ArticleGlobal mental health (Cambridge, England)2026
Beyond treatment non-adherence: A qualitative study of clinicians' perspectives on structural and social determinants of schizophrenia relapse in South Africa.
Article in Global mental health (Cambridge, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The objective of this study is to explore public sector clinicians' perspectives on factors associated with relapse in schizophrenia within a South African context, focusing on structural, social and environmental contributors beyond treatment non-adherence. Three focus groups were conducted with 14 public-sector clinicians (psychiatrists, medical officers, psychiatric registrars and psychiatric nurses) with ≥5 years' experience in schizophrenia care. Data were analysed using reflexive thematic analysis to identify themes relating to relapse risk. Clinicians consistently described medication non-adherence, often the immediate trigger for relapse, as emerging from interrelated health system and socio-structural constraints, including poverty, unemployment, unsafe communities, fragmented services and stigma. Limited access to newer-generation antipsychotics, medication stockouts, early discharges due to bed shortages and scarce post-discharge rehabilitation compounded relapse risk. Family support was frequently undermined by financial strain and competing demands, while crime and gang violence discouraged clinic attendance. Stigma within both communities and healthcare settings reduced trust and engagement. In this lower-middle-income country context, relapse prevention depends on integrated strategies that combine clinical management with interventions addressing structural and social determinants. Policy priorities include strengthening primary-level mental healthcare, ensuring medication supply continuity, expanding supervised care and vocational programmes, implementing stigma-reduction initiatives and fostering intersectoral collaboration to address safety and spatial inequities in service provision.
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