Towards a decolonial medical treatment team approach : the case of mental healthcare in South Africa

Towards a decolonial medical treatment team approach : the case of mental healthcare in South Africa Asongu, Acha-Anyi Collaborative medical treatment teamwork through effective communication can enhance mental healthcare. Therefore, medical treatment teamwork is widely advocated as an approach for treating mentally ill patients, since diverse healthcare professionals, contribute expertise for patient care. Effective communication amongst members of the medical treatment team, is fundamental for effective medical treatment teamwork. Therefore, this research focused on exploring how the medical treatment team interacted in order to achieve effective patient care, from a South African perspective. Approximately 80 per cent South Africans are influenced by socio-cultural factors when approaching and treating mental illness. Hence, a decolonial medical treatment team approach to mental healthcare, enables the medical treatment team to cater for important aspects such as cultural diversity within the medical treatment team, medical treatment team collaboration with traditional healers, and catering for the patient’s cultural context in mental healthcare. This focus caters effectively for mental healthcare in a South African context. However, there is no single model or theory that caters for important aspects (such as the medical treatment teamwork context and socio-cultural aspects catering for diversity) that influence mental healthcare. Hence, the aim of this study was to propose a comprehensive conceptual framework that was synthesised from literature, which included various health communication theories, medical treatment teamwork theories, decolonial theories and cultural theories. The conceptual framework was verified using four data collection methods namely, document analysis, observation, face-to-face semi-structured interviews, and focus group discussions. Data was analysed using specific steps from Braun and Clarke (2006) via a thematic analysis. The key findings from this study indicated that collaborative medical treatment teamwork which considers the socio-cultural context in mental healthcare, is beneficial in achieving effective mental healthcare. As a result, a comprehensive conceptual framework for a medical treatment team approach to mental healthcare was proposed as a contribution for this study.; Samewerkende mediesebehandelingspanwerk deur doeltreffende kommunikasie kan geestesgesondheidsorg verbeter. Mediesebehandelingspanwerk word dus wyd voorgestaan as ’n benadering vir die behandeling van pasiënte met geestesongesteldheid, aangesien diverse gesondheidsorgpersoneel kundigheid tot pasiëntsorg bydra. Effektiewe kommunikasie tussen lede van die mediesebehandelingspan is die grondslag vir spanwerk in effektiewe mediesebehandelingspanwerk. Hierdie navorsing het dus gefokus op die ondersoek na die wisselwerking tussen die mediesebehandelingspan om effektiewe pasiëntsorg te bereik, vanuit ’n Suid-Afrikaanse perspektief. Ongeveer 80 persent van Suid-Afrikaners word deur sosiokulturele faktore beïnvloed wanneer hulle geestesongesteldheid benader en behandel. Gevolglik stel ’n dekoloniale mediesebehandelingspanbenadering tot geestesgesondheidsorg die mediesebehandelingspan in staat om voorsiening te maak vir belangrike aspekte soos kulturele diversiteit binne die mediesebehandelingspan, samewerking van die mediesebehandelingspan met tradisionele genesers, en voorsiening vir die pasiënt se kulturele konteks in geestesgesondheidsorg. Hierdie fokus maak doeltreffend