ of medicine. Lack of money for transportation and medication for the patients was suggested to be the main impediment to the patient comeback.

Disruption of family unit functioning

Family unit functioning is the power of the family unit to continue with daily activities despite an internal or external threat. Most participants expressed disturbances in their normal routine as a outcome of having a mentally ill person in the household every bit explained beneath:

Disrupted household routines

Disruption of household tasks and other responsibilities were important sources of distress revealed by many caregivers. Unpredictable patient symptoms seemed to exist a sad factor which limited caregivers' time for other family responsibilities. Parents of patient with mental illness had multiple roles including caring for the patient too as making sure that other family members were getting their needs met. One caregiver whose ill relative was totally dependent said that she devoted most of her time doing activities for the patient. This affected the family caregiver income and hence made life more than difficult as expressed by i of the respondents:

"So far, I am no longer doing whatever work, my work has been compromised by staying at home all the fourth dimension caring that 1 (the ill daughter); no any more piece of work to practise. I accept to requite medication, making certain she is safe and my properties are safe" (51 years old mother).

Another one added:

"Actually I am affected …….you ought to remain at home to protect him probably unanticipated catastrophe may occur. If you lot attempt to become out to do your piece of work, you get anxious because he (the patient) may be vehement." (42 years one-time father).

Most parent caregivers stated that it is their responsibility to intendance for the patient because information technology is their child who is suffering and they cannot give to anyone else. Because they have to work, some caregivers reported locking in the patient when they needed to get out for daily activities. One caregiver aged 59 years one-time caring for her son with autism expressed that, "even this time I am here; I accept locked in my son in his room until I come back." She insisted that the patient is totally dependent on her and that he is unable to limited his needs. Although some informants said that they take other family members living in the aforementioned household, they contribute trivial to intendance of the patient.

Lack of family harmony

Resilience in the family was also affected past the patient'southward disruptive or by family members disagreeing about the management of the mentally ill relative. One caregiver expressed business about her husband by saying:

"...........He uses abusive language to my son because his is mentally sick only he does not show such behaviour to the children. We e'er quarrel for that reason" (50 years old mother).

Other informants revealed that a frequent source of misunderstanding revolved around how to find solutions to the patient's issues. It was revealed that one parent/member may seek out help from a traditional healer for treatment while the other may seek out spiritual handling. However, most caregivers resolved to seek out professional handling.

Confusing behaviuor of patients

Problems in managing patients' symptoms

Participants had difficulties in managing patients' symptoms. They expressed concern that at that place was no one else who would exist able to handle the unpredictable behaviour of the patient. They were the only one who had learned how to handle the patients' behaviour; therefore, they had to remain at domicile to protect the patient and other people from patient's uncontrolled behaviour. The majority expressed fright of being attacked by the patient every bit well as business organisation for safe of the patient as elaborated beneath:

"I have got many problems with my patient because, he is very strong and fat and his intention is to kill me and his father. The problem which I get is that I can't even chop onions in public, I always do that in the locked room, and all knives and everything are subconscious in the closet." (51 years erstwhile mother).

Some other informants expressed that they had to be modest and humble when talking with the patients. They revealed that some family members do not bother to learn nigh the patients' behaviour and how to handle him or her when agitated. Thus leaving care of the patient to the main caregiver despite the dangers to that person.

Patients' safe

A good number of caregivers expressed concern about condom of the patients who at times aimed to attack and kill others or themselves as echoed by a 35 year old man caring for his young brother with paranoid schizophrenia:

"………there is a twenty-four hour period he will succeed to kill, if not to kill him, he may be killed, because I can prevent him from attempting to hurt me, unfortunately he can hurts himself." (35 years onetime brother).

Business concern by family members for the safety of the mentally ill relative caused many to experience anxiety especially when the relatives go lost in the street or when they become confusing and violent. Parents caring for epileptic patients stressed that when their ill children get out, they did not remember to return home. The caregivers had to take time and effort to await for the patient everywhere. Some patients were reported to go lost for several weeks.

"That day I told him to go home alone, but he was lost for about a month, I mean he did not return home. Afterwards looking for him for two weeks, I constitute him in the social beach nigh a deep h2o level" (56 years old father).

