implication on caregiving experiences of families and persons living with serious mental health ...

246 Pages·2012·1.9 MB·English

POLICY IMPLEMENTATION: IMPLICATION ON CAREGIVING
EXPERIENCES OF FAMILIES AND PERSONS LIVING WITH SERIOUS
MENTAL HEALTH PROBLEMS IN NIGERIA

BY

IZIBELOKO OMI JACK-IDE

A Thesis submitted to the School of Nursing, Faculty of Health Sciences, University of
KwaZulu-Natal

In fulfillment of the requirements for the degree of Doctor of Philosophy (Nursing)

Supervisor: Leana R. Uys

Co-Supervisor: Lyn E. Middleton

2012
DECLARATION
I hereby declare the sole ownership of this dissertation

POLICY IMPLEMENTATION: IMPLICATION ON CAREGIVING EXPERIENCES OF
FAMILIES AND PERSONS LIVING WITH SERIOUS MENTAL HEALTH
PROBLEMS IN NIGERIA

This research thesis has been submitted for PhD in Nursing (Mental Health) at the
University of KwaZulu-Natal, Durban, South Africa on the merits of its originality, through
observation of the scientific process of academic writing, tremendous input from my
supervisors. It has never been submitted for any degree or examination in any institution.
Work used and cited in this dissertation has been appropriately acknowledged both within
the text and in the reference list.

Signature……………………………………….Date…………………………………
Name: Izibeloko Omi Jack-Ide Student Number: 209527704

This study has been approved for submission by the Supervisors

Prof Leana R. Uys and Dr Lyn E. Middleton

Signature.………………………………………..Date……………………………….
Signature…………………………………………Date……………………..…….......

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DEDICATION

This work is dedicated to persons and families living with mental health problems and to
God Almighty for His love and mercies in my life

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ACKNOWLEDGEMENTS

First and foremost I give thanks to God Almighty who gave me life and the privilege to
embark on this PhD journey and saw me through to the end of my study and residence in
Durban, South Africa.

Special thanks and appreciation
There are many people without whom this dissertation could not have been accomplished.
With a grateful heart I express my thanks and appreciation to the following persons who, in
no small measure, contributed greatly through financial, physical, emotional and spiritual
support to the successful accomplishment of this project work. I humbly wish to
acknowledge the contributions of the following persons to whom I am greatly indebted.

Prof Leana R. Uys
My indefatigable and amiable supervisor for helping me develops passion for academic
writing and the value for research. Who has been a pillar of my success, your dynamism
and enthusiasm has led me on even during very stressful time. Thanks Prof for accepting to
supervise me and provided an intellectually enriching experience in the area of mental
health research which enhanced this study in a very unique manner. Your supervision was
tremendous, and is greatly cherished. Without which this project work would have been
consigned to oblivion. I am “here” because you made this dream come true. Thanks Prof!!

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Dr Lyn E. Middleton
My co-supervisor, for helping me develop appreciation for the value of research in mental
health nursing specialty. Thanks for your time and the light you ignited that cultivated a
deep interest for academic writing and for providing a rich wealth of practical experiences
that enhanced this study in a knowledgeable manner and for this; your supervision was
excellent and greatly appreciated. Thanks so much!!

My loving family
Thanks to my children Ivy and Miriam, stepchildren Etimekize and Amelia, my adopted
son Peter alias AA and my grandchildren Ekiye Junior alias J-boy, Sini and Gbavieme for
their unending love, support and encouragement in my ongoing pursuit of my goals and
most especially my beloved husband, Hyacinth Ben Ide “Dearest” never stopped believing
in me and reminded me many times of what I am able to accomplish. I cannot thank you
enough for your never ending patience, kindness and love, you have always been, and
continues to be, a source of love and strength.

To my relatives
My elder brother, Chief Boma Spero Jack “Daddy” Thanks for your fatherly support and
holding forth the home front, your enormous financial and emotional support. To my
mother Mrs. Fanny Gwegwe Jack and my sisters, may God replenish and keep you all in
good health.

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Prof Musa Kola Jinadu
Words are not enough to express my heartfelt gratitude for your great initiatives, to secure
my admission into University of KwaZulu-Natal. This story began with you and for this,
you are greatly appreciated. Thanks so much for all!!

Niger Delta University (NDU)
My sincere thanks and appreciation for granting me study leave to pursue further studies in
the hope that I return home to serve the institution and the young Faculty of Nursing as a
foundation staff, Bayelsa State and my country on completion.

Neuro-Psychiatric Hospital
Thanks to the management and staff of the Neuro-Psychiatric Hospital, Rumuigbo, Port
Harcourt, Rivers State, Nigeria for the support during data collection. I will always cherish
your hospitality, eagerness and assistance in all. Sincere thanks!!

Study Participants
To all of you, who volunteer to take part in this study, my heart is full of thanks and
appreciation for providing useful and relevant information needed for this study.

