Abstract
Unheard of; the problem of appropriate care provision for psychotic patients from different ethnic backgrounds
Therapy non-compliance and drop-out are major concerns in the treatment of psychotic patients from ethnic minority groups. Kleinman (1980) developed a theory according to which Explanatory Models (EM's) play an important role in such problems.
... read more
Discrepancies between the EM's of the professional caregiver and the patient and/or his social network can cause misunderstandings on both sides, leading - especially when there are large cultural differences - to treatment that is experienced as inappropriate or irrelevant. The importance of EM's has been a theme of many authors since Kleinman. However, the role of discrepancies between the EM's of caregivers and patients has not yet been systematically investigated for different diagnostic categories and different ethnic groups. The aim of this study is to enrich and develop the theory in the case of psychotic patients from certain minority ethnic groups in The Netherlands, by assessing the importance of EM's to appropriate care delivery for these patients. Twenty-one Dutch, 17 Surinamese-Hindustani and 16 Turkish psychotic patients were interviewed in their homes with a topic list relating to their Explanatory Model(s), social network, coping or help-seeking strategies, and their satisfaction with the treatment they received. The caregivers of all these patients were also interviewed separately concerning the same topics, using the same method. Ten patients from each group were also interviewed together with their family and their caregiver. These interviews were also video-recorded, transcribed and described. All the written reports and transcriptions were subsequently analysed using the method of Grounded Theory. The most important conclusions of this research are firstly, the crucial role of negative social factors in the life of patients and in the presentation of their narratives. These narratives concerned life problems and, far less often, psychotic disorders. Secondly, the relevance of Explanatory Models. How useful are they, taking into account that they are usually expressed in a fragmentary and strategic way, and that congruence of EM's does not seem to be an essential ingredient of care that is experienced as appropriate? We propose that EM's should be regarded as an instrument for initiating and sustaining a discussion between the caregiver and patient and relatives. The third topic of importance in this research is the major cause of poorly-matched care: the biodeterministic model that is adhered to by most caregivers, in particular nurses. This model encourages caregivers to neglect the social context of their patients. In our view, the aim of treatment should be to prevent the patient from falling even further into poverty and isolation, rather than simply keeping the psychotic symptoms under control. Particularly for ethnic minority patients, the neglect of the social situation has disastrous consequences. The prospect of treatment for this difficult group of patients which is not labour-intensive and therefore relatively inexpensive, seems to have been irresistible for policymakers in mental health care. This 'health care on the cheap', however, has led to care for chronic psychotic patients that is characterised by the problems described in this thesis: lack of attention from caregivers and an excessive emphasis on biological factors. This results in inadequate concern for the social context and experiences of patients and their relatives, poorly matched care (especially for patients from the ethnic minority groups studied here) and for many patients, severe degeneration.
Een handelsversie van dit werk is beschikbaar is bij Garant uitgevers, Antwerpen/Apeldoorn)
show less
