PROPOSAL

Title

Family-Centered Care : Enhancing Recovery and Reintegration of Patients from Chikurubi

Psychiatric Unit

Introduction

Mental health disorders remain a major public health concern globally and in Zimbabwe,
contributing significantly to disability, social exclusion, and reduced quality of life. In Zimbabwe,
Psychiatric institutions such as Chikurubi Psychiatric Unit play a crucial role in stabilization and
treatment of individuals with severe mental illnesses. However, recovery from mental illness
extends beyond clinical treatment and hospitalization. Successful recovery requires sustained
psychological support, particularly from family members who often serve as the primary
caregivers after discharge.

Traditionally, psychiatric care has focused mainly on the individual patient, with limited
involvement of family members in treatment planning and recovery process. While this
approach addresses clinical symptoms, it often overlooks the essential role families play in
emotional support, treatment adherence, and community reintegration. In Zimbabwe where
families are central to caregiving, limited family involvement may reduce the effectiveness and
sustainability of recovery outcomes ( Chibanda et al., 2016 )

Family-centered care (FCC) is an approach that actively involves family members in the
assessment, treatment, discharge planning, and follow-up care of patients. Evidence suggests
that families who are educated, supported, and in engaged in care can positively influence
treatment adherence, emotional stability, and long-term recovery outcomes of psychiatric
patients.

Despite the recognized importance of family involvement, psychiatric care in many low-resource
settings remains largely institution-centered, with minimal structured family participation. In
Zimbabwe, limited research has explored the role of family-centered care in promoting recovery
and successful reintegration of patients discharged from psychiatric units such as Chikurubi. This
proposal therefore seeks to explore the role of family centered care in enhancing recovery and
reintegration of patients discharged from Chikurubi Psychiatric Unit, with the aim of informing
improved mental health service delivery and promoting holistic, patient-centered care.
Background of the study

Modern mental health care has moved away from keeping patients in hospitals for long periods.
Historically, staying in a hospital for too long caused patients to lose the social skills needed to
live on their own ( Goffman, 1961 )Today, the World Health Organization (2022) emphasizes
recovery oriented care, which focuses on helping patients live a meaningful life in their own
communities. In Zimbabwe, while the Mental Health Act of 1996 supports this idea, economic
challenges and a lack of resources often make it difficult to provide enough follow-up care after
a patient is discharged ( Chibanda et al., 2016 )

In Zimbabwe, the family is the main support system for people with mental illness, a role rooted
in the cultural value of ubuntu ( Mbigi, 2006 ). However, a significant gap exists between the
clinical care provided at institutions like Chikurubi Psychiatric Unit and the reality of care at
home. Many families lack skills and psychiatric knowledge needed to manage a patient’s
condition after discharge. Instead of being a bridge to the community, an unprepared family can
become a barrier that hinders the patient’s recovery and leads to relapse.

Chikurubi Psychiatric Unit serves a diverse population of patients with various mental health
conditions. After discharge, many patients return to families that may lack adequate knowledge,
skills, or emotional preparedness to support recovery. In some cases, family misunderstanding,
stigma and lack of involvement contribute to poor adherence to treatment and frequent
readmissions.

Family-centered care emphasizes collaboration between healthcare professionals, patients, and

families. It recognizes the family as a key support system in the healing process. Despite its
proven benefits in mental health care, the extent to which family-centered care is practiced at
Chikurubi Psychiatric Unit and its impact on patient recovery and reintegration remains
underexplored. This study focuses on exploring how family-centered care can enhance recovery
and reintegration of patients from the unit. The goal is to ensure that once a patient is
discharged from Chikurubi, they have a competent support system that promotes a permanent
and successful recovery.

Problem Statement

Despite the important role played by psychiatric institutions in the treatment of mental illness,
many patients continue to experience serious challenges after being discharged ( World Health
Organization [WHO], 2013. At Chikurubi Psychiatric Unit, care is largely focused on stabilizing
patients during admission, while limited attention is given to preparing families for their role in
supporting recovery at home. As a result, patients often return to environments where family
members lack understanding of mental illness, feel unprepared to provide care, or hold negative
attitudes influenced by stigma and fear (WHO, 2021)
The absence of structured family involvement in treatment and discharge planning can weaken
recovery efforts and affects patients’ ability to reintegrate into family and community life.
Without proper guidance and support, families may struggle to manage medication, recognize
early signs of relapse, or provide emotional and social support. This situation increases the risk
or relapse, poor treatment adherence, and repeated hospital readmissions, placing further
strain on both families and the mental health system ( Falloon et al., 2014 )

Although family centered care has been recognized as effective approach in improving recovery
outcomes for patients with mental illness, its practice at Chikurubi psychiatric unit remains
unclear and un developed. There is limited information on how families are currently involved in
patient care, the challenges they face and how this involvement affects patient’s recovery and
reintegration. This lack of evidence makes it difficult to design effective interventions and
policies that promote sustainable recovery beyond hospitalization.

