Families of the mental health care users (MHCUs) face different challenges in dealing with, supporting and caring for MHCUs on a daily basis. The divergent coping mechanisms that the family members use aim to lower the negative, psychological and emotional impact of the stress. These include: escape, avoidance and denial.
To explore, describe and contextualise coping mechanisms used by the families of MHCUs and to suggest recommendations for improving their coping mechanisms in Mahikeng sub-district, North West province (NWP), South Africa.
The study was conducted in three community health centres in Mahikeng sub-district, NWP, South Africa.
A qualitative-exploratory-descriptive and contextual research design was used. Non-probability convenience and purposive sampling techniques were used to select participants. WhatsApp video calls were used to collect data which were analysed following Creswell’s six steps of qualitative data analysis.
The study established three themes namely; challenges experienced by the family members, coping mechanism used by the family members, and suggestions for improvement in the coping mechanisms for the family members.
The findings of this study show that the family members of MHCUs are faced with different challenges. Some of the coping mechanisms used by the family members are insufficient and require improvement to enable them to cope effectively. When the coping mechanisms of the family members of MHCUs are improved, their well-being and that of the MHCUs might improve significantly.
The findings of this study provides information that may be used to improve the coping mechanisms of the families of MHCUs in the NWP, South Africa.
Mental disorders affect both the mental health care users (MHCUs) and their family members (Tristiana et al.
In spite of the above concerns, literature shows that different families use different coping mechanisms when caring for their MHCUs (Ata & Doğan
Based on the above information as well as the researcher’s personal experience as a professional nurse for almost 5 years, it is clear that the families of the MHCUs face different challenges in dealing with, supporting and caring for the MHCUs on a daily basis, particularly in Mahikeng sub-district, North West province (NWP). This requires family members to use various coping mechanisms, some adaptive and some maladaptive in nature. The different coping mechanisms that the family members use aim to minimise the negative emotional impact of the stressor. These include: escape, avoidance, denial or looking to religion to deal with behavioural problems of the MHCUs. Consequently, this makes dealing with, supporting and caring for them easier (Madathumkovilakath et al.
A qualitative-exploratory-descriptive and contextual research design was used to explore, describe and contextualise coping mechanisms used by the families of the MHCUs in Mahikeng sub-district, NWP. WhatsApp video calls were used to collect data, which was analysed following Creswell’s six steps of qualitative data analysis.
The study was conducted in three community health centres in Mahikeng sub-district, NWP. There are four districts in the province namely, Ngaka Modiri-Molema, Dr Kenneth Kaunda, Dr Ruth Segomotsi Mompati and Bojanala. There are approximately 19 sub-districts in the province namely, Mahikeng, Ditsobotla, Tswaing, Rustenburg, Ramotsere Moiloa, Tlokwe, Naledi, Ventersdorp, Matlosana, Greater Taung, Moses Kotane, Moretele, Madibeng, Lekwa Teemane, Mamusa, Kagisano-Molopo, Maquassi Hills, Kgetlengriver and Ratlou sub-district. The researcher chose Mahikeng sub-district as it was noticed that the families of the MHCUs in this district are severely affected by the challenges of dealing with supporting and caring for the MHCUs on a daily basis. Based on these concerns, the researcher became interested in understanding how the families of the MHCUs cope. The three clinics where the study was conducted were selected with the help of the sub-district manager.
The population of the study included all family members of MHCUs who were over the age of 18 years and residing in Mahikeng sub-district, NWP. A non-probability sampling approach was used. Only those members of the population who were knowledgeable about the topic were selected by an independent person. Convenience and purposive sampling techniques were used to select 10 participants. Data saturation determined sampling size of the study which was 10 participants.
