Mental Illness in Black Community in South Africa

Research Concept

Mental illness has always implied a certain amount of social stigma due to the existing misrepresentations of the subject matter and the resulting misconceptions and prejudices associated with it. Cultural perspectives on mental illness play a noticeable role in behaviors toward and perceptions of people suffering from mental health issues in specific communities. In South Africa, the extent of prejudices against people with mental health concerns has been disturbingly high, as the recent research warns (Ward et al., 2013). Therefore, understanding the causes of prejudiced thinking toward people experiencing mental health problems is vital for developing a strategy that will allow mitigating the observed phenomenon.

This paper seeks to examine the problem of mental health stigma and discrimination in South Africa, including its nature and causes. Furthermore, the results of this review are expected to inform the selection of strategies for addressing the problem of mental health discrimination in the outlined environment. Moreover, the key similarities and differences in the studies collected for this review, as well as the shared issues and limitations, will be outlined in the process. Thus, the existing knowledge gap in the current state of research on discrimination against mental health patients in South African will be discovered, setting the course for future analysis.

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By scrutinizing the shared themes, similarities, and differences, as well as strengths and weaknesses of the studies dressing the stigma of mental disorders in South Africa, one can offer a strategy for managing the described problem. Currently, the lack of awareness appears to be the prevalent theme in all of the studies. Therefore, despite the limitations that the articles at hand demonstrate, the focus should be placed on promoting mental health literacy and offering patients screenings, consultations, and related services. As a result, an increase in the levels of well-being is expected.

Shared Issues

Each of the studies above reestablishes the fact that the presence of stigma faced by people suffering from different mental health issues is a source of continuous concern in the South African environment. For example, Taiwah et al. (2015) assert that discrimination against patients suffering from mental health problems not only affects both the target demographic and their caregivers but also obstructs the way for them to receive appropriate healthcare support. As a result, the quality of care suffers drastically. The described sentiment is shared by a plethora of other authors of multiple studies on the subject. Namely, Keating and Robertson (2004) noticed that the increase in prejudice against mental health patients causes the target audience to avoid seeking professional help. Makanjuola et al. (2016) expand the scope of the analysis, scrutinizing the changes in self-perception among mental health patients, discovering that the presence of prejudices leads to patients developing self-stigma as a result.

Likewise, the effects of fear remain the shared topic that all of the studies at hand incorporate into the analysis. The application of the analytical perspective allows making the study more coherent. An important point of comparison for the article in question emerges when considering the differences in the themes observed in each study. For example, one of the articles makes a very valid point concerning the increase in the levels of fear that the target demographic experiences once the level of prejudice rises in the target setting. Explaining the effects of deep-seated personal biases against people experiencing mental health problems, Keating and Robertson (2004) touch upon the problem of violence against mental health patients, as well as the threat of social ostracism toward individuals experiencing a mental health problem. The specified sentiment is reiterated in several other research papers under analysis, including the study by Franz et al. (2010). Specifically, the article in question mentions the increased propensity toward fear in mental health patients since they are afraid of the label of mental disorder that is likely to be applied to them in their community.

Comparison

Similarities

The articles under analysis share quite a few similarities in their assumptions and conclusions regarding the subject matter. Specifically, all of the authors address the same problem of prejudices against people with mental health issues, thus pointing to the presence of an obvious problem within some of the present-day communities. The themes discussed in the articles mostly overlap due to the common focus on the presence of a problem rooted deeply in local culture and framework for social interactions.

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The problem of ubiquitous fear observed in mental health patients in the identified scenario is the next common characteristic presented in every study. Driven by the unwillingness to become a social pariah, people with mental health problems are often unwilling to disclose their health status to the rest of the community. Multiple articles declare that the specified strategy frequently leads to an increased danger for both mental health patients and community members (Tawiah et al., 2015). Overall, the problem of fear as the primary driver behind the decision not to disclose one’s status as a mental patient is linked to the threat of social reprimand in every study. The research by Franz et al. (2010) mentions that the fear of facing social disdain both by patients and their family members leads to the specified categories developing coping mechanisms that often turn out to be very unhealthy.

