A needs assessment of persons suffering from Schizophrenia

This quantitative exploratory descriptive survey at­ tempted to identify the needs of persons suffering from schizophrenia who live in the Mogoto Village, Zebediela District, Limpopo Province. Data obtained from 60 com­ pleted questionnaires indicated that these persons con­ tinued to be regarded as valued community members by their care-givers. Despite the apparent lack of com­ munity mental health services, the vast majority of the respondents reportedly took their medications regularly and would know when to seek help in case their symp­ toms deteriorated. Their greatest need related to a lack o f employment opportunities. They could also benefit from counselling services for themselves and their fami­ lies. Opsomming Hierdie kwantitatiewe verkennende en beskrywende opname het gepoog om die behoeftes van persone wat aan skisofrenie ly, en woon in die dorpie Mogoto, Z ebed iela D istrik , in die L im popo P rovinsie , te identifisser. Data wat van 60 voltooide vraelyste verkry is, het aangedui dat die persone steeds as gewaardeerde gemeenskapslede geag is deur hulle versorgers. Ten spyte van die waargenome gebrek aan gemeenskaps geestesgesondheidsdienste, het die meeste respondente hulle m edisynes gereeld gedrink en geweet wanneer om hulp te soek indien hulle simptome sou vererger. Die grootste behoefte het betrekking op die gebrek van werksmoontlikhede gehad. Hulle kon ook baat vind by beradingsdienste vir hulleself asook vir hulle families. Introduction and background information The assessment of clients’ needs is an important and inte­ gral part of health service planning. Considerable time has been devoted to the assessment of the needs of people requiring mental health services (Carter, Crosby, Geerthuis & Startup 1995:383). Reports about community based care, for persons suffer­ ing from schizophrenia, are not favourable in all countries. While some efforts demonstrated positive results, others resulted in worsened states for the persons and their fami­ lies due to inability of the government, the community, the health care delivery system and the family to meet these persons’ needs. Where deinstitutionalisation is done too hastily and/or the needs of the person have not been met in the community, the person, his/her family and the community might suffer adverse effects. According to Clark (1999:669) identifica­ tion and assessment of needs of individuals suffering from schizophrenia in rural areas is a neglected, and often a mis­ understood aspect, of human service programme planning. Purpose and rationale for conducting the research The primary purpose of this research was to explore and describe the holistic needs of persons suffering from schizo­ phrenia who live in a rural area. The rationale for this re­ search included that hospitals were overcrowded and short staffed necessitating hospitals to discharge persons suf­ fering from schizophrenia as soon as possible to be cared for by their relatives within their own communities. These care givers in the community might lack knowledge and skills, possibly contributing to the high rates of hospital re­ admissions of these patients. Prior to planning and imple­ menting community services, an assessment of the needs of persons suffering from schizophrenia in Mogoto Village had to be done.


Introduction and background information
The assessm ent of clients' needs is an important and inte gral part of health service planning.Considerable time has been devoted to the assessm ent o f the needs o f people requiring mental health services (Carter, Crosby, Geerthuis & Startup 1995:383).Reports about community based care, for persons suffer ing from schizophrenia, are not favourable in all countries.W hile some efforts dem onstrated positive results, others resulted in w orsened states for the persons and their fam i lies due to inability o f the governm ent, the community, the health care delivery system and the family to m eet these persons' needs.W here deinstitutionalisation is done too hastily and/or the needs o f the person have not been met in the community, the person, his/her family and the comm unity might suffer adverse effects.According to Clark (1999:669) identifica tion and assessm ent of needs o f individuals suffering from schizophrenia in rural areas is a neglected, and often a mis understood aspect, o f human service program m e planning.

Purpose and rationale for conducting the research
The primary purpose o f this research was to explore and describe the holistic needs of persons suffering from schizo phrenia who live in a rural area.The rationale for this re search included that hospitals were overcrowded and short staffed necessitating hospitals to discharge persons suf fering from schizophrenia as soon as possible to be cared for by their relatives within their own communities.These care givers in the community might lack knowledge and skills, possibly contributing to the high rates of hospital re admissions o f these patients.Prior to planning and im ple menting community services, an assessment o f the needs o f persons suffering from schizophrenia in Mogoto Village had to be done.

