The use and abuse of substances, especially among adolescents continues to be a serious concern within the international community. This behaviour affects adolescents as individuals, their families, the community in which they live, and society at large. Substance abuse causes social and family disorganisation, economic instability, social insecurity, and curbs progress for individuals, families, and the State. Some effort towards intervening in this challenge, focussing on mental health promotion and substance abuse prevention was made, yet it appears it was not enough (Steel et al. 2020; World Health Organization [WHO] 2020). There are some shortfalls in these interventions as there is no satisfying improvement related to this phenomenon; instead, the prevalence of substance abuse is becoming worse each day (Cardenas et al. 2021; Setlalentoa, Ryke & Strydom 2016) Findings from the researcher’s minor dissertation (Rikhotso 2008) indicate that adolescents who abuse substances experience a range of emotional, physical, academic, and social setbacks and challenges.

Certain interventions concerning adolescents’ substance abuse were cited in another study (Salam et al. 2016) and included promoting sexual and reproductive health, nutrition interventions, immunisation, mental health promotion, substance abuse prevention and the prevention of unintended injuries. Another study conducted in the North-West Province of South Africa (Setlalentoa et al. 2016) proposed some interventions to address alcohol abuse. These called for holistic, multi-level and multi-sectoral interventions for all role-players, such as government departments, non-governmental organisations, the community, and faith-based organisations (Setlalentoa et al. 2016). Moreover, (Gallop et al. 2020) recommendations to reduce adolescent substance abuse included (Rikhotso 2008) health promotion activities, programmes, and services; (WHO 2020) constructive media-based public education campaigns; (Steel et al. 2020) development and implementation of school-based substance abuse programmes; and (Cardenas et al. 2021) provision of recreational facilities.

Among the interventions that were developed so far, according to the latter studies, it is evident that few had minimal impact while most of them had no effect at all. The South African Nursing Council has not acknowledged the facilitation of mental health of adolescents abusing substances for inclusion in the scope of practice of psychiatric nurses. The researcher, therefore, conceived the idea that developing a model whereby psychiatric nurses who provide care for adolescents abusing substances while admitted in psychiatric institutions to facilitate their mental health would bridge the gap. Moreso, because the model would not be something that is imposed on the adolescents but a step-by-step interactive process between the psychiatric nurses and those adolescents.It would be a participatory interaction for both on the way towards achieving adolescent’s mental health. To develop such a model, the researcher had to identify the concepts from the previous study, (Rikhotso 2008) define and classify these concepts, and place them into relationship. As a result, this study of concept analysis to develop a model to facilitate the mental health of adolescents was conducted.

The objective of this article is to define the central concept ‘facilitation of mental health’ of adolescents abusing substances.

This study utilised a qualitative, exploratory, descriptive, contextual approach and theory generating design, and was guided by a Post-modern Constructivist Philosophy of Science. This philosophy relies on two concepts: post-modernism and social constructivism. Post-modernism’s emphasis is on setting knowledge claims within the conditions of the world today and in the multiple perspectives of class, race, gender and other group affiliations (Creswell 2018). Social constructivism occurs through social and environmental interactions and emphasises that knowledge exchange between researchers and healthcare professionals must happen in a mutually created social context (Thomas et al. 2014).

According to Walker and Avant (2011), concept analysis is the process of examining the basic elements, structure, and functions of a concept. Rodgers, Jacelon and Knafl (2018) view concept analysis as a branch of empirical linguistics, as it contains the assumption that a definition of a term may be found that pertains to its representation in a natural language. The concept analysis process was undertaken during model development, since it provides precise theoretical and operational definitions for use in model development and research. It also enables the researcher to classify similar concepts.

The basic elements, structure, and functions of a concept were examined, following the theory development approaches, namely, analysis, synthesis, and inductive reasoning strategy (Martinez et al. 2021) to define the central concept. The identified central concept in this study was analysed to identify essential criteria to define it (Gomba 2017; Walker & Avant 2011). This study warranted the application of synthesis so that the broken down and sorted concepts from the researcher’s previous study (Rikhotso 2008) could be reconnected to form a meaningful and comprehensive whole (Leedy & Ormrod 2015; Walker & Avant 2011). The researcher followed the inductive reasoning approach whereby the conclusions that were developed through the phenomenological interviews and the observations, as reflected in the field notes, were drawn from the participants’ shared experience (Ravitch & Carl 2016; Tema 2017).

The process of concept analysis was implemented over two phases. Phase One involved identifying the central concept ‘facilitation of mental health’ of adolescents abusing substances, derived from the researcher’s minor dissertation (Rikhotso 2008), in which the lived experiences of adolescents were explored using semi-structured individual phenomenological interviews. Phase Two involved defining the concepts and placing them into relationship. Those took place through the use of theoretical and operational definitions obtained from dictionaries and subject sources.

The results of Phase One helped the researcher identify the central concept, and in Phase Two, the central concept was defined and classified. The process unfolded as presented in the following sections:

To obtain the desired outcomes of defining the central concept ‘facilitation of mental health’ of adolescents abusing substances, dictionaries and subject sources were used (Walker & Avant 2011). It was critical to define ‘facilitation of mental health’ since the concept is new in its context. The role-players, especially psychiatric nurses, should understand this concept comprehensively because they are at the front line in the facilitation of mental health of adolescents abusing substances assigned to their care when they get admitted to psychiatric institutions. The definition of ‘facilitation’ shares its components with the Theory for Health Promotion in Nursing (University of Johannesburg 2017) and other South African literature sources. Therefore, the conclusion can be drawn that the definition was derived and analysed in the South African context. Another crucial element in the description of the central concept ‘facilitation of mental health’ is that it was used to develop a model to assist psychiatric nurses in facilitating the mental health of adolescents abusing substances. The model case highlights the need for psychiatric nurses to assist adolescents abusing substances to make behavioural and emotional adjustments to achieve mental health.

