Abstract
Despite evidence for the value of family-based interventions for mental disorders, there have been relatively few attempts to establish these in low-income settings. This chapter describes the development of a non-profit organisation, Cuenta Conmigo (CC), in Nicaragua which offers social support and education to families caring for relatives with psychotic disorders. In common with many low-income countries, Nicaragua has very limited mental health services and many families are living in conditions of poverty which can be exacerbated by the onset of mental illness. This chapter uses case examples drawn from the experience of the author in setting up CC to illustrate the potential benefits of the intervention for poor families in a rural town where there are few mental health services beyond brief psychiatric consultation and the provision of medication. The chapter also illustrates some of the challenges in ensuring the sustainability of CC, in particular securing long-term funding and the support of policy makers. The chapter concludes by arguing that community-based family interventions in mental health care can play an important role in enhancing recovery and social inclusion and can be implemented at low cost. However, while non-governmental organisations such as CC are valuable in establishing such interventions, government commitment is vital to ensure their sustainability.
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Notes
- 1.
All names of patients and family members in this chapter are pseudonyms.
- 2.
The case material in this chapter is partly derived from Van der Geest (2011).
- 3.
This name is a pseudonym.
- 4.
Side effects of first-generation antipsychotic drugs such as chlorpromazine are common and disabling and include tremor, restlessness and muscle stiffness.
- 5.
The explanations family members give for the change in their loved one are often formulated in a way that reduces social stigma. By naming external causes, like susto or hitting the head as a child, families are able to keep their dignity and social prestige (Van der Geest 2011).
- 6.
The demands of caregiving include paying for psychiatric treatment, supervising the patient, dealing with the social stigma associated with mental illness and coping with the emotional distress that the symptoms of the disorder may cause.
- 7.
Covert administration of medication is common in low-income countries. In the absence of adequate health services, health professionals and families feel they have no other viable alternative. The ethical aspects of this phenomenon relating to autonomy and consent have been discussed in several studies. Some argue that restoring the patient’s capacity serves to promote their autonomy. Others argue that patients can be abused in the process (Srinivasan and Thara 2002: 534–535, Teferra et al. 2013: 6).
- 8.
Comisión de Personas con Discapacidad (Commission for People with Disabilities).
- 9.
Federación de Asociaciónes de Personas con Discapacidad (Federation of People with Disabilities).
- 10.
Asociación de Capacitación e Investigación para la Salud Mental.
- 11.
Fundación Interamericana.
- 12.
Red Regional de Salud Mental Centroaméricana: Una red de grupos de usuarios y familiares (Central American Regional Network for Mental Health: A network of user groups and family members).
- 13.
This qualitative approach to evaluation has also been employed by BasicNeeds who collect first-person narratives as evidence and use these to promote their work.
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Acknowledgements
I want to thank Geertje van der Geest, Gerben Wieldraaijer, Kate Matuszewski, Kees van der Geest, Koen Kusters, Sjaak van der Geest and Wendy Nelissen for their helpful comments on earlier drafts of this chapter. Above all, I am especially grateful to everybody who participated in the research and contributed to CC.
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van der Geest, R. (2017). A Family-Based Intervention for People with a Psychotic Disorder in Nicaragua. In: White, R., Jain, S., Orr, D., Read, U. (eds) The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-137-39510-8_25
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