Research questions
The following research questions guided this research:

Research objectives
The objectives of the research were to identify and de scribe the physical, psychological, social, emotional, spir itual, economic and education needs of persons suffering from schizophrenia in M ogoto Village.Attempts were also made to identify available support systems in this commu nity.

Operational definitions
■ P a tie n t (in this research referred to as the person suffering from schizophrenia): According to the Mental Health Amendment Act 19 of 1992 (chapter 1:575) a patient refers to a person who is mentally ill to such a degree that it is necessary that he/she be detained, supervised, control led and treated.In this research the term person/patient refers to an individual/person diagnosed with schizophre nia and living in the M ogoto Village.■ D SM -IV : By definition, the DSM diagnosis of schizophrenia was established by determining the pres ence o f firstly fundamental and secondarily associated dis turbances of mental life.Disturbances of reality relation ships and disturbances o f concept form ation were desig nated as the two fundamental disturbances.Disturbances in affect and intellect were designated as associated dis turbances (Holliday, Ancill & McEwan 1997:70).DSM -IV refers to the fourth edition of the Diagnostic and Statistical M anual o f Mental Disorders, published in 1994 which describes diagnostic categories in order to enable clinicians and investigators to diagnose, com m unicate about, study, and treat the various mental disorders like schizophrenia (APA 1994;Spitzer& Williams 1997:vii).■ S chizophrenia: Schizophrenia is a complex syn drome involving psychotic disturbances o f thinking, per ceptions, emotions and behaviours, commonly leading to the disintegration o f the personality.Schizophrenia is an illness characterised by exacerbations and rem issions.During acute psychotic events, persons suffer impairments in their ability to test reality.Persons frequently experience hallucinations such as hearing voices speaking to or about them, believing that they are being persecuted and behav ing in bizarre ways (Stein 1993:7).During remissions per sons are generally in touch with reality.However, they suffer from other impairments that interfere with their abili ties to organise and maintain the resources required to make unassisted, stable adjustments to community life.Accord ing to DSM -IV schizophrenia is "a disorder of brain struc ture and function which is characterised by extreme disrup tions of thought, em otion, behaviour and perception, lead ing to progressive deterioration of the person's ability to relate to others and to social withdrawal" (APA 1994;Spitzer & Williams 1997: vii).® A need: A need is referred to as specific areas re lated to the c lie n t's health identified for intervention (Spradley & Allender 1996:673).In this research a need was defined as the gap between what is evaluated as a necessary level or condition by those responsible for this assessment and what actually existed.

■
Needs identification: Needs identification is "a de scription of mental health and social services needed in a geographic or social area" (Ironbar & Hooper 1989:3).

■
Needs assessment: Needs assessment is a study in which the researcher collects data from estimating the needs of a group (such as the persons suffering from schizophre nia in the Mogoto Village), community or organisation and provides input into the planning process (Brink 1996:117;Polit & Hungler 1997:175).This exploratory descriptive research attempted to identify the following needs: □ Physical needs.Physical needs involve all the physi ological processes of a human being, for example, breath ing, elimination, eating, housing, activity, rest, sleep, hy giene and health (Uys & Middleton 1997:32).□ Psychological needs.Psychological needs enable individuals, and in this case persons suffering from schizo phrenia, to strike a balance between their own needs and those of society and concern the feelings that persons ex perience throughout life, for example, fear, anxiety, happi ness, loneliness ( Meyer, Moore & Viljoen 1997:329).□ Social needs.Social needs involve the needs of the persons suffering from schizophrenia, to belong, to com municate and to interact with other human beings and to contribute to society in meaningful ways ( M eyer et al 1997:329).□ Spiritual needs.Spiritual needs represent the mean ing an individual, in this study the person suffering from schizophrenia, attaches to life experiences at any stage and represent a holistic integration of physical, social, psycho logical, cultural, sexual and theological experiences.(Phipps, Cassmeyer, Sands & Lehman 1995:51).□ Education needs.Educational needs refer to the needs considered important for the mentally ill person, in this study the person suffering from schizophrenia, in or der for him to get to know himself, to develop his remaining potential, and to identify his goals (M eyer et al 1997:360).

