The problems faced by adults institutionalised with depression upon re-entering society

Abstract

Background Information: Although huge steps have been taken throughout these past years in the medical field, especially in the mental health (MH) area, there are still areas that should be improved. In fact, there is a lack of literature that directly targets individuals with depression upon re-entering society after being institutionalised (Poulsen et al., 2017). There could be different reasons why this literature gap is present, for example: lack of knowledge, lack of awareness, prejudices, stigmatisation, discrimination, emotional burdens or financial problems (Henderson et al., 2013). Objectives: The difficulties faced by people with depression in Malta, both when institutionalised in Mount Carmel Hospital (MCH) and when referred to the Richmond Foundation (RF), will be explored in this study, which will also explore the opportunities offered throughout the re-integration process. Another objective is to identify and understand the help that MH sufferers need from the MH sector, from the general public and from their families. Moreover, by evaluating in depth these realities, one will gain a better understanding of the intricate stories and narratives of individuals with depression, who are challenged when re-integrating in society, after being hospitalised in a MH institution. Finally, the aim is to detect if discrimination and stigmatisation are still present in Malta and in what ways these can be avoided. Research Design: A qualitative narrative phenomenological study design will be used for the purpose of this research question by using semi-structured interviews with open-ended and non-direct questions (Creswell, 2016). Settings: The RF acted as an intermediary in the selection of the participants, using a set of inclusion/exclusion criteria. Participants were included if they were Maltese, between 25-40 years old, had been institutionalised at MCH, but then were discharged and are presently living in the RF community services. This occurred after obtaining the ethics approval from both the Faculty Research Ethics Committee and the University Research Ethics Committee within the University of Malta. Participants: Six subjects, four adult females and two males, participated. Methods: Semi-structured interviews were conducted with the participants; four were done face to face and two virtually, due to COVID-19 measures. The interviews lasted approximately one hour each. Participants were asked about their psychiatric hospitalization experience and their life afterwards. The same set of questions was asked to each participant and the researcher used a reflective diary to write down side notes or ideas that were noted during the interviews. Findings were analysed according to the Creswell (2016) narrative analysis design in order to provide the necessary conclusions from their stories (Chapter 5). Using this design, the researcher listened carefully and reflectively to the stories being told by the participants. Then, these stories were combined with the personal reflections, in order to obtain results, which would be backed by the relevant available literature. Results: The interviewees’ past events were then written, as the participants presented their story; all the stories were compared to find common trends, while highlighting their epiphanies (Chapter 4). Two core themes were found: the MH sector in Malta has made huge advances and is suitable to help and treat the majority of those in need and that there is still more room for improvement in the health care system and in educating the general public, in order to facilitate the re-integration process. From these two core themes the researcher deducted nine other minor themes common in all the interviewees’ stories. Discussion: A mixed bag of findings resulted from this study. On one hand, it is encouraging that the participants are aware that that there is more knowledge and awareness on MH in society, a factor that may decrease discrimination and stigmatisation towards sufferers. On the other hand, the participants pointed at a number of factors that are still required, so that the reality of individuals with depression and with a past history of institutionalisation, will be adequately re-integrated in society. Recommendations: There are still ways for improvement especially in infrastructure, for example, the importance of a more relevant psychiatric in-patient hospital and better MH care facilities in the community. Educational platforms should be used to increase more awareness, even through the personal experiences of sufferers themselves. There should be more local individuals undertaking qualitative research, to investigate the experiences of the re-integration process.