Browsing by Author "Protas,Joyce."
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Item Engagement, Disengagement and Re-Engagement in MentalHealth Services Among Young Patients With First-EpisodePsychosis: A Scoping Review(Wiley, 2025-09-18) Protas,Joyce.Introduction: Engagement in mental health services among young patients with first-episode psychosis (FEP) is crucial for pre- venting relapse. We conducted this scoping review to establish the proportion and determinants of engagement, disengagement and re-engagement in outpatient mental health care among young patients from 13 to 35 years with FEP. Methods: We used the guidelines for scoping review by the Joanna Briggs Institute (JBI) and the Arksey and O'Malley frame- work. We searched for published and unpublished studies guided by the inclusion criteria: studies published in English from 1990, the expansion of psychiatric outpatient, focused on engaged, disengaged and re- engaged in outpatient mental health care using quantitative, qualitative and mixed methods studies. We performed the numerical and thematic analysis and reporting using Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for scoping review (PRISMA-ScR). Results: About 25 articles published from 2002 to 2020 met the inclusion criteria for this review; the proportion of young peo- ple with FEP who remained engaged was 45.5% for 6 months of follow-up, and the proportion of re-engagement after initial disengagement was 78.8%. Disengagement ranged between 13% and 56.3% for 12–36 months. The socio-demographic factors associated with disengagement were older age, male, black, unmarried status, living alone, unemployment, social and material deprivation, poverty, substance use and involvement with criminal justice. Some clinical determinants included a history of mental illness in the family and a psychosis disorder diagnosis other than schizophrenia. Conclusion: Disengagement from mental health services is consistently high among people with FEP, indicating the need for intervention studies that address the associated individual and clinical factors to ensure their retention in treatment.Item Feasibility and acceptability of unconditional cash transfers intervention among unemployed young adults with first-episode psychosis in South Africa: a pilot randomized controlled trial(International journal of mental health, 2026-04-25) Protas,Joyce.There is a lack of high-quality evidence on cash transfers as an intervention to support young people with first-episode psychosis (FEP) in Africa. To address this gap, we conducted a pilot randomized controlled trial (RCT) with a 3-month follow-up period to assess the feasibility and acceptability of an unconditional cash transfer (UCT) intervention among FEP. We enrolled 60 unemployed young adults (18–29 years) with FEP from three public hospitals in KwaZulu-Natal, SA, and allocated participants into the intervention (n = 30) or the control arm (n = 30) using simple randomization. The intervention arm participants received a monthly transfer of R1,350 for three consecutive months. All 30 participants in the intervention arm completed the three-month follow-up, and 24 (80%) completed follow-up in the control arm. Although the effect of UCT on clinical and social outcomes is not the primary focus of this RCT, we observed significantly greater quality of life (p < 0.05) and medication adherence (p < 0.02) in the intervention group as compared to control group at the 3-month follow-up period. Although personal/social functioning challenge (p = 0.24) and cumulative relapses (p = 0.10) were greater in the control group, no statistically significant group differences were observed. Our study contributes the first evidence on UCT feasibility and acceptability for FEP.Item Strategies for relapse prevention among people with schizophrenia in KwaZulu-Natal Province, South Africa: Healthcare providers' perspectives(Plos One, 2025-03-10) Protas,Joyce.Introduction Relapse is a significant challenge among people with schizophrenia and is broadly recog- nized by the aggravation of positive or negative symptoms, the need for re-hospitalization, more intensive case management, and/or changes in medication. The quality of inpatient care and proper transition to outpatient care are crucial in reducing the risk of relapse. Healthcare providers play vital roles in ensuring the continuity of care after patients are discharged from the hospital. Little is known about the roles of preventing relapse from the perspective of healthcare providers. This study explored the currently existing strategies for preventing relapse from the perspective of healthcare providers. Methods We captured the view of healthcare providers providing services to psychiatric patients using a qualitative methodological approach with descriptive phenomenology. We con- ducted audio-recorded, in-depth interviews with 15 consenting clinical providers from a public psychiatric hospital in Durban, South Africa. To facilitate analysis, we used Dedoose software (SocioCultural Research Consultants, LLC [www.dedoose.com]), and the themes were inducted from the data. Results Six major themes inducted from the analysis: Preparing patients and caregivers for discharge; Developing consistent and caring therapeutic relationships; Using an active approach to transition; Working with patients and caregivers concurrently; Creating and sustaining interagency connections; and Facilitating alternative forms of treatment. Conclusions Discharge planning and preparation are needed to ensure smooth transitions from hos- pital to outpatient care for relapse prevention. The healthcare system should ensure the availability of human resources for health at all levels of health facilities, and multidisci- plinary teamwork will help a successful transition.Item Unmet needs of young adults following first-episode psychosis in KwaZulu-Natal, South Africa: Baseline findings from a pilot randomised controlled trial of basic income support(South African Journal of Psychiatry, 2026-02-26) Protas,Joyce.BackgroundPeople with psychosis have multiple and complex needs. The first episode of psychosis (FEP), as a distinct health challenge that occurs frequently during adolescence or early adult years, is a serious threat because of high levels of poverty among the youth in South Africa. AimThis study quantifies the needs among unemployed FEP adults aged 18–29 years in South Africa for potential early intervention targeting. SettingThe study was conducted at government psychiatric facilities in Msunduzi Municipality, KwaZulu-Natal province, South Africa. MethodsAs part of a pilot randomised controlled trial of an unconditional cash transfer (UCT) intervention, also known as basic income support (BIS), 60 FEP participants were enrolled, and we assessed their needs using the Camberwell Assessment of Needs, the Household Food Insecurity Access Scale and the Water Insecurity Experience Scale. Descriptive cross-sectional analyses were summarised for various domains of needs. ResultsMost participants were black people (n = 58, 96.7%), male (n = 47, 78.3%), with a median age of 23 years (interquartile range [IQR] = 20.0–25.5), with half being diagnosed with schizophrenia (n = 30, 50%). The most significant severe unmet need was the inability to access government benefits to which one is entitled. Despite the limited availability of mental health services in South Africa, the majority reported that their need for managing psychotic symptoms was met or partially met. ConclusionThe needs of youth must go beyond the temporary management of psychotic symptoms. ContributionThis study highlights the unmet needs of young adults with FEP in resource-constrained environments and underscores the need for integrated interventions.