Research methodology Research Design
A quantitative exploratory descriptive design was adopted to assess the needs of persons suffering from schizophre nia, living in Mogoto Village in a rural area o f the Limpopo Province.A research design is the overall plan for obtain ing answers to the research questions and it spells out the strategies the researcher adopted to attain the stated ob jectives (Polit & Hungler 1997:129).Quantitative research involves the systematic collection of numeric information, usually under conditions of consider able control and the analysis o f that information using sta tistical procedures (Bums & Grove 1997:37).The research method considered to be the most appropriate for the study was explorative research enabling the needs of persons suffering from schizophrenia in the M ogoto Village, to be identified and described.A descriptive study raises ques tions based on ongoing events o f the present and is of considerable value to the nursing profession (Polit & Hungler 1997:14).

Research population and sample
A population is the entire aggregation o f cases that meets a designated set of criteria (Polit & Hungler 1997:223).Sam pling refers to the process o f selecting a portion o f the population to represent the entire population.A sample refers to the sum of individuals within a specific territory or a small portion o f a population or a smaller representation of a larger whole, intended to reflect and represent the char acter, style or content o f a population from which it is drawn (Brink 1996:133).In this research 60 persons (from Mogoto Village) suffering from schizophrenia were selected at the clinic by the clinic nurse, and visited at their homes by the researcher.A sampling method refers to the process of selecting the sample from a population in order to obtain information regarding a phenomenon in a way that represents the popu lation o f interest (Brink 1996:133).Using a convenience sampling technique persons suffering from schizophrenia were selected provided they were aged between 16 and 65 years; diagnosed with schizophrenia and receiving treat ment for schizophrenia irrespective o f the duration of such diagnosis and/or treatment; oriented to time, place and per son and had no secondary diagnosis of substance abuse or cognitive disorders; attending the clinic to receive medi cations for schizophrenia, irresp ectiv e o f attendance patttem (s).W hen 60 questionnaires had been completed, these were analysed by a statistician.As sim ilar responses were recorded, the statistician recom m ended that these would be sufficient as it appeared to be unlikely that fur ther respondents would supply any new information.

The data collection process
The researcher was introduced to each respondent at the clinic and visited him /her at his/ her home for completing the questionnaire.The questionnaire was com pleted by the researcher in cases where respondents could not read and/or write.

Research instrument
The specific tool, often a questionnaire or interview guide, used to measure the variables in a study is called a research instrum ent (Spradley & A llender 1996:604).A question naire was used as it is a useful self-report instrument where the respondents were required to write their answers in response to questions asked.A total of 115 questions were included in the questionnaire.Both closed and open-ended questions were included.The questionnaire was subdi vided into different sections attempting to obtain inform a tion about respondents' biographic profiles; physical, psy chological, social, em otional and spiritual needs; support systems used to cope with problems; community resources that the respondents utilised to remain in the community and to become fam iliar with the priorities o f the patients' needs -as stated by the respondents themselves.

Validity and reliability
Guyatt (1993:461) points out that "questionnaire design can be problematic and that scales need to be adequately tested for their reliability and validity, and these are the two important criteria by which an instrument's quality is evalu ated".According to Polit and Hungler (1997:467) "an ideal instrument is one that results in measures that are relevant, accurate, unbiased, sensitive, unidimensional and efficient" .A fter the instrument was developed, it was tested for its validity and reliability before the actual data collection was done.
V a lid ity Brink (1996:124) and Nieswiadomy (1993:204) agree that validity refers "to the extent to which the instrument meas ures what it is supposed to measure" .Validity is concerned with the soundness and effectiveness o f the measuring instrument.It is the assurance that an instrument meas ures the variables it is supposed to measure.In this re search a written questionnaire was the instrument used.Questions included were evaluated to make certain they w ere appropriate to the subject (content validity) and whether the variable o f interest (needs) was actually being measured (construct validity).