voorsiening vir geestesgesondheidsorg in ’n Suid-Afrikaanse konteks. Daar is egter geen enkele model of teorie wat voorsiening maak vir belangrike aspekte (soos die mediesebehandelingspanwerkkonteks en sosiokulturele aspekte wat voorsiening maak vir diversiteit) wat geestesgesondheidsorg beïnvloed nie. Die doel van hierdie studie was dus om ’n omvattende konseptuele raamwerk voor te stel wat uit literatuur gesintetiseer is wat verskeie gesondheidskommunikasieteorieë, mediesebehandelingspanwerkteorieë, dekoloniale teorieë en kulturele teorieë ingesluit het. Die konseptuele raamwerk is geverifieer deur gebruik te maak van vier data-insamelingsmetodes, naamlik dokumentontleding, waarneming, aangesig-tot-aangesig semi-gestruktureerde onderhoude en fokusgroepbesprekings. Data is tematies ontleed aan die hand van spesifieke stappe van Braun en Clarke (2006). Die sleutelbevindinge van die studie het aangedui dat samewerkende mediesebehandelingspanwerk wat die sosiokulturele konteks in geestesgesondheid in ag neem voordelig is in die bereiking van effektiewe geestesgesondheidsorg. Gevolglik is ’n omvattende konseptuele raamwerk vir ’n mediesebehandelingspanbenadering tot geestesgesondheidsorg voorgestel as ’n bydrae vir hierdie studie.; Ukusebenzisana kwethimba lokwelashwa ngokuxhumana okuphumelelayo kungathuthukisa ukunakekelwa kwezempilo yengqondo. Ngakho-ke, ukusebenzisana kwethimba lokwelashwa kukhuthazwa kabanzi njengendlela yokwelapha iziguli ezigula ngengqondo, njengoba ochwepheshe abahlukahlukene bezokunakekelwa kwempilo, benikela ngobuchwepheshe bokunakekelwa kwesiguli. Ukuxhumana okuphumelelayo phakathi kwamalungu ethimba lezokwelapha, kubalulekile ekusebenzeni kwethimba lokwelashwa okuphumelelayo. Ngakho-ke, lolu cwaningo lugxile ekuhloleni ukuthi ithimba lezokwelapha lisebenzisana kanjani ukuze kuzuzwe ukunakekelwa kwesiguli okusebenzayo, ngokombono waseNingizimu Afrika. Cishe amaphesenti angama-80 abantu baseNingizimu Afrika bathonywa yizici zezenhlalo namasiko lapho besondela futhi belapha ukugula ngengqondo. Ngakho-ke, indlela yethimba lezokwelapha elingasekho ekunakekelweni ngokwengqondo, yenza ithimba lezokwelapha likwazi ukubhekelela izici ezibalulekile njengokuhlukahluka kwamasiko eqenjini lezokwelapha, ithimba lezokwelapha ukusebenzisana nabelaphi bendabuko, kanye nokubhekelela amasiko esiguli ekunakekelweni kwengqondo. Lokhu kugxila kusiza ngempumelelo ekunakekelweni kwengqondo esimeni saseNingizimu Afrika. Kodwa-ke, asikho isifanekiso esisodwa noma umbono obhekelela izici ezibalulekile (njengomongo wethimba lokwelashwa kanye nezici zenhlalonhle-zamasiko ezibhekelela ukuhlukahluka) ezinomthelela ekunakekelweni kwengqondo. Ngakho-ke, inhloso yalolu cwaningo kwakuwukuphakamisa uhlaka lomqondo olubanzi olwahlanganiswa ezincwadini, olwaluhlanganisa imibono yezokuxhumana yezempilo ehlukahlukene, imibono yethimba lezokwelapha, imibono yokuqeda ubukoloni kanye nemibono yamasiko. Uhlaka lomqondo lwaqinisekiswa kusetshenziswa izindlela ezine zokuqoqwa kwemininingwane okungukuthi, ukuhlaziya imibhalo, ukubuka, izingxoxo zobuso nobuso ezihlelwe kancane, kanye nezingxoxo zamaqembu agxilile. Imininingwane yahlaziywa kusetshenziswa izinyathelo ezithile ezivela ku-Braun and Clarke (2006) ngokuhlaziywa kwendikimba. Okutholiwe okubalulekile okuvela kulolu cwaningo kubonise ukuthi ukusebenzisana kwethimba lokwelashwa okucabangela umongo wenhlalonhle-ngokwesiko ekunakekelweni kwezengqondo, kunenzuzo ekuzuzeni ukunakekelwa kwezempilo yengqondo okusebenzayo. Ngenxa yalokho, kwahlongozwa uhlaka olubanzi lomqondo wethimba lezokwelapha ekunakekelweni ngokwengqondo njengomnikelo walolu cwaningo.