Participants reported that patients were more ambitious and violent when they practise non take their medication and this was a mutual problem provided that some medications had to be bought at private pharmacies. Furthermore, family resilience was likewise disrupted when the patient interfered with normal family social life such every bit by preventing family members from engaging in basic activities such eating and watching goggle box.

Conflict with neighbours

The caregivers revealed that their relatives' uncontrolled behaviour such as temper tantrums, shouting in public, insulting people and neighbours and striking people had caused them to accept difficulty in forming and maintaining practiced social relationships. Some caregivers had been blamed for their relative's behaviour in court of constabulary causing countless misunderstanding between family with the sick relative and the neighbourhood family. One informant reported that:

"When you make jokes of him several times, so, he becomes aggressive all of a sudden attacks you lot fifty-fifty stabbing y'all if in access with a pocketknife; I have been arrested by law about two times to respond cases." (42 years old begetter).

It was said that most people do non know the nature of the mental illness and think that the person was pretending. Most of the family members tried to illuminate that their ill relative is not pretending and that he/she is suffering from mental affliction.

Lack of social support

In this study many informants expressed lack of support from other people, both inside and outside the family. It was revealed that distance between other relatives and the caregivers increased as the patient's symptoms increased. Ignorance of family members in regards to the nature of mental illness was said to be a contributing factor to lack of back up as most of them thought that the illness was of short duration. For example, if the patient'due south symptoms lasted longer than they expected, they gave up and withdrew their support. Others reported that the patient's symptoms are caused by the parents trying to become wealthy past making their child mentally ill. 1 caregiver reported that 'no relative will come to give you lot anything rather than advising you to become to the traditional healers.' Financial or material assistance was mentioned to be very of import merely this was not always offered even though some have close relatives in good fiscal positions:

"She (the patient) has many siblings here in Dar es Salaam, her brother, sister; both are workers but not even phoning to know how you are progressing there. ……..they are educated with cars, oh, no even phoning." (46 years old sister).

Participants best-selling that family unit dynamics are irresolute from that of an extended family system to more of a nuclear family system where the welfare of a kid is the sole responsibility of the parent. No one may take office in taking care of one's' child in health or in illness. A man aged 58 years old caring for his son with epileptic psychosis said:

"When you become such issues bear in mind that it is yours; neither uncle, cousin nor whoever, according to the electric current situation will assistance you in anyhow." (58 years former man).

Caregivers described feelings of helplessness related to the fact that no one else was willing to help them treat their child and that they had to persevere with caring issues as living with such patients need cooperation with other members of the families.

Need of cocky-aid groups

Some caregivers reported a desire for social back up groups designed to improve the quality of life of mentally ill individuals. These social groups could be of any nature including simply not express to educational or religious in guild to help their ill relatives in socializing and thus save any distress acquired by loneliness. Too they were concerned about the deteriorating cognitive function of their mentally ill relative and expressed a desire to find educational groups.

"If we get such grouping which can aid to socialize and assist such children and intermingle with those who are mentally stable, could greatly help them. …….considering we toil to go hither and in that location as a issue we become weary in vain." (A 42 years old father).

Furthermore, information technology was also revealed that there is a need for caregiver back up groups to address concrete and psychological problems developed by caregivers themselves every bit a effect of caring for their mentally sick relatives. Professional or social support was frequently mentioned by caregivers while venting almost their emotional distress:

"You become tired of everything; yous wish to take new ideas or people to help or group to mix with for getting new challenges……..you find that we are besides tired of thinking, tired of strength, at the same time running short of coin." (A 40 years old mother).

Many informants suggested having this social group equally a way to simultaneously meliorate the welfare of the patient and their ain well-being. This was suggested as an alternative to admitting mentally ill relatives to mental health institutions, something some informants had seriously considered. Others suggested creating schools for mentally ill individuals with qualified teachers because some patients had improved their mental condition but were unable or afraid to join public schools.