As a result of the coronavirus 2019 (COVID-19) outbreak, physical contact with participants was avoided to protect them and the researcher from the risk of exposure to COVID-19. WhatsApp video calls were therefore used by the researcher to collect data from the participants. The interviews were free flowing in structure, limited only by the focus of the research. The video call interviews were conducted in a conversational style, albeit with a specific purpose in mind, which was to explore, describe and contextualise coping mechanisms used by families of MHCUs in Mahikeng sub-district, NWP. Communication techniques such as clarifying, summarising and reflection were used by the researcher in facilitating the discussion in all the semi-structured individual interviews. The following open-ended questions were asked in all the semi-structured individual interviews: What are some of the challenges that you experience in caring for your family member who suffers from a mental illness? How do you cope? What helps you to cope? What do you think might help you or other people to cope effectively?
Data were analysed independently by both the researcher and an independent co-coder following Creswell’s six steps of qualitative data analysis (Creswell
The following four criteria were followed to ensure trustworthiness of this study: credibility, confirmability, transferability, and dependability as outlined by Taylor, Bogdan and DeVault (
Ethical clearance was sought and obtained from the North-West University Health Research Ethics Committee (NWU-HREC, Ref: NWU-00959-19-S1). Permission was obtained from the North West Provincial Department of Health (DOH) Ethics Committee, Mahikeng sub-district office as well as operational managers of the clinics where data were collected. Participants were informed by an independent person about their right to choose to participate and the right to withdraw from the study at any given time without being penalised. The researcher ensured the protection of information obtained from the participants in line with
WhatsApp video call interviews were conducted with 10 participants, all females. Six (6) of the participants were mothers, three were sisters and one was the daughter of MHCUs. Age of the participants ranged between 27 and 63 years.
Demographic information of participants.
Participant number | Age (years) | Gender | Relationship | Socio-economic status | Years looking after MCHU |
---|---|---|---|---|---|
Participant A | 57 | Female | Mother | Unemployed | 26 |
Participant B | 63 | Female | Mother | Pensioner | 28 |
Participant C | 38 | Female | Sister | Employed | 10 |
Participant D | 55 | Female | Mother | Unemployed | 15 |
Participant E | 27 | Female | Daughter | Student | 6 |
Participant F | 50 | Female | Mother | Domestic worker | 16 |
Participant G | 56 | Female | Mother | Employed | 12 |
Participant H | 49 | Female | Mother | Unemployed | 17 |
Participant I | 36 | Female | Sister | General worker | 8 |
Participant J | 42 | Female | Sister | Unemployed | 17 |
MHCUs, mental health care users.
The following three themes emerged from the findings of the study: challenges experienced by family members, coping mechanisms used by family members as well as suggestions to improve family members’ coping mechanisms (
Themes and sub-themes.
Theme | Sub-theme |
---|---|
1. Challenges experienced by family members | Difficult, uncooperative behaviour by MHCUs MHCU substance use Defaulting treatment Stigma because of mental illness Negative attitudes from the nursing staff Insufficient income to care for MHCUs |
2. Coping mechanisms used by family members | Acceptance of MHCUs conditions Love and respect for MHCUs Effective continuous communication with MHCUs Prayer for coping Pastoral counselling enhance family members coping |
3. Suggestions to improve family members coping mechanisms | More mental healthcare facilities are needed locally Families need intervention by the police. |
MHCUs, mental health care users.
Six sub-themes emerged from the challenges experienced by family members of MHCUs: difficult, uncooperative behaviour by MHCUS, MHCU substance use, defaulting treatment stigma because of mental illness, negative attitude from the nursing staff, insufficient income to care for MHCUs.
