In Namibia, mental health is considered as a low priority health concern hence resources are instead diverted to life threatening illnesses. Furthermore, it is estimated that about 15% of the Namibian population suffers from mental health, with schizophrenia being the most common mental disorder. Despite the limited resources, The Ministry of Health and Social Services seeks to promote the extension of health for the care of people living with mental disorders to the family and community at large; however, such services are not yet in existence. Consequently, the responsibility of caring for the mental health users is shifted to the family caregivers who tend to be negatively affected. Additionally, only a few mental health users receive adequate mental health services and this places even more burden on the caregivers (MoHSS, 2005:5; MoHSS, 2010:13). It is against this background that the present study was conducted. The goal of the study was to explore the experiences among the caregivers of mental health users with schizophrenia in the Nankudu District, Namibia. The study was explorative in nature hence the qualitative research approach was used. Furthermore, the study adopted the case study design to explore the lives of caregivers in a modern restricted system through interviews to gain in-depth data and to understand of their lives. One on one, semi structured interviews were used to collect data from ten caregivers of mental health users with schizophrenia in Nankudu district. The purposive sampling method was used to select the participants for the study. The findings revealed that the caregivers experience physical, psychological, emotional, social and financial burden as a result of their caregiving roles and responsibilities towards the mental health users. The psychotic episodes for instance were negative experiences for all the caregivers. The caregivers adopted various roles and responsibilities towards the care of persons with schizophrenia such as overall involvement in their treatment plan, seeking for alternative traditional medicine and daily functional support of the mental health users. Moreover, they also experienced stigma from the community members and it constituted to more social and psychological effects. The study further revealed the lack of community based mental health care services and social work services for the mental health users and caregivers. Subsequently, the caregivers rely on other family members, friends and neighbours and interestingly, police officers for support. The study also highlighted some positive experiences encountered by caregivers such as acceptance of their caregiving role, good support system and the mental health user’s adherence to medication and recovery. Due to the highlighted findings, it is recommended that the Ministry of Health and Social Services should establish and implement family psychoeducational programmes for the caregivers and mental health users with schizophrenia to ensure their active involvement in the treatment plan, improve the quality of care and their well-being. Moreover, the Ministry of Health and Social Services should expedite the implementation of community based mental health services to offer support to the mental health users and caregivers as highlighted in the National Mental Health policy. Lastly, health professionals such as Social Workers should provide continuous psychosocial support to the caregivers in order to help them to address their negative experiences. / Dissertation (MSW (Health care))--University of Pretoria, 2019. / Social Work and Criminology / MSW (Health care) / Unrestricted

Il coinvolgimento di utenti e familiari nella progettazione, gestione e valutazione dei servizi di salute mentale consente di migliorare i servizi, facendo valere gli interessi e la prospettiva di stakeholders che spesso vengono visti esclusivamente come ricettori passivi di prestazioni. La tesi prende il via da queste considerazioni, legate ad approcci recovery oriented, con l’obiettivo di analizzare come le organizzazioni sociosanitarie possono favorire la partecipazione e accogliere il punto di vista degli utenti e dei familiari attraverso l’introduzione di pratiche innovative. Per raggiungere questo obiettivo si è scelto di analizzare due casi: il Fareassieme del Servizio di salute mentale di Trento e il Social Point del Dipartimento di salute mentale di Modena. Attraverso osservazione e interviste, sono stati raccolti dati qualitativi che hanno portato a una interpretazione complessa e sfaccettata. In particolare, sono emersi due versanti: (1) quello del cambiamento culturale necessario per introdurre nell’organizzazione un nuovo approccio centrato sulla partecipazione e (2) quello della formalizzazione delle nuove pratiche partecipative, con i risvolti positivi e negati dell’incardinamento nell’organizzazione. Nelle conclusioni, si ipotizzano possibili sviluppi per la ricerca futura e si elencano i suggerimenti operativi emergenti dalla ricerca per i manager dei servizi sociosanitari. / The participation of users and family members in the design, management and evaluation of mental health services can improve services, relying on the interests and perspective of the stakeholders that are often seen only as passive recipients of services. The thesis takes away from these considerations, related to recovery-oriented approaches. The aim is to analyze how organizations can promote the health and social participation and accept the point of view of users and their families, through the introduction of innovative practices. I analyze two Italian cases: “Doing Together” (a project of the Mental Health Service of Trento) and “Social Point” (a service of the Department of Mental Health of Modena). Two issues emerged from qualitative data: (1) the organizational cultural change related to the introduction of a new approach, centered on participation and (2) the formalization of the participatory practices, with positive and negative consequences. In conclusion, I propose possible development for future research and suggestions to managers of health services.