Recovery conceptualization and Treatment preferences: Choices for Clients with Psychosis in Northern Malawi By: Charles Masulani Mwale 1, 1 St John of God Community Services, Mzuzu; 2013-Mental Health Dissemination Conference-Mzuzu

INTRODUCTION 14% of the global burden of disease attributed to chronically disabling nature of psychoses and other mental health problems Traditional research approaches to psychosis have been concerned primarily with biopharmaceutical treatment aspects This medical approach, is seen as limiting, as it does not address the wider personal, psychological and social dimensions so central to the broader conceptualisation of recovery Studies have shown the growing recognition that recovery does not simply mean the absence of symptoms, cure or a return to the former self. Such definitions include the concept of personal change in which the development of a new sense of self can lead to the establishment of a fulfilling life, whether or not symptoms are present

INTRODUCTION 2 Provision of quality & acceptable care to patients, need consulting patients living with psychoses by: –getting a broader understanding of recovery from the clients’ perspective –determining treatments that they prefer & prioritise so that the providers can be sensitive when proving services to such clients. This is important due to significant differences between the priorities of clients and the professionals treating them. This study, therefore, proposed to explore clients’ understanding of recovery (from available options); and their respective treatment preferences in Malawi.

OBJECTIVES To list treatment preferences of clients’ living with psychotic illnesses in Malawi. To list common stipulations that constitute recovery from perspective of clients living with psychotic illnesses in Malawi. To establish association of treatment preferences and recovery conceptualization among clients living with psychotic illnesses in Malawi. (To be done in the final report).

METHODS 1 Cross-sectional descriptive study design. Done at two main mental health outpatients’ clinics in Mzuzu, and Karonga (plans to finalise data collection in Bwaira and Zomba mental Hospitals). Clients having a Psychotic diagnosis attending the above clinics (but meeting inclusion criteria) were requested to take part in the study. Formula by Lwanga & Lameshow (1992) for calculating sample size for a cross sectional survey, 384 patients are to be interviewed by end of study. But presentation is based on data for 104 patients interviewed so far.

METHODS 2 Data collection done using a questionnaire based on priority preferences for Treatment by Byrne et al. and common recovery conceptualisation by Pitt et al. from psychosis: a user-led project. preferences recovery After piloting the data collection tool, and training two research assistants, the study Questionares was administered to consenting participants. This study was cleared by the National Health Sciences Research Committee and adhered to all ethical principles as detailed in the Helsink declaration. Frequencies computed by SPSS was used to analyse data to determine the common conceptualization of recovery; most preferred treatments Chi-tests will be used to determine the association between the two.

RESULTS 1 On preferred treatment options: –96% participants prioritized medical treatment options (Medication prescribed sufficiently & low-dose medication). –85% prioritized advisory treatment options (advice on coping with psychosis; Supportive counselling and family advice on coping with clients’ behaviour). –78% prioritized relational treatment options (Continuity of caregiver and help with re-socialization –Very few (37%) prioritized environmental treatments aspects(quiet environment and practical help in the clinical environment).

RESULTS 2 On areas identified by clients as constituting recovery, more than 80% of the participating clients chose reduction in symptoms of psychosis e.g. Preoccupation with psychotic experiences and loudness of voices. Very few patients who chose options under Emotional change; behavioural change; Occupational change; Relationships and social behaviour; Support and treatment; Understanding and control as signs for recovery from psychosis.

Discussion On treatment preferences contrasted with a study by Crane-Ross, D., Roth, D., & Lauber, B.G. (2000) where clients prioritized privacy during treatment. All other preferences similar to similar studies Findings on recovery similar to most studies carried in other developed countries apart from perceived occupational change & empowerment. Limitation: Use of close ended questionnaire limiting compared to use of use of mixed methods

RECOMMENDATIONS These study findings re-affirm the importance that: Health care workers do a lot on medical aspects of clients’ care they also need to more on relational and advisory counselling aspects of care for individuals with psychotic problems. Health care workers should be sensitive with other aspects of care that clients with psychosis prioritise

St John of God for sponsoring the study Agatha Nyirenda& Mrs Chimalilo for data collection Study participants Thanks for attention!!! Acknowledgement