Stakeholders' perceptions of recovery from psychosis in Blantyre, Malawi: Definitions, goals, and interventions

Goals for recovery from psychosis are perceived differently among those who have been directly impacted by the illness: people with lived experience, caregivers, community members, and those providing treatment. Such differences can limit effective recovery. Understanding the perceptions and goals of each of these groups and the resources needed in different settings is crucial to delivering treatments leading to recovery. Little is known about these perceptions in low- and middle-income countries like Malawi. To understand different stakeholders' definitions of and goals for recovery, and the necessary resources needed to achieve recovery from psychosis in Malawi, we conducted a qualitative study at an outpatient mental health clinic in Malawi involving in-depth interviews and focus group discussions with key informants (n = 48), including people with lived experience (PWLE) and their caregivers, medical practitioners, traditional healers, and community and religious leaders. A thematic approach was used for analysis. All groups shared similar perspectives on recovery, viewing it as the cessation of psychotic symptoms and a return to premorbid function. The cessation of psychotic symptoms included stopping hearing voices and the return of socially appropriate behaviour. A return to premorbid function was described as being able to fully engage in activities of daily living, social interactions, and occupational responsibilities. In contrast to medical practitioners, PWLE additionally emphasized the importance of stopping medications, in part to avoid side effects like sedation. Common subthemes on the goal of recovery included self-reliance and reintegration into the community. To achieve recovery and meet the goals for recovery, all stakeholders reported a need for medication adherence, community involvement, government involvement, and counselling. However, PWLE also noted that recovery was not as complete if one was still on medications. Successful recovery requires a multidimensional approach involving different institutions and stakeholders. Community-based rehabilitation programs may help facilitate cooperation and integration of care.