Therefore, the problem addressed in this study is the limited use and understanding of family-
centered care in enhancing the recovery and reintegration of patients from Chikurubi Psychiatric
Unit. Addressing this gap is essential for improving patient outcomes, strengthening family
supports systems, and promoting a more holistic and sustainable approach to mental health
care in Zimbabwe.

Literature Review

Summary of Existing Research

Previous studies on mental health care emphasise the importance of support systems in
promoting long-term recovery. Research on family-centered care highlights its contribution to
improved communication, shared responsibility, and continuity of care beyond hospital settings
(Falloon et al., 2014). Several studies report that structured family involvement leads to better
psychosocial outcomes, including improved coping skills and reduced relapse rates among
patients with mental illness (WHO, 2013).

Analysis and Synthesis of Existing Literature

A review of the literature shows strong agreement that recovery from mental illness extends
beyond clinical treatment and requires sustained support within the home environment. While
different studies use varied approaches to family involvement, they collectively suggest that
families act as a stabilizing factor in recovery when adequately guided. However, the literature
also indicates that without institutional support and clear frameworks, family involvement may
be inconsistent and less effective (Knafl et al., 2012). This demonstrates the need for organized
and context-specific family-centered care models.

Gaps and Limitations in Existing Research

Although international studies provide useful insights, they often fail to reflect the realities of
mental health care in low-resource and institutionalized settings. There is limited research
examining how family-centered care functions within psychiatric units in Zimbabwe, particularly
in facilities such as Chikurubi Psychiatric Unit. In addition, few studies explore practical
challenges faced by families during patient reintegration, leaving a gap in understanding how
family-centered care can be realistically implemented in such contexts (WHO, 2021).

Context for the Current Study

This study responds to these gaps by examining family-centered care within a local psychiatric
setting, focusing on recovery and reintegration outcomes. By exploring current practices and
family experiences at Chikurubi Psychiatric Unit, the study positions itself as a context-specific
contribution to mental health research. It seeks to generate evidence that can inform practice,
policy, and future research aimed at strengthening recovery-focused mental health care in
Zimbabwe.

Theoretical Framework

This study is grounded in theories that emphasize the role of family involvement, social support,
and long-term recovery in mental health care. These theories provide a framework for
understanding how family-centered care can enhance recovery and reintegration of patients
discharged from Chikurubi Psychiatric Unit.

The primary theory guiding this study is Family Systems Theory, developed by Bowen (1978).
Family Systems Theory views the family as an interconnected unit in which changes in one
member affect the entire family system. In the context of mental illness, the condition of one
individual influence’s family roles, relationships, and daily functioning, while family responses
can either support or hinder recovery. This theory directly aligns with the focus of this study, as
it explains why involving families in care is essential for improving patient recovery and
reintegration. By strengthening family understanding, communication, and support through
family-centered care, the family system can become a positive environment for recovery
(Bowen, 1978; Goldenberg and Goldenberg, 2013).

The study is further informed by the Recovery Model, as articulated by Anthony (1993). The
Recovery Model views recovery as a continuous process that extends beyond hospital
treatment and focuses on hope, empowerment, and meaningful participation in society. This
model supports the shift from institution-based care to recovery-oriented approaches that
prepare patients for life after discharge. Within this framework, family involvement

is critical, as families provide ongoing support that helps patients maintain stability and
reintegrate into family and community life. The Recovery Model therefore reinforces the need
for family-centered care at Chikurubi Psychiatric Unit to promote sustained recovery rather than
short-term symptom control (Anthony, 1993).

In addition, the study draws on Social Support Theory, associated with scholars such as Cobb
(1976) and House (1981). Social Support Theory highlights the importance of emotional,
informational, and practical support in improving health outcomes. For patients with mental
illness, families are often the primary source of support after discharge. When families are
informed and involved in care, they are better able to assist with treatment adherence,
emotional wellbeing, and social adjustment. This theory supports the argument that
strengthening family support through family-centered care can reduce relapse and improve
reintegration outcomes (Cobb, 1976; House, 1981).

Together, these theories form an integrated framework that explains the link between family-
centered care and patient recovery and reintegration. Family Systems Theory explains the
influence of family relationships, the Recovery Model emphasizes recovery beyond
hospitalization, and Social Support Theory highlights the role of family support in sustaining
recovery. This theoretical framework therefore provides a strong foundation for examining how
family-centered care can enhance recovery and reintegration of patients from Chikurubi
Psychiatric Unit within the Zimbabwean mental health context.