Stigma and discrimination

Many caregivers described people around them having negative attitudes toward their mentally ill relative. Virtually informants reported that the relative was more stigmatized than the caregivers themselves and that when they hear or encounter their ill relative being ostracized, they experience guilty and are psychologically disturbed. Withal, the experience of societal stigma and discrimination is worsened past negative attitudes from close relatives towards the caregivers, thus creating an increased altitude among them and the customs at large. Negative attitudes from close relatives were explained to occur on dissimilar occasions such as when using public transportation and at other social gatherings. 1 participant whose sick relative had cannabis induced psychosis complained that his neighbours shunned his son from social events:

"Because fifty-fifty if he sees them sitting and chatting, and if he decides to get there to sit with them, you find that they all stand up up and outset leaving away. They perceive him as insane and tin can't chat with them." (38 years sometime mother).

Some highlighted that stigma was present amid family members. This was apparent after the onset of disease. This seemed to exist an unbearable burden to the caregiver as everything is left to him/her.

"Stigma is nowadays even amidst the states, because, you discover that initially, y'all will exist with your family and the society in full general, but when the trouble happens, none of your relative will come up to know your progress with the patient." (38 yr old mother).

Stigma was said to be acquired past lack of knowledge about the nature of mental illness. The caregivers expressed their conventionalities that education regarding mental illness should be provided to people in order to foreclose stigma and bigotry. About caregivers had demonstrated involvement in understanding the origins of mental illness and some had even obtained brochures from some mental wellness facilities with respect to their relative'south condition. Patients were said to be more than stigmatized than the caregiver probably due to awkward behaviour. However, caregivers were blamed for causing the ill relative to be in that situation to begin with.

Coping and adaptation

Coping and accommodation are one of the important aspects to be applied when caring for a patient with chronic mental disease. Different types of coping and adaptation were reported past the participants.

Acceptance and religion were two of the most frequently cited strategies for coping. Caregivers had learned to accept and reconcile the disability or deviant behaviour in the mentally ill relative so equally to avert the dissatisfaction and disappointment that could have resulted from the patient's baroque behaviour.

"You need to accept, no way, that is your child, whether your relative, your family fellow member. …….where would you lot inquire help? That is your gift from Almighty God, you lot have to accept." (58 years old father).

Some family caregivers took a positive pace by utilizing problem solving strategies to accost their relatives' psychological, emotional and practical needs. Most family members brought their sick relative to the hospital later on consulting dissimilar areas especially from traditional healers.

"Then, it is the hospital services we are continuing with until now. It gives me hope and satisfaction I and the patient volition never go to the traditional healer once again" (60 years old female parent).

Other family caregivers sought religious support every bit the simply ways of hope and encouragement. They said that their religious practise gave them peace of mind and helped them to endure the caregiving situation. They believed that praying was besides likely to reduce the suffering of their sick relative likewise, thus making their faith indispensable to continued caregiving of the relative, irrespective of their distressing behaviour.

"Whenever the aggressive behaviour of my son begins, I immediately enter into my room, lock the door, kneel down and pray for Almighty God; Oh God! Help me to touch the Cross until my time of decease!" (fifty years old mother).

Some caregivers displayed signs of despair due to the difficult life situation caused by the patient's critical demands coupled with unrealistic daily income. They had no ways of coping or adapting to manage their situation either due to persistent baroque behaviour by the patient or their own lack of energy. However, they notwithstanding had hopes due to their organized religion;

"That'southward why sometimes you speak rudely to me, and I reply rudely to y'all too. What respect do I expect from you I wonder! I always provide care for you so what! It is merely my faith which makes me to be hither." (46 years sometime sister).

Honey, patience, and knowledge of the problem were other coping strategies mentioned past the family caregivers as important for difficult situations. However, none of the caregivers had abandoned his/her relative but virtually showed signs of desperation.

Discussion

This written report has offered insight into the social and psychological bug of caring for mentally ill patients on families' caregivers. Feelings and coping strategies experienced past family caregivers were revealed in the study. This study found that the main challenges faced by caregivers of mentally sick relatives were lack of social support, stigma, and disharmonize caused by the patients. Similar findings were reported in rural Ghana where caregivers reported financial difficulties, social exclusion, depression, and inadequate time for other social responsibilities as their main challenges [16].