‘The main challenge at first was that he refused to bath, refused to go to the clinic or doctor.’ (Participant B, Female, 63 years old)
‘When I have to go somewhere, he refuses to be left with other people.’ (Participant A, Female, 57 years old)
‘Even our communication is not good because when you tell him something, he says the opposite.’ (Participant D, Female, 55 years old)
‘We take them to (mentioned name of hospital) they give them treatment, but they don’t drink those pills even they admit them when they come back, they use drugs again.’ (Participant G, Female, 56 years old)
‘For an example when I have left food for us to eat them the following day, he eats them, and he refuse to quit cannabis.’ (Participant C, Female, 38 years old)
‘We take them to (mentioned name of hospital), they give them treatment, but they don’t drink those pills even they admit them when they come back, they use drugs again.’ (Participant G, Female, 56 years old)
‘Ok, well so at times, my father skips drinking his medication we have to monitor him if he has taken his medication sometimes he says he took them while he did not take them.’ (Participant H, Female, 49 years old)
‘Yes, sir there is also the problem of stigma in the community as other community members have accepted the mentally ill patient and others don’t accept her.’ (Participant A, Female, 57 years old)
The views shared by some of the other participants were:
‘The other thing is that other people in the community will greet him and laugh then he will become violent.’ (Participant C, Female, 38 years old)
‘The (mentioned name of the community) community members wanted to beat him up then the headman of the village stopped the community members and called me then I told him that he is mentally ill.’ (Participant G, Female, 56 years old)
‘Another challenge is that when my daughter has episode and I take her to the hospital, at the hospital they ill-treat us especially the nurses, they don’t treat us well at all.’ (Participant A, Female, 57 years old)
‘Sometimes nurses at hospital are impatient, shout at my child and I don’t like it.’ (Participant E, Female, 27 years old)
‘At home we live together only the two of us and he does not work when he has to come to the clinic at times he does not have transport money, and he will go around asking money for the taxi like today he is supposed to go to (mentioned name of the hospital) he does not have transport money.’ (Participant J, Female, 42 years old)
‘Sometimes it is difficult financially to take care of my father, especially when he has to go to the clinic for monthly treatment or to hospital when he is not well.’ (Participant H, Female, 49 years old)
The following five sub-themes emerged from the coping mechanisms used by family members: acceptance of MHCU’s conditions, love and respect for MHCUs, effective continuous communication with MHCUs, prayer for coping and pastoral counselling to relieve stress.
‘My child like any other child is a gift from god and I accept her for how she is, and she did not choose to be mentally ill.’ (Participant A, Female, 57 years old)
Another participant added:
‘What can help us to cope firstly we have to accept our situations, because if you don’t accept your situation you will not cope and accept and love your child.’ (Participant I, Female, 36 years old)
‘Just treat him like a normal person like when I am not home my children love and respect him because he is their uncle, they don’t treat him like he is crazy.’ (Participant C, Female, 38 years old)
‘Our relatives have to love their children and be patient with them don’t be too harsh on them just reprimand them like any other child, because even if they are mentally ill, they can see if you love them and treat them like your other children.’ (Participant D, Female, 55 years old)
‘Sometimes nurses communicate with us continuously, for example, they would call me to remind me to come collect his treatment and they also give me information about his illness.’ (Participant F, Female, 50 years old)
‘One day professionals invite a group of parents or people who take care of mental ill patients and motivate us telling us about the advantages and disadvantages, what can we do and tell us if there is a cure for mental illness or our children will suffer from it till death we must accept them as they are.’ (Participant E, Female, 27 years old)
‘I don’t want to lie my only coping mechanism is a prayer I pray every day before I sleep asking the lord to help me.’ (Participant G, Female, 56 years old)
‘We just pray because he likes to pray, I travel a lot with work so when I am not home my children will pray, he likes it when we pray that someone put their hands on him then he will sleep after.’ (Participant C, Female, 38 years old)
‘I am a Christian and I love praying. So praying and my pastor’s counselling helps me a lot as I have accepted my daughter’s situation because of the counselling from the pastor.’ (Participant A, Female, 57 years old)
‘It is only prayer and talking to my pastor, I don’t have any other way.’ (Participant B, Female, 63 years old)
Sub-themes that emerged from suggestions to improve coping include more mental healthcare facilities and intervention by the police.