Content validity
This refers to the extent to which the instrument samples the situation under study.Nieswiadomy (1993:205) defines content validity as the representativeness o f the behav iours sampled by a measuring device, the extent to which an instrument samples "... all relevant aspects of the do main of behaviours which are to be assessed" and con cerned with the scope or range o f items used to measure the variable.It is concerned with how accurately the ques tions asked tend to elicit the information sought (Leedy 1992:25;Polit & Hungler 1997:375).Content validity in volves getting a panel of judges or experts in the field un der study to review and analyse all items to see if they adequately represent the content universe.In this study, to test content validity, the instrument was given to diffemet members o f the multi-disciplinary team, including a psy chiatrist from the Limpopo Province; a psychologist from the University of the North; a social worker from Groothoek Hospital; nurse educators from the University of the North and from Groothoek Nursing School (psychiatric nursing) and staff from the District Health Services from Greater Zebediela.These members were requested to exam ine the instrument and to add items which they deem ed necessary and to delete those deemed irrelevant.The instrument was also sent to the research project supervisors and to the Department o f Statistics at the University of South Africa (Unisa).The supervisors and the statistician agreed that the instrum ent contained questions pertaining to psychi atric patients' needs assessment.

Face validity
Face validity, indicating w hether the instrument appeared to be m easuring what it purported to measure, was found to be present because all questions in the instrum ent ap peared to focus on the selected topic o f needs assessment of persons suffering from schizophrenia in M ogoto Village.

External validity
External validity refers to the degree to which the results of a study can be generalised to settings or samples, other than the ones studied (Brink 1996:125).In this study the researcher provided a detailed database and dense descrip tion so that someone other than the researcher could deter mine whether the findings of the study were applicable in other settings or contexts where the method of data collec tion was precisely and thoroughly reported (Brink 1996:124).Potential threats to external validity were addressed in the following ways: Selection o f respondents All the psychiatric patients diagnosed with schizophrenia who were receiving their monthly treatment from Mogoto clinic were used in the study, thus the research sample was selected with the study style and purpose in mind (Talbot 1995:214).

Setting
The study was done in the natural setting because the purpose o f the study was to analyse a phenomenon occur ring in the community, namely persons suffering from schizo phrenia living in M ogoto Village, in the Zebediela District in the Lim popo Province of the RSA (Talbot 1995:214), where the questionnaires were completed in the persons' homes.

History
The influence o f previous research was not applicable.No research grant was received and consequently no respon sibilities nor expectations from external authoritative sources needed to be considered (Talbot 1995:214).Nieswiadomy (1993:201), Brink (1996:124) and Polit and Hungler (1997:367) agree that reliability refers to the degree with which the instrument measures the attributes it is sup posed to be measuring.Reliability entails the stability, con sistency, accuracy and dependability of a measuring in strument.M uller's (1996:54) guidelines were adopted in enhancing the reliability of the results by ensuring that the instructions to the participants were clearly written, the responses were recorded honestly and objectively.The responses were analysed by a statistician not involved with the data collection process.

Data analysis
The data obtained from the com plete questionnaires were coded and analysed with the Statistical Package for Social Sciences (SPSS) by a statistician from the University of South Africa.

Ethical considerations
The rights o f the participants were respected throughout the research process.The researcher ensured that no par ticipant was subjected to any physical, emotional, spiritual, economical, social or legal harm.The privacy of the partici pant was ensured by not sharing any of the collected infor mation with other persons.All data gathered was kept con fidential by the researcher.Informed consent was obtained from each participant in the research project.Permission to conduct the research was obtained from the relevant au thorities including the Training and Development Commit tee of the Southern Region of the Limpopo Province where the research was conducted.Participants and their families also consented to the participation in this research.Each respondent's participation was voluntary and any partici pant was free to withdraw at any time.No treatment or nursing care was withheld from those who elected not to participate in the research.No remuneration was granted .

Research results
In order to contextualise these research results against the background as to who the 60 persons were who partici pated in this research, some biographic data will be pre sented prior to discussing the research results as such.