The financial constraints found in this study approve findings from other studies that explored the relationship between mental illness and poverty [17]. In this study, information technology has been establish that people with mental illness are oftentimes unable to generate income and that they often have to rely on the financial support of family members to run across bones living needs and to pay for any health expenditure associated with mental illness. Thus, family unit members may take to set aside a significant amount of their time to care for an ill family fellow member. This tin can diminish caregivers' chances to go or proceed a job or earn income, which farther increases the adventure of poverty and poor mental health of the patient. This finding also shows like financial brunt as reported by a report conducted in Nigeria that explored relatives caring for schizophrenic patients [18]. Even so, our study did not explore the level of brunt and its associations with caregivers' educational level, age of patient, employment status of patients and global rating of difficulty in coping with caregiving.

In Mtwara region, the written report from BasicNeeds in 2009 revealed that the shortage of psychotropic drugs resulted in commutation of patients' usual medicine with alternative ones that were not as effective. In our research, the shortage of drugs was reported to decrease the credibility of health facilities, which are the master source of support for many families with mentally ill members. Equally such there is a need to better mental health services including adequate provision of antipsychotic medication and then that caregivers can keep getting them at the hospital gratis of charge every bit the policy stipulates.

Our findings demonstrate that there is a need for social support for the benefits of the family affected by mental affliction. This unity helps to prevent stigma confronting the mentally ill patient in the family and the customs at large. In the United State (US) inquiry findings reports that families presume major roles in supporting relatives with mental disease [ten]. The study in USA is inconsistent with these findings probably because of different cultural background of Tanzania and USA. However, education on the nature of mental affliction can likewise be a problem, which calls for more emphasis on community awareness of mental illness in Tanzania. A qualitative study conducted in Thailand to explore the lived feel of Thai family caregivers found that extended family was a major source of back up to caregivers physically, financially and emotionally [xix]. This is not the example in this study because the caregiving was described to be occurring in a more nuclear family unit unit which resulted in decreased support to the family caregivers and may be due to the fact that the study was conducted in an urban setting. In essence, neighbours and the customs are important components of social support. This research suggests that a strong social support organization is critical for the improvement of mentally ill patients. Even so, a lack of this important component has hampered efforts to meliorate mentally ill patients' condition and is the drawback to the psychosocial rehabilitation of chronic mentally ill patients. This statement is supported past findings from India which revealed several reasons for difficulties encountered by patients cared for at domicile [20]. The most important way to better the social support organization in Tanzania is to integrate mental health into the primary health care organisation [21]. In primary health care practice, family unit members with their mentally ill relative can access the health facilities hands and with low costs. Although mental health is addressed in the National Health policy of 2007, the step of progress is also tiresome to cater to the increasing burden and demand of mental wellness intendance in the local setting. The government'south support is essential non but in improving primary mental health intendance merely also in ensuring acceptable provision of complimentary treatment and gratuitous medication. Still, effort is needed past the regime to increase the number of training institutions in order to create more mental wellness professionals.

Our study reported stigma as one of the biggest social challenges affecting families caring for patients with mental illness. Similar studies have shown that stigma may erode the morale of family caregivers and results in withdrawal of potential supporters [11, 15]. The study supports the finding in this report that some caregivers lose the support of their close relatives besides as other sources of social support after the onset of their relative's mental illness. However, a longitudinal written report is required to establish a causal relationship between the stigma and the loss of social support for families caring for relatives with mental illness. Due to the fact that participants were concerned about their caregiving obligations in this research, there is a pregnant demand for education of the general population well-nigh the causes, presentation, and treatment of mental disorders. Although stigma and discrimination is a socially and culturally influenced phenomenon [3], increased education and understanding among the general population may decrease the stigma experienced by people who have a mental illness, their caregivers, and their families. Stigma is best-selling globally as ane of the major issues to the success of customs mental healthcare and it prevents a person from being fully integrated into society. In Republic of zambia, research institute that stigma could be reduced if people with mental health problems were treated in principal health care settings rather than in mental or district hospitals [22]. In Tanzania, most health care facilities in the local setting have non yet incorporated mental health into their basic health care packages; this could aid in reducing stigma. Furthermore, research suggests that the media plays a pivotal role in the stigmatization of mental illness and therefore could also play a function in the de-stigmatization process [23]. Media should exist effectively utilized to improve the general population's understanding of mental disorders.

