Abstract

A significant burden and treatment gap associated with serious mental illness (SMI) exists in low- and middle-income countries (LMIC). In order to address these issues, a range of community-based rehabilitation models in alignment with the Capabilities Approach is necessary, including opportunities for people with SMI to be rapidly engaged in meaningful work within their communities. This paper outlines the development processes and evaluation of the proof of concept for the Community REcovery Achieved Through Entrepreneurship (CREATE) strategy in Kenya. The CREATE strategy pairs Work Integration Social Enterprises (WISE) with a focused, low-cost, recovery-oriented Psychosocial Rehabilitation (PSR) toolkit within a peer involvement/support model as a means of addressing marginalization and fostering health, wellbeing, and participation of people living with SMI. Qualitative research methods were used to understand the experiences of a range of stakeholders involved in CREATE implementation in Kenya. Three overarching themes explicated the experiences of the various stakeholders involved: (1) experiencing a business like other businesses – yet different; (2) expanding capacities, opportunities, and networks through meaningful work; and (3) promoting knowledge and empowerment through education. Within each theme, there was evidence of the attenuation of central elements of marginalization. The CREATE strategy demonstrated acceptability and a variety of potential positive impacts in a low resource setting in Kenya. Application of the CREATE strategy to other low resource settings within Kenya and other LMIC merits further exploration.

摘要

低收入和中等收入国家 (LMIC) 存在与严重精神疾病 (SMI) 相关的重大负担和治疗差距。为了解决这些问题，需要一系列与能力方法相一致的基于社区的康复模式，包括让 SMI 患者有机会在其社区内迅速从事有意义的工作。本文概述了肯尼亚通过创业实现社区恢复 (CREATE) 战略的开发过程和概念验证评估。CREATE 策略将工作整合社会企业 (WISE) 与同伴参与/支持模式中的专注、低成本、以恢复为导向的社会心理康复 (PSR) 工具包配对，作为解决边缘化和促进健康、福祉、和 SMI 患者的参与。定性研究方法用于了解参与肯尼亚 CREATE 实施的一系列利益相关者的经验。三个总体主题阐述了所涉及的各个利益相关者的经验：（1）像其他企业一样体验企业——但又不同；(2) 通过有意义的工作扩大能力、机会和网络；(3) 通过教育促进知识和赋权。在每个主题中，都有证据表明边缘化的核心要素有所减弱。CREATE 战略在肯尼亚资源匮乏的环境中展示了可接受性和各种潜在的积极影响。将 CREATE 策略应用于肯尼亚和其他中低收入国家的其他低资源环境值得进一步探索。定性研究方法用于了解参与肯尼亚 CREATE 实施的一系列利益相关者的经验。三个总体主题阐述了所涉及的各个利益相关者的经验：（1）像其他企业一样体验企业——但又不同；(2) 通过有意义的工作扩大能力、机会和网络；(3) 通过教育促进知识和赋权。在每个主题中，都有证据表明边缘化的核心要素有所减弱。CREATE 战略在肯尼亚资源匮乏的环境中展示了可接受性和各种潜在的积极影响。将 CREATE 策略应用于肯尼亚和其他中低收入国家的其他低资源环境值得进一步探索。定性研究方法用于了解参与肯尼亚 CREATE 实施的一系列利益相关者的经验。三个总体主题阐述了所涉及的各个利益相关者的经验：（1）像其他企业一样体验企业——但又不同；(2) 通过有意义的工作扩大能力、机会和网络；(3) 通过教育促进知识和赋权。在每个主题中，都有证据表明边缘化的核心要素有所减弱。CREATE 战略在肯尼亚资源匮乏的环境中展示了可接受性和各种潜在的积极影响。将 CREATE 策略应用于肯尼亚和其他中低收入国家的其他低资源环境值得进一步探索。