Biographic data
All the respondents (100%; n=60) in this research were South African citizens and all lived in Mogoto Village.All respondents understood and spoke Northern Sotho, the language in which the interviews were conducted, although some indicated their home languages to be Tsonga or Ndebele.Both males (51.7%; n=31) and fem ales (48.3%; n=29) participated in the research.The respondents' ages ranged from 21 to 60, but 43.3% (n=26) fell within the age group from 41 to 60 years of age.These findings appeared to be consistent with those of Stuart and Sundeen (1996:476) who stated that "about ninety percent (90,0%) of the per sons being treated for schizophrenia are between 15 and 5 5 years old" .Reportedly more than half o f males and one third of females had their first schizophrenic episodes be fore the age o f 25.This was apparently consistent with what Kaplan, Sadock and Grebb (1998:461) found, report ing that "the peak ages of onset o f schizophrenia for men are 15 to 25 and for women the peak ages are 35 and above" .The majority of the respondents, 78.3% (n=47) were never married, 20% (n=12) were married; and 1,7% (n = l)) were divorced.This high percentage (78,3%) of respondents who never married correlated with the view of Engel (1996:372) who stated that "respondents who were never married sig nifies the fact that the persons suffering from schizophre nia are shy people and find intimate and sexual relation ships difficult" .
Only three (5,0%) respondents completed their high school training.The majority were barely literate with 21,7% (n= 13) having had no schooling and 46,7% ( n=28) having com pleted grades 1 to grade 5.The low educational standards o f persons suffering from schizophrenia could be due to the alteration in their thoughts making it difficult for them to progress at school.Common thought alterations experi enced by persons suffering from schizophrenia include flight of ideas, thought retardation, thought blocking, au tism, poverty o f speech, poor concentration and confusion (Keltner, Schwecke & Bostram 1995:364).Twenty six (43,3%) of the respondents lived with one or both parents or step-parents.Twelve (20,0% ) respondents lived with their spouses; eleven (18,3%) lived alone; seven (11,7%) lived with other relatives; two (3,3%) moved from one relative or friend to another; two lived with non-rela tives.The majority, namely 44 (74,6%) respondents indi cated that their only source o f income was from disability benefits; the others were receiving some form o f financial assistance from their family members.Only four (6,7%) of the respondents were em ployed outside the home, whilst the majority (91,7%; n=55) were unemployed and one per son (1,7%) was unsure about his/her work status.Some unem ployed respondents stated that they were too disa bled to work, while others indicated that, although they were able to work, due to the lack of job opportunities and the high unem ployment rate in the area, they remained un employed.
All the respondents (100,0%; n=60) indicated that they were using public transport to go wherever they w anted to go especially to the hospital or nearest town.None o f the respondents made use o f private transport and none had their own transport.

Needs of persons suffering from schizophrenia
In order to maintain their physical and mental health, peo ple have certain essential requirem ents or needs that must be met.W hen people have mental health problem s, how ever, their ability to m eet these needs independently could be adversely affected.The fundamental role o f the mental health nurse, therefore, is to enable people with mental health problems to meet their needs and to restore the individual's w ell-being as far as possible.This process is only possible if a needs assessment is carried out in order to identify their unmet needs and the problems that individuals experience in their daily living that ham per them from meeting those needs.

Physiological/physical needs
The 60 respondents indicated their state of physical health to be poor (1,7%; n = l); fair (18,3% ; n = l 1); satisfactory (36,7%; n=22); or good (43,3%; n=26).In this study no major problems with vision nor mobility were reported, which could result from the extra pyramidal side-effects of drugs used in the treatm ent o f persons suffering from schizo phrenia (K eltn eretal 1995:363).Physical needs reported by more than 50% o f the respondents included: • recreation was extremely problematic for 2 0 ,0 % and somewhat problematic to 63,3% • sexual libido was extremely problematic for 5 8,3 % somewhat problematic for 23,3%.The extrapyramidal symptoms caused by antipsychotic drugs could aggravate a poor sexual libido as well as the lack of energy (K eltneretal 1995:364).Reportedly 88,3% o f the respondents took their prescribed medications on a perm anent basis and 90,0% (n=54) o f the respondents indicated that they watched them selves for signs of relapse and they knew where and when to obtain help.