A model case is a concept that constitutes all the defining criteria of the concept (Walker & Avant 2011). The essential criteria of the concept ‘facilitation of mental health’ forms the basis of the model case (Rikhotso 2019).

Mr X is an 18-year-old boy who lives in a village in the Greater Giyani Municipality, situated around 20 km from the psychiatric institution where the study was conducted. He is the firstborn of two children and is living with his single mother and younger sister. His mother sells fruit to earn a living. He is still in Grade 10 because, in recent years, he has repeated every grade and sometimes does not even sit for examination because of hospitalisations on account of substance use induced psychosis. As a result of the scarcity of public transport in this area and the inaccessibility of police services to intervene, he is typically brought to the hospital in a hired vehicle, which is very expensive. He shared his story as follows:

The story, as explained to me by an old lady from the neighbourhood, is that Mr Smith (not the real name) impregnated my mother while she was still a teenager and lied to her that he was single. When she went to live with him in a nearby village, she discovered he was married and had children. For my mother, life became miserable, and she decided to return home. A few months later, when she was 4 months pregnant with me, she was proposed to by Mr Jones (not the real name), a man with whom she attended school and lived in the same village. Since he spent most of his time in Johannesburg, where he was working, he was not aware she was pregnant. My mother accepted the proposal and went back to Johannesburg with him. A month later, she returned home to Giyani, and she called him to say she was pregnant. Three months later, I was born. Mr Jones got the news that a baby boy was born, and he realised I was not his son. He rejected my mother, and she returned to her parents’ home with me. I had mixed feelings when I heard the story, but I was happy I finally got the truth.

At this stage, I was drinking beer, and every time I was drunk, I would confront my mother about her reasons for lying to me about my father. I got used to drinking, so I would drink more frequently, even alone, and bitterness started to build up in me. My academic performance declined; hence, I am still in Grade 10. My relationship with my mother became bad. My younger sister became fearful when I was around because I would hit her for no reason. At times, I would be irritable and aggressive. In my own corner, I was overwhelmed with feelings of hatred, anger and loneliness. My drinking habit resulted in me being admitted to this psychiatric institution. I am told I would become violent, beat my younger sister, swear at my mother, spend sleepless nights, and turn the radio to maximum volume. I’ve had numerous admissions to this institution. Upon discharge after every admission, I would vow I would not be admitted again, but when I get home, the same peers and circumstances push me to the edge, and I start drinking again. I could see that my future was bleak and wished to change my lifestyle, but it was not easy. I wished I could get some help, but did not know from who, where, and how.

By God’s grace, during my previous and last admission almost a year ago, I met Sister Margaret (not the real name), a psychiatric nurse in the ward in which I was admitted. To date, I am still in awe because for the first time in my admission history to this institution, I have spent many years at home without being readmitted. She introduced herself to me and offered to assist me. Although I was uncertain whether I would really get assisted, considering my recurrent admissions, I accepted her offer. At last, my question on where to go and from whom to get assistance was answered, though I still did not know how this would occur.

Together, we embarked on a journey of a dynamic interactive process that enabled me to open to her and share all my challenges regarding the use and abuse of substances, especially alcohol. This was possible after my conviction of her trustworthiness, and I became free to interact with and confide in her. I shared my addiction to drinking beer, my motives for continuing with the habit, the setbacks this has caused in my life, and the emotional, physical, and social challenges this has created with her. Although I did not have all the information, I was aware that my mind had been affected, and I therefore needed someone to guide and make it easier for me to become fully functional and for subjective wellbeing to unfold in my life.

She pointed out that from the information I gave her, I failed to fulfil my responsibilities as a young person and lacked a sense of maturity. Once I become willing to resume my responsibilities and become resilient, this dynamic interactive process would succeed. She further clarified that I am the one holding the key to my own future. Unless I take actions to enable me to improve my wellbeing and emotional intelligence, the process of our interaction would be of no use.

From that encounter to date, I cannot stop thinking about where I would be now if I did not have the opportunity to engage in the process of interacting with that sister. I am forever grateful for this because my life has not been the same since. I can relate socially to my mother and other people with whom I live. I manage to control my emotions and respond positively to challenges without being easily angered. Even my psychological state has improved; I am able to reason well and adjust to different situations I encounter. For a change, I have passed my examinations, and next year will attend Grade 11. I am very happy about this and never thought it would be possible. The changes that I already see in my life give me hope that I will end up living a life free from mental illness.

The literature sources for the definition of the concept ‘facilitation’ were commonly obtained from the field of psychology.

Recommendations are made for psychiatric nursing practice, education and research.

The analysed concept acted as the foundation for developing a model for psychiatric nurses to facilitate the mental health of adolescents abusing substances. The nursing profession is enriched by defining the central concept since the ‘facilitation of mental health’ of adolescents abusing substances has never been defined before. It also illuminates psychiatric nurses’ added role in facilitating the mental health of adolescents abusing substances, which the South African Nursing Council has not acknowledged for inclusion in the scope of practice of psychiatric nurses.