University of KwaZulu-Natal (UKZN)
Thanks for granting me admission to pursue higher education in a stimulating and serene
environment that reflect academic scholarship. The academic and support staff, School of
Nursing, UKZN, Durban, for your dedication to duty and willingness to assist and support
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during the time of my study. Thanks for your wise counsels and support throughout my
stay in Durban, South Africa.

My friends
Prof Adeleka A. Ojo, Theresa Obi, Akeghyifa Diffa, Prayer Solomoba Hogan, Mmoni
Ndibo Tabengwa and my Durban family Bro Swana Munduku and wife Sister Steve
Munduku. I appreciate your care and support, the special phone calls you make to know
how I am faring in Durban, and they were of great support. Thanks for being there!!

My Classmate and Friend
Mrs. Penehafo Angula, we met first week of arrival in Durban at School of Nursing. You
also came from afar (Namibia), we bonded together and our friendship became a beacon of
strength. We cried together when the cloud of academia became gloomy and we also
laughed and rejoiced together during times of successes. Thanks!!! You were more than a
friend “You are a Sister”

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TABLE OF CONTENTS

SECTION ONE: INTRODUCTION
1. Introduction………… ………………………….…………………………….…..1-9
1.1 Format of the study……………………………....………………………………9-11
1.2 The Nigerian mental health context…………………………...………................12-16
1.3 Problem statement……. …………………………………………………............16-18
1.4 Aim of study…….. ………………………………………….…………………..18-19
1.5 Research objectives………………………………………………………………19
1.6 Research questions ……………………………………..………………………..19-20
1.7 Significance of the study…………………..…………….………………..……..20-21
1.8 Conceptual framework …………………………………………………………..21
1.8.1 Introduction ………………………………….……………...…………………21
1.8.2 Townsend et al’s (2004) policy template framework …...……………...………22-23
1.8.3 The context domain ……………………...…………………...………..............23-24
1.8.4 The resources domain ……………………………………...…..………………24
1.8.5 The provision domain ……………………………………………….…...…….24-25
1.8.6 The outcomes domain ……………………………………………………..…...25-26
1.8.7 Non-recursive relations…………………………………………….…………...26-27
1.9 Operational definition………………………………………………………….…27
1.10 Conclusion……….……………………………..……………………………….28-29

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SECTION TWO: ARTICLES AND POLICY BRIEF
2. Layout of articles ………………………………..………………….…...........……30-31
2.1 Flow Chart…………………………………….…..…………………..…..………31-32
2.2 Articles one: A comparative study of mental health services in two African countries
South Africa and Nigeria ………………………………………….…………..……..33-61
2.3 Article two: Caregiving experiences of families of persons with serious mental health
problems in the Niger Delta region of Nigeria ……………………………………….62-93
2.4 Clients with serious mental health problems experiencing care within the current mental
health policy in the Niger Delta region of Nigeria ………………………………..….94-123
2.5 Article four: The experiences of mental health care professionals providing mental
health care services in a neuropsychiatric hospital Port Harcourt, Rivers State,
Nigeria……………………………………………………………………………….124-145
2.6 Article five: Policy brief: Increasing access to mental health care service through PHC
in Nigeria…………………………………………………………………………….146-151

SECTION THREE: CONCLUSION
3. Discussion …………………………………………...……………………….…...152
3.1 How is the mental health system in Nigeria organized and services delivered compared
with that of South Africa? ………………………………………..……..………….152-155
3.2 What are the caregivers, clients (Service users) and mental health professionals’
experiences within the mental health system environment?.....………………….….155-156
3.2.1 Context Domain…………………………………………….…………………156-160
3.2.2 Resources Domain………………………………………….…………….........160-162
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3.2.3 Provision Domain……………………………………………………………...162-165
3.2.4 Outcomes Domain………………………………. ……….…………...………165-167
3.3 What is the pathway to be followed in engaging policy makers in Nigeria on mental
health policy improvements?........……………………………………………….…..167-172
3.3.1 Goals………………………………………………….…………..………….…172
3.3.2 Objective……………………………………….…………………………..…..172
3.3.3 Strategy to lobby policy………………………………………………………..172-173
3.3.4 Expected outcomes…………….………………………………………………173-174
3.4 What policy improvements to ameliorate the burden on clients and families of those
experiencing serious mental health problems?.......................................……..……...175-178
3.5 Application of the Townsend’s conceptual framework…………………………179
3.5.1 Service users perspectives of mental health services……………………….…179-181
3.5.2 Mental health professionals’ experiences of providing care………….……….182-184
3.6 Relevance of study to Nursing Knowledge, scholarship and practice…..……....185-186
3.7. Limitation of the study……………………………….………………….……..186-187
3.8 Implication for further study……………..…………………………….…..........187
3.9. Conclusion …………………….……………………………………….…….....188-190
References…………………..…………………….…………………………………191-205

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