Family functioning has been affected by caring for patients with mental disease. There is change in the role of family members as the parents become involved or more consumed by patient'southward needs. The patient has many needs which must be fulfilled by the caregivers at the same time that they must engage in daily tasks to earn an income. This increases fact increases the overall burden on the caregivers. A large quantitative written report in Australia reported that higher levels of the burden of care were associated with lower levels of family operation, which in plow were associated with college levels of anxiety, depression and perceptions of poor health [24]. Our findings also demonstrated that there was a low level of family functioning that was associated with patient's uncontrolled behaviour. The results of this inquiry would farther suggest that families affected by mental disease feel less cohesive and perceive themselves to be less continued to ane another and less bonded equally a unit of measurement than the normative family. In improver, the families of the mentally ill felt dissatisfied with the functioning of their family. This gives an impression that individual families should maintain their roles and relationships, thereby enabling the caregivers to maintain equilibrium. Any occurrence of mental disease of a family member which needs caring at dwelling results in psychological and emotional disturbances for the whole family [25]. In relation to the conceptual approach of family unit caregiving [26], these family beliefs and relationships can exist of bang-up importance to understanding caregiving bug and any socio-cultural factors influencing family care of people with mental affliction. Nevertheless, it is too important to examine further and distinguish between the availability of social support resources and the actual use of that resource to strengthen family unit operation.

Violence and threatening behaviour displayed past patients in this study would seem to exist the issue of insufficient symptom management. Proper management is of importance not only to the family caregiver but to all people who come into contact with the patient. This inquiry has found that families are perplexed past trigger-happy patients. This is because many violent patients fail to see their behaviour as threatening and may really perceive the family to be threatening. This threatening behaviour of patients comes at the price of family caregivers who are ofttimes required to pay fines for destroyed belongings or pay compensation for injury caused by the patient. This phenomenon demoralizes the caregivers and further increases the stigma of mental illness. Data in regards to arroyo and management of violence are required when interacting with the mentally ill person.

Coping strategies are an important aspect of caring for a patient with mental disease. In this study caregivers take shown a narrow range of strategies for dealing with patients' disruptive behaviours. Acceptance and praying are i of the near cited coping strategies. Some researchers accept revealed different means of coping with distressing situations including cognitive, behavioural and avoidance strategies [14, 27]. This is non the instance in our study as most of them were engaged in caring activities, fifty-fifty though with difficulties.

A research study which specifically examined differences in coping strategies among caregivers of unlike age, ethnic, gender, and education groups plant some bear witness that older people were more than religious than younger adults [27]. In their report, religious coping seemed to focus more on informal activities, particularly informal beliefs, rather than on more formal religious activities. This is consequent with the findings in this written report although we did not consider gender, age, ethnic and education groundwork. Praying every bit one of the coping mechanism in our study, is like to the findings from studies in Thai family caregivers [nineteen]. However, there is a difference in religious beliefs in that Thai families were predominately Buddhist compared to mostly Christian and Muslim participants in Tanzania. In this research, both Christians and Muslims had developed a habit of praying as a way to deal with caregiving situation. Findings advise that different consultation is sought equally a fashion of finding solutions or treatments for their loved one. Some were advised to seek treatment from traditional healers merely when they establish no relief, they turned back to God and sought hospital services. Most were satisfied with the hospital treatment after individual try to seek data apropos the disease of their loved ones (cognitive coping). Maladaptive coping strategies were not described although though some did shown signs of desperation in caring for their sick relatives as they were tired and did not know what to do to make their sick relative feel better.

Limitation of the study

At that place are several limitations in this research. Firstly, the sample was besides small with few participants in each FGD. This might take an event in a normal interaction during the interview and consequently contributed to limited information. Secondly, the FGD groups were non homogenous which might have affected the freedom of expression among the participants.

