Factores de riesgo que influyen en la violencia

Participants expressed how the programme helped them to become empathetic and non- judgemental towards people with mental disorders. Two sub-themes were abstracted from the data reflecting their change in attitudes and behaviours: Developing empathy and Being non-judgemental.

6.4.3.1 Developing empathy

Involvement in the programme helped participants to appreciate the difficulties experienced by people with mental disorders. The video presentations referred to earlier, about two individuals sharing their experiences of mental disorder, prompted discussion about the need for empathy. These two individuals shared their difficulties and narrated how the empathetic natures of their partners, friends and family were helpful in their well-

being and recovery. The video highlighted the consequences of being empathetic or unsympathetic. Participants shared stories from within their communities about families who had been empathetic or lacked empathy and related these attitudes to the outcomes of the family member with the mental disorder. According to the participants, empathetic families had satisfying outcomes, while those who lacked empathy had less satisfying outcomes with their affected family member. These conclusions fostered in participants a more empathetic view of people with mental disorders. For them, this highlighted that lack of empathy was inappropriate and unhelpful. A better alternative was to appreciate the difficulties and to be accepting of people with these disorders.

… we shouldn’t neglect them, we shouldn’t neglect them. Let them be in the society that we live, so that we talk to them. We (can) discuss their treatment with them, so that they will recover. We shouldn’t go and put them somewhere [e.g., prayer camps, herbal centres and fetish camps68] and think that they are not part of us. We have to bring them closer (to us). Whatever we do we (should) involve them, so that they will know that we are there for them. (IC2.M6)

One participant commented that the problem-solving Story-bridge exercises had helped him to confront his unfavourable attitude toward people with mental disorders. He noted the importance of being empathetic during the exercises. He explained that, by role- playing as a person in need of help in the exercises, his attitude changed to a more empathetic stance, which allowed him to participate meaningfully in addressing the mental health problem of the person highlighted in the exercise.

How we grouped ourselves [during the Story-bridge exercises], and if you put yourself in the shoes of the one who is mentally disturbed, and you consider his situation as part and parcel of you, [being affected] you will solve the problem [mental health problem of the person] very well. (IC2.M15)

Another participant recounted how previously he had ostracised and neglected his brother who had a mental disorder. He attributed this behaviour to a lack of understanding and empathy for his brother. He emphasised that, because of participating in the programme,

68 _{A traditional place that deals in spiritualism and is run by a fetish priest who serves as an intermediary between the spiritual}

world and the living. Fetish priests are consulted about people with mental disorders because of a belief in its spiritual cause, and the linkage of fetish priests with the spiritual world to address these conditions.

he now understood his brother’s condition. He also had become empathetic towards him and was supporting him to make lifestyle changes to aid his recovery.

We [my family] have stopped stigmatising against him and that [the] discrimination that we exhibited had really changed. Now, he sometimes comes to visit me at my present location. Previously, I would never let allow him to visit me …. I have been visiting them [his brother and mother] more regularly since the training [mental health literacy programme], and when I go, I just sit with him, talk with him. I walk with him. Sometimes we go for some physical training on Saturdays; we go jogging. After the programme, this is what I have been doing with him. (IC2.M16)

Participants commented favourably about how the training programme helped them to comprehend the difficulties faced by people, which, in turn, had made caring for and supporting a family member easier and less stressful. A participant also recounted her application of the knowledge about the difficulties encountered by people with mental disorders during a travel experience with her niece, after completing the training programme.

I have been able to spend some days with her there [Nigeria] and she did not act abnormally. But if she is with my mother she acts abnormally and beats my mother and others. She lives with my mother in the same house, but when I went with her, she did not do anything that was annoying. If she did anything that was provocative, as I have already said, I now deal with her patiently and coax her. So, I was able to spend a few days with her without any problem. Therefore, on their part [carers and family members] all that they need is patience and tolerance. (IC2.F11)

6.4.3.2 Being non-judgemental

Before participation in the programme, participants admitted to being judgmental about people with mental disorders. This entailed the belief that individuals with mental disorders were responsible for their condition. Participants (mis)perceived that mental disorders occurred as result of engaging in culturally unacceptable behaviours, such as substance misuse or because of a spiritual curse placed on individuals.

I was having some misconceptions that mental health issues are for the less privileged or those who abuse drugs, and also from spiritual attacks. (IC2.M16)

Participants used some stereotypical labels that were attributed incorrectly to people with mental disorders. For example, a common stereotypical label used in the Akan69 language was abodam anitie, meaning that people with a mental disorder who had a clear understanding of contemporary events and engaged in rational conversation were not ‘genuinely’ ill and feigning their condition. This labelling was based on an incorrect belief that people who had a ‘genuine’ mental disorder lacked awareness of contemporary events and were unable to engage in rational conversation. Participants also (mis)perceived that mental disorder was self-induced, particularly among less privileged people in their community. This (mis)perception was thought to be attributable to people’s inability to cope with social and financial hardship prior to the onset of their mental disorder. However, when the participants watched the videos of two individuals narrating their experiences of depression and schizophrenia and engaged in related discussion with their intervention group members, they realised that both stereotypes were incorrect.

I have seen that mental illness, irrespective of your status [in society], because, look at a law professor [in one of the videos] suffering from that kind of situation. So, it has really made me aware that it is not only the less privileged people that have been suffering from mental illness; any person can be affected (IC2.M16)

Actually, the videos were so helpful to me. I remember one lady, I forgotten [sic] the country she mentioned. She told her story as being someone who is wealthy. She has everything, yet she suffered from mental illness. So, the video made me know that, in fact, it is not about those we perceive to be suffering from such illness; anybody at all can affected. (IC3.M23)

After taking part in the programme, participants reported a change in their attitude and that they had become non-judgemental about people with mental disorders (depression and schizophrenia). Information about the disorders and sharing individual experiences had been helpful in reinforcing the need for attitudinal change. They realised that nobody

decides to develop mental illness deliberately and suffer the consequences.

At first, I thought mental disorder was self-inflicted but now I realise that, like any other disease, anybody can be affected. Now it has helped me to go closer to them. If I see someone with this problem I am now able to approach him and talk with him. (IC2.M17)

This programme has changed my attitude. At first, I was having some misconception that mental health issues are for the less privileged or those who abuse drugs and also from spiritual attacks, but this programme has changed my life, my attitude towards them [people with mental disorders]. (IC2.M16)