title: "Finding a way out": Case histories of mental health care-seeking and recovery among long-term internally displaced persons in Georgia.
abstract: Trajectories of illness and recovery are ongoing and incomplete processes cocreated by individuals, their informal support networks, formal care-givers and treatment contexts, and broader social systems. This analysis presents two case histories of care-seeking for, and recovery from, mental illness and psychosocial problems in the context of protracted internal displacement. These case histories present individuals with experiences of schizophrenia and depression drawn from a sample of adult long-term internally displaced persons (IDPs) in Georgia, a country in the South Caucasus. Dimensions of care-seeking were compiled into a matrix for analysis. Interviews were open coded, and codes were linked with matrix dimensions to construct each case history. Findings illustrated that individuals moved cyclically among self-care, household support, lay care, and formal services domains to understand and manage their problems. Living with mental illness and within displacement are experiences that intersect at various points, including in the recognition and perceived causes of illness, stressors such as discrimination and isolation, the affordability and availability of services, and the capacity of social networks to provide informal care. Interventions are needed to support informal care-givers and build lay referral networks, as well as to identify intervention points within care-seeking processes. Interventions that target the mental health needs of displaced persons have the potential to contribute to the development of an innovative community mental health care system in Georgia.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health namrita.singh@jhu.edu.
authors.forename: Namrita S
authors.initials: NS
authors.lastname: Singh
authors.affiliation: University of Mississippi.
authors.forename: Nino
authors.initials: N
authors.lastname: Jakhaia
authors.affiliation: Tbilisi State University.
authors.forename: Nino
authors.initials: N
authors.lastname: Amonashvili
authors.affiliation: Johns Hopkins Bloomberg School of Public Health.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
mesh_terms: D000328:Adult; D003156:Community Mental Health Services / Q000592:standards*; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D005846:Georgia (Republic); D006801:Humans; D007407:Interviews as Topic; D010342:Patient Acceptance of Health Care; D012559:Schizophrenia / Q000628:therapy*; D012944:Social Support
keywords: Caucasus; Georgia; care-seeking; community mental health; internal displacement; recovery