Thirdly, only one primary caregiver and who spent almost of the time with the patient was recruited. There could be variety in the types of problems associated with caregiving amid different caregivers, due to different family unit roles and perceptions of caregiving. Finally, the study was hospital-based which means the findings are not generalizable to a community-based sample.

Conclusion

Family caregiving for persons with mental illness has its advantages, yet information technology has multiple social and psychological challenges for both family caregivers and mental wellness professionals. Coping strategies and skills are important to the well-being of the caregiver and the patient.

Tackling of these problems needs a collaborative arroyo between wellness intendance providers and the regime so that the needs of the caregiver and the family in general can be addressed.

Replication of the written report with a larger sample based on age, gender, didactics groundwork, occupation volition be useful for further enriching the knowledge base of the miracle and in providing a foundation for time to come research in clinical practice.

Ethics approval and consent to participate

Ethical clearance was obtained from the Muhimbili Academy of Wellness and Allied Sciences Ethics and Publication Committee. Farther permission and approval was obtained from the Temeke Municipal Medical Officeholder in charge. Earlier the interview started, the informants were given a total explanation of the data collection process. Each participant was fully informed and understood the nature of the study and voluntarily agreed to participate. The written consent form was read, understood, and signed by the participants.

Consent for publication

The participants were informed that the findings of the written report would be published in different journals and that their names would not announced in the publications. The participants agreed and signed the consent form.

Abbreviations

FGDs:

Focus Group Discussions

MUHAS:

Muhimbili University of Wellness and Allied Sciences

UBS:

Republic of uganda Agency of Statistics

UNAIDS:

The Joint United Nation Programme for HIV/AIDS

UNHS:

Uganda National Health Services

WHO:

World Wellness Organisation

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Acknowledgement

Much appreciation goes to the Ministry of Health and Social welfare for fiscal support for this study. A lot of thanks go to Dr. Edith M. Tarimo and Ms Renee for the important role she played in editing the manuscript, Mr. Joel Ambikile Seme helped in data drove and conducting interviews. Finally, thanks go to Temeke Municipal Infirmary where the report was conducted.

Funding

The inquiry was funded by Ministry of Health and Social welfare of Tanzania.

Author information

Affiliations

1. Section of Clinical Nursing, Muhimbili University of Wellness & Centrolineal Sciences (MUHAS), P.O.Box 65004, Dar es Salaam, Tanzania

   Masunga G. Iseselo

2. Department of Psychiatry and Mental Health, Muhimbili University of Health & Allied Sciences (MUHAS), P.O.Box 65001, Dar es Salaam, Tanzania

   Lusajo Kajula

3. Tanzania Commission for Science & Technology (COSTECH), Ali Hassan Mwinyi Road, Kijitonyama (Sayansi) COSTECH Building, P.O. Box 4302, Dar es Salaam, Tanzania

   Khadija I. Yahya-Malima

Corresponding author

Correspondence to Masunga K. Iseselo.

Additional information

Competing interest

The authors declare that they have no competing interests.

Authors' contributions

MKI did all the work from research proposal development, data collection and analysis, and report writing. KIYM supervised the whole work from proposal development, ensuring proper information drove instruments, relevant data analysis method, and adherence to ethical issues and newspaper writing skills. LK was involved in the footstep past step procedure of data assay and germination of themes. All authors read and canonical the last manuscript.

Authors' data

MKI is the Assistant Lecturer at Muhimbili University of Health and Allied Sciences. He has Masters of Scientific discipline (MSc) in Mental Health and Psychiatric Nursing. MKI teaches mental health for both undergraduate and postgraduate students at the academy.

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Iseselo, One thousand.Thou., Kajula, L. & Yahya-Malima, Yard.I. The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: a qualitative urban based written report in Dar es Salaam, Tanzania. BMC Psychiatry sixteen, 146 (2016). https://doi.org/ten.1186/s12888-016-0857-y

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• Received: 28 Feb 2015

• Accepted: x May 2016

• Published: xiv May 2016

• DOI : https://doi.org/10.1186/s12888-016-0857-y

Keywords

• Relatives
• Mental illness
• Psychosocial problems
• Caregiver

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