Psychosocial rehabilitation for people with mental illness in the South African context : an evaluation from a service-users perspective

Master Thesis


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University of Cape Town

The aim of this study was to explore perceived significant changes in the quality of life of people with mental illness accessing psychosocial rehabilitation programmes. Furthermore a comparison was drawn between the outcomes experienced by these service-users and the vision and aims of Cape Mental Health Society's programmes. These included the Fountain House clubhouse model, community-based support groups, supported housing and a self-advocacy body. The aim of psychosocial rehabilitation as an empowerment model is that service-users gain improved functioning, an increase in social functioning and an enhancement of their subjective quality of life. Embedded in these programmes is the provision of safe spaces, where meaningful interactions with others in shared activities occur. This contributes to skills development, social competence and the building of a positive sense of self, which is in line with principles of the recovery paradigm. Few such services exist in Cape Town, South Africa and no relevant studies have been documented. A qualitative participatory approach was used utilising focus groups on two levels: first in mapping the territory and defining outcomes according to service-users; and secondly, for data collection of lived experiences of participants. The 'most significant change technique', a process which involves the collection of stories of subjective change, was used to focus the group processes. All groups were digitally recorded and transcribed. Data was examined according to a basic method of thematic analysis and participants' stories were classified according to broad domains of social, personal, learning, work, and living. A total of 44 service- 4 users from the four Cape Mental Health Society programmes, all diagnosed with severe mental illness, from varied demographic backgrounds and levels of functioning participated in nine focus groups. Participants felt that in attending the programmes they had experienced improved interpersonal connection, interaction and activity. This then seems to indicate some process of reclamation and recovery in the face of the loss of meaningful relationships when becoming ill with a mental illness. The positive benefits experienced by participants in the supportive community offered by the programmes, seem to be in line with programme objectives. The findings support the importance of opportunities for participation in valued meaningful activities, within a social context. Participants felt that by attending the programmes they benefitted on a personal level, building a positive sense of self, which included increased confidence and self-esteem, gaining hope, improved positive attitude, self-knowledge and acceptance, increase in motivation, increased vitality, increased motivation, increased awareness and interest in life, and gaining a sense of purpose and meaning. Subjective quality of life improvements for most participants in this study included an improved positive sense of self as well as valued socialization experiences, confirming the importance of these factors in recovery. The Cape Mental Health Society psychosocial rehabilitation programmes are accordingly robust in nature. In line with the philosophy of psychosocial rehabilitation and recovery principles, the programmes seem to be providing safe spaces for people with mental illness, creating opportunities for meaningful interactions with others, 5 thereby enhancing the confidence and self-esteem of participants while, at the same time building social skills.

Includes bibliographical references (leaves 83-93).