Another characteristic that each of the studies chosen for the review possess is the examination of implications that the presence of discrimination against mental health patients entails. The failure to follow the suggested treatment guidelines that result from the attempts at concealing one’s status of a mental health patient, as well as the following health complications, is also mentioned in most studies. For example, Franz et al. (2010) specify that patients often face rapid deterioration or at least aggravation of their condition due to the unhealthy coping mechanisms developed as a way of shielding themselves from social disdain. Likewise, Ward et al. (2013) emphasized that the presence of social hostility toward people seeking support from mental health professionals reduces the initiative for seeking help in managing mental health conditions among South African residents. Ward et al. (2013) also mention unhealthy coping mechanisms that patients tend to develop in the specified setting, implying that the behavioral patterns created by patients in the described scenarios need to be addressed as fast as possible before they cause significant damage. However, due to the social pressure, patients are unable to seek help, which every study under analysis determines as the core problem to be managed.

Differences

Despite the common topic, namely, the analysis of mental health perceptions in South Africa, each of the studies contains a unique characteristic that sets it apart from the rest. Therefore, multiple differences between the articles under consideration can be noticed. The inclusion of different demographics into their analysis and the attempts at examining the issue as it pertains to different groups is one of the principal distinguishing characteristics of the specified studies. For example, Ward et al. (2013) seek to consider differences between male and female patients with mental disorders. In turn, Corrigan and Rao (2012) do not seek to target a particular population, instead, providing a broad overview of the problem across all types of patients. Overall, methodological differences are what sets the studies under analysis apart and emphasize the individual value of each. With specific research questions, goals, and study design, every article represents a unique argument that adds to the discourse, expanding it and enriching it with new ideas.

In addition, the location and the resulting changes in the approach toward sampling can be seen as the foundational difference between the articles at hand. Although South Africa remains the main location chosen for the assessment of prejudices and discrimination toward people with mental health concerns, every study focuses on a different area or state, thus either expanding or limiting its scope. For example, the article by Kapungwe et al. (2010) is set in the Tanzania context, which is quite different from the perspective that the paper by Quinn and Knifton (2014) adopts, selecting Uganda as the main research environment. Some studies, such as the ones by Franz et al. (2010), Conner et al. (2010), and Egbe et al. (2014), opt for disregarding the selection of a specific setting and, instead, examine the problem of prejudice towards people with mental health problems as a general concern. Although the latter approach broadens the study, making the results applicable to any context, it also makes the research less poignant, generalizing it and making it less relevant to the South African context.

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Key Local and International Authors

The articles considered in this review feature a wide variety of authors from South African and global backgrounds. Among the most notable local contributors to the research, one should list A. Kapungwe, J. Mwanza, L. Mwape, A. Sikwese, R. Kakuma, T. Kathree, One Selohilwe, B. Oladeji, and O. Gureje, to name just a few. These authors have contributed vastly to the research of discrimination that mental health patients have been facing in the South African community. By conducting meticulous studies of the key challenges and obstacles to receiving healthcare assistance, the authors have defined the further development of an appropriate intervention.

Limitations

Each of the researches used for this review incorporated several limitations that slightly reduced the corresponding applicability of its results. For example, the choice of the sample size has contributed to limiting the reliability of research results in several articles due to the inherent biases in the selection of the target population. Namely, by restricting the range of research subjects to a single location, the papers by Kapungwe et al. (2010) and Quinn and Knifton (2014) suffer from a slight limitation in the applicability of research outcomes.

Gaps in the Literature

The assessment of the problem of perceiving the target demographic in the South African context has indicated that several major gaps in literature exist. Namely, the factor behind discrimination-based attitudes toward people having mental health disorders is a noteworthy outcome. It is central to effective care to study the sources of discrimination and intolerance to mental health patients among the South African population so that appropriate measures could be introduced to manage the concern.

Moreover, the absence of viable interventions aimed at handling the problem is a notable gap found across the studies incorporated into this review. Although several articles, such as Egbe et al. (2014), suggest possible measures against the presence of prejudices toward people facing multiple mental health problems, the lack of a general framework that would be upheld by healthcare practitioners is truly baffling. Thus, the assessment of the articles infers the necessity to establish a framework that could serve as a social intervention for reducing the level of prejudice san discrimination that the specified demographic suffering from mental health conditions experiences.

