"They treat us like rabid dogs": Stigma and discrimination as experienced by people living with psychosis and their caregivers in Malawi-A photovoice study.

Psychosis in Malawi presents significant challenges for individuals living with psychosis and their caregivers, compounded by stigma, discrimination, and systemic barriers to healthcare access. This study employed a participatory photography method (photovoice) to explore the lived experiences of individuals with psychosis and their caregivers in the Chiradzulu and Salima districts. Sixteen participants, comprising eight People with Lived Experience (PWLE) of psychosis and eight caregivers, documented their experiences and perceptions through photographs. Photovoice participants reported stigma and discrimination in the form of social and economic exclusion and dehumanisation. Love, care, and self-reliance were identified and described as essential to recovery and combating exclusion. In contrast, healthcare access was described as both a facilitator and a challenge to recovery and caregiving. This study underscores the need for targeted community-based and policy-driven interventions to combat stigma and discrimination through intersectoral and multisectoral approaches. It also calls for integrated healthcare services such as task-sharing to address systemic barriers experienced by PWLE of psychosis and improved involvement of individuals with lived experience to improve recovery.