Psychological needs
All people have essential basic human needs, programme planning and im plementation are indicated when the indi vidual cannot independently satisfy these needs.Signifi cant needs include a sense o f security; the maintenance of identity as an individual; acceptance; a sense o f being wanted and belonging; the opportunity of socialising; in dependence (and at times dependence and interdepend ence); freedom to make decisions and the opportunity to develop and use one's innate potential.Individuals should have interests and goals and opportunities for developing self-respect, in addition to feeling useful and having a sense of achievement (Royle & Walsh 1992:5).
The majority • felt safe in their home environments and secure about their physical safety; probably because most lived with relatives • were secure about their financial position as they received disability grants • were satisfied (to different extents) with the long term plans for their care, probably because the m a jority lived with relatives and could use public trans port to obtain their medicines • were hardly ever satisfied with their vocational/oc cupational status, because of the lack of job oppor tunities and of sheltered em ploym ent opportuni ties in this area: the lack o f these opportunities ap peared to be the major psychological need to be addressed in M ogoto Village.

Social needs
The m ajority of the respondents were: • sometimes (35%) or often (43%) satisfied with their self-reported social effectiveness • sometimes (30%) or often (48.3%)satisfied with their social participation • often (63%) satisfied with their roles within their families • often (65%) comfortable requesting help when necessary • sometimes (73.3%) satisfied with their participation in family activities and traditions • hardly ever (60%) or never (2 0 %) satisfied with their level of sexual fulfilment.
Although the majority of the respondents were reportedly satisfied with their social functioning within their families, and even within their community, they desired greater le vels o f satisfaction with regard to their perceived levels of sexual fulfilment.

Emotional needs
Em otional satisfaction is derived largely from feeling that one is valued by those around one.Emotional satisfaction comes from within.It is related to the assessment of one's adequacy, one's performance and capacity in the various arenas of one's life, both personal and professional.Self approval (that is liking oneself no matter what) is essential (Ellis &Nowlis 1981:38).
All the respondents (100%; n=60) indicated that they were affiliated to a church.The largest percentage belonged to the Zionist Christian Church (ZCC).M embers of the ZCC Church (36,7%; n=22) indicated that they had trust, hope and faith in the church's treatment o f their schizophrenia.The ZCC headquarters were situated nearby and it was easy to visit the headquarters when experiencing mental problems.Their faith was vested in the church leader who was believed to perform miracles and to cure illnesses.Some persons suffering from schizophrenia visited the ZCC headquarters prior to admission to and also after discharge from psychiatric hospitals.Their reasoning was that drugs used for the treatment o f schizophrenia stabilised these individuals but did not cure the condition, hence they vis ited the ZCC headquarters to get cured.
The major emotional need related to respondents' dissatis faction with their level of education and/or occupation.The respondents' low levels o f education jeopardised their chances o f obtaining jobs which were extremely limited in this area.

Spiritual needs
Concerning their spiritual needs the 60 respondents indi cated that they were • sometimes (73,4%) satisfied with the amount of reli gion in their lives • often (75,0%) satisfied with the state of spiritual ful filment they experienced • sometimes (36,6%) and often (30,0%) optimistic about reaching their life goals • hardly ever (30,0%), or sometimes (40,0%) or often (23.3%)satisfied with the level of hope experienced in their lives • hardly ever (15,0%), sometimes (43,3%) or often (38,3% ) satisfied with the amount o f meaning and purpose in their lives Sixteen (26,7%) of the respondents belonged to the A pos tolic Church.These individuals reported believing that their condition was attributable to being bewitched.The treatments they got from faith healers included drinking "holy" water which induced vomiting, or enemas causing diarrhoea.They believed that whatever was driving them "crazy" would be expelled with the w ater taken orally or rectally.Both the ZCC and the Apostolic Churches treated their clients with "holy"water.