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Finally, the analysis of the extent of disdain and emotional ostracism that South African residents show toward people suffering from mental health disorders is mostly absent in all of the studies considered for this review. Although Quinn and Knifton (2014) have attempted to gauge the assessment of the emotional weight that the described attitudes have on people with mental health concerns, the general scale of the problem is yet to be examined. Instead, the research points to the fact that the extent of the social stigma toward patients having different mental health conditions is roughly the same across South African cultures. However, to measure the level of the problem under consideration, one will have to perform a meticulous linguistic analysis, which is presently an unattainable goal due to the lack of common perspective between South African languages and the English language, as the authors explain (Quinn & Knifton, 2014). Therefore, the article creates an impetus for further research aimed at the study of South African cultural specifics.

Paucity

Notably, the range of studies conducted on the issue of discrimination toward patients suffering from mental health issues in Africa is quite scarce. The paucity of the specified type of research can be explained by the lack of interest in the subject matter defined by the specifics of the South African culture. Namely, since the idea of discriminating toward the specific type of population is deemed as a natural part of interpersonal communication within South African communities, the subject matter is not considered to be worthy of additional research. Indeed, a closer analysis of the extent of study on the problem of discrimination toward patients with mental health conditions in South Africa will show that a significant portion of these articles comes from states other than the designated area. Therefore, in South Africa, the problem at hand is not viewed as a legitimate source of concern.

The identified line of thinking needs to be challenged so that the exploration of the outlined social problem could continue in the South African context. Thus, the perceptions and attitudes of residents could be challenged and changed with the introduction of appropriate interventions. Moreover, conducting research in the South African environment from the perspective of local researchers will allow gaining a better insight into the nature of the problem and the factors that keep it alive in the specified setting. As a result, frameworks for subverting social biases and encouraging a shift in the social paradigm can be created. The resulting alteration in the social representations of mental health issues will allow changing people’s outlook on the problem and reshape their current stance toward that one of support for those with mental health conditions.

The proposed change is expected to have vastly positive implications on the management of mental health problems. Apart from the obvious removal of a major factor causing distress in mental health patients, the eradication of biases toward mental health patients will have to imply a significant societal change. Namely, the promotion of mental health literacy within the community will be needed to introduce positive change.

References

Conner, K. O., Copeland, V. C., Grote, N. K., Koeske, G., Rosen, D., Reynolds III, C. F., & Brown, C. (2010). Mental health treatment seeking among older adults with depression: the impact of stigma and race. The American Journal of Geriatric Psychiatry, 18(6), 531-543. Web.

Corrigan, P. W., & Rao, D. (2012). On the self-stigma of mental illness: Stages, disclosure, and strategies for change. The Canadian Journal of Psychiatry, 57(8), 464-469. Web.

Egbe, C. O., Brooke-Sumner, C., Kathree, T., Selohilwe, O., Thornicroft, G., & Petersen, I. (2014). Psychiatric stigma and discrimination in South Africa: Perspectives from key stakeholders. BMC Psychiatry, 14(1), 191-204. Web.

Franz, L., Carter, T., Leiner, A. S., Bergner, E., Thompson, N. J., & Compton, M. T. (2010). Stigma and treatment delay in first‐episode psychosis: a grounded theory study. Early Intervention in Psychiatry, 4(1), 47-56. Web.

Kapungwe, A., Cooper, S., Mwanza, J., Mwape, L., Sikwese, A., Kakuma, R.,… Flisher, A. J. (2010). Mental illness-stigma and discrimination in Zambia. African Journal of Psychiatry, 13(3),192-203. Web.

Keating, F., & Robertson, D. (2004). Fear, black people and mental illness: A vicious circle? Health and Social Care in the Community, 12(5), 439-447. Web.

Makanjuola, V., Esan, Y., Oladeji, B., Kola, L., Appiah-Poku, J., Harris, B.,… Gureje, O. (2016). Explanatory model of psychosis: impact on perception of self-stigma by patients in three sub-saharan African cities. Social Psychiatry and Psychiatric Epidemiology, 51(12), 1645-1654. Web.

Quinn, N., & Knifton, L. (2014). Beliefs, stigma and discrimination associated with mental health problems in Uganda: implications for theory and practice. International Journal of Social Psychiatry, 60(6), 554-561. Web.

Tawiah, P. E., Adongo, P. B., & Aikins, M. (2015). Mental health-related stigma and discrimination in Ghana: Experience of patients and their caregivers. Ghana Medical Journal, 49(1), 30-39.

Ward, E., Wiltshire, J. C., Detry, M. A., & Brown, R. L. (2013). African American men and women’s attitude toward mental illness, perceptions of stigma, and preferred coping behaviors. Nursing Research, 62(3), 185-194. Web.

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