‘I think if government can build more psychiatric clinics or hospitals nearby for example I was living in (mentioned where she is staying) thinking I am nearer to (mentioned name of clinic), because when he was giving me problems I will call his brother to take us to the clinic so I think when there are clinics near and we have a problem it will be easy to get help fast.’ (Participant B, Female, 63 years old)
‘At … they keep children like this they keep them and then they are given activities sort of rehabilitating them. I was wondering if the government can take these kids to rehab because these children are many if you can go to (mentioned name of hospital) you will be hurt.’ (Participant G, Female, 56 years old)
‘The police are very helpful, for example, when she was missing, we went to the police station to report her missing, when we arrived to the police station they told us there is a lady who was found wondering around, so we need their interventions at all the times ….’ (Participant F, Female, 50 years old)
‘I think the police will help by talking to him because when he sees the family members he does not listen but when police talks he listen, I think the police can assist us to cope.’ (Participant B, Female, 63 years old)
The aim of the study was to explore, describe and contextualise coping mechanisms used by the families of the MHCUs in Mahikeng sub-district, NWP, South Africa. Additionally, the study aimed to make recommendations for improving coping mechanisms of the families of the MHCUs. The study revealed three themes namely; challenges experienced by family members, coping mechanism used by family members, and suggestions to improve family members coping mechanisms.
Challenges experienced by family members emerged as the first theme of this study. Sub-themes under this theme were that MHCUs at times demonstrated difficult and uncooperative behaviours such as refusing to bathe, eat, or taken care of by other family members. Kito and Suzuki (
A further challenge that was mentioned was stigmatisation experienced from community members. Experiencing stigma is severely damaging to MHCUs and their families, and may result in low self-esteem, feeling of shame, need to isolate the MHCUs from the community, high levels of stress and overall poor quality of life (Valery & Prouteau
Another major challenge which emerged was the financial impact of taking care of MHCUs. Rohanachandra, Amarabandu and Rohanachandra (
Different coping mechanism used by family members emerged as the second theme of the study. This includes acceptance of the condition, respect and loving the MHCUs and access to spiritual support. Acceptance of the MHCUs’ condition was the first sub-theme that emerged in this theme. According to Aldersey and Whitley (
Together with acceptance, a sub-theme emerged around the need for the MHCUs to be loved and respected. Loving and respecting MHCUs improves their recovery and in turn reduces participants stress levels (Iseselo, Kajula & Yahya-Malima
The role of prayer and pastoral support in coping were two further subthemes. Most of the participants mentioned that they use prayer as a coping mechanism. Fife, Brooks-Cleator and Lewis (
The last theme that emerged from the findings of this study was suggestions to improve family mechanisms for coping with MHCUs. The first sub-theme was around access to mental healthcare treatment facilities. Participants revealed that there is a need for more local mental healthcare facilities in their sub-district. Torrey et al. (
A second sub-theme was around the timeous intervention by the police when MHCUs are difficult to handle. Omoaregba et al. (
The study was conducted in three community health centres in Mahikeng sub-district in NWP of South Africa and cannot be generalised to other community health centres in the province or in the country.
The study recommends further research on the strategies to improve coping mechanism of the families of the MHCUs. The study adds to what is already known about the topic and also recommends that more research be conducted regarding more coping mechanisms used by the families of MHCUs in order to improve them and effectively improve their well-being.
The findings of this study highlighted that the participants were faced with diverse challenges. Their challenges include unruly behaviour fuelled by substance use by MHCUs which often results in MHCUs defaulting treatment. In addition, the participants experienced stigma from the community and negative attitudes from the nursing staff. This was compounded by the financial strain in caring for a MHCU and the need for increased access to mental healthcare and timely support from police. A positive outcome of the study was the coping mechanisms currently used by family members including acceptance of MHCUs conditions, love and respect for MHCUs, effective continuous communication with MHCUs, use of prayer for coping and pastoral counselling.
The authors would like to thank the North-West University, North West Department of Health, sub-district and all the clinics for approving this study. They also wish to express gratitude to all the families who participated in the study. This manuscript is based on a masters’ research work conducted by T.P.M. under the supervision of I.O.M. and L.A.S.
The authors declare that they have no personal or financial relationship which may have influenced them inappropriately in writing this manuscript.
T.P.M. drafted the manuscript, I.O.M. and L.A.S. contributed equally in finalising the manuscript.
This study was funded by the North-West University.
Data are available but cannot be shared with anyone in terms of the agreement made with participants according to research regulations and POPIA, safeguarded by HREC.
The views and opinions expressed in this manuscript are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.