Support systems
A support system is identified or categorised in various ways in the literature.The Oxford Advanced L earner's Dictionary (1989:426), for example, conceptualises support systems as being functional, or structural.Functional sup port provides one or more o f the following: material aid, emotional support, affirmative acknowledgement, informa tion guidance and com panionship (Baldw in & Woods 1994:324).Structural support can be analysed in terms of size, type and others but does not necessarily imply func tional support (Masilela & Macleod 1998:11).In this study

Internal and external sources of support
Despite the family problems reported by some respond ents, their families remained committed to providing assist ance to mentally ill persons, as reflected in table 1. Profes sional systems and friends were indicated as being the most important external sources o f support.Persons suffering from schizophrenia need friends to turn to in times of crises (Palmer-Erbs & Anthony 1995:38).(As respondents could provide more than one answer to each item in this section o f the questionnaire, the total num ber of responses to any question may exceed 60).

Advice or help received from rehabilitative care centres
The main goals in a rehabilitative care approach is to in crease the functioning potential in the major role areas with em phasis on the developm ent o f skills and the resources necessary for support as well as those needed for success ful living, learning, and working in the community (Palmer-Erbs & Anthony 1995:40).All respondents (100%; n=60) indicated that they had received advice about medical and psychiatric matters; 76,7% indicated that they had some one they could consult.; 3,3% received advice on finances..Only 18,6% o f the respondents received advice pertaining to social and leisure activities and 1 0 ,2 % pertaining to coun selling and support.
Sources of advice or help (n = 6 0 ) As many as 98,3% (n=59) of the respondents indicated that they received advice from professionals followed by 75.0%(n=45) who received advice from relatives and 31.7%(n= 19) from friends.It would appear from these findings that pro fessionals cannot succeed alone in advising persons suf fering from schizophrenia about m ental health matters.Support from relatives and friends is needed as well.Surprisingly, 98.3% o f the respondents received advice from health care professionals and assistance with their m edi cal/psychiatric care, while 1 0 0 % received legal assistance.
However, the majority expressed needs for vocational train ing, individual and family counselling and alternative ac commodation.Reasons were not provided for the last need, which was unexpected in the light o f responses to other questions indicating that the majority o f the respond ents lived with relatives and were satisfied with their per sonal safety and social functioning within these families.

Services desired to be offered in Mogoto Village
Vocational training is considered important by society as it enhances independence and prestige."Persons suffering from schizophrenia and who became ill during their youth, until they develop the skills to make any contribution, offer little to society except their existence" (O 'Brien 1998:40).

Prioritisation of needs
According to Tsuang and Faraone (1998:103), a full picture o f the persons should include their views about what they need and how these should be prioritised.The respond ents were requested to rank their needs on a scale from 1 to 9, where 1 was the greatest need and 9 the smallest need.
The results summarised in table 3, appear to contradict some o f the responses provided to earlier questions.For example, the lack o f employment repeatedly emerged as the major problem but the need for vocational training was only ranked the sixth (out o f nine) most important need o f the respondents.Interestingly, the need fo r counselling superceded the need for vocational training.It proved im possible to explain these apparent discrepancies from the available data, but some possibilities could include that the respondents • were focussed on issues o f medical treatm ent and counselling as these questions preceded this last section o f the structured interview schedule • might have regarded medical, financial and support needs as priorities but these were possibly met by the available health care services, disability grants and support from the family members with whom the majority o f the respondents lived • regarded education as being the least important need probably because they lacked the drive and will to persevere at im proving their educational qualifica

Conclusions: Needs of persons with Schizophrenia in mogoto village
Despite a number of identified needs, the majority of the 60 respondents managed to meet their daily needs mostly be cause they lived with relatives who supported them, they had access to disability grants enabling them to meet their most important financial needs, they took their medications regularly and could recognise signs of relapse requiring them to seek help from Groothoek Hospital.The psychiat ric nurses apparently succeeded in teaching the respond ents and their families about the importance o f using the medications regularly and o f recognising signs of relapse.The m ost pressing unmet needs of these respondents re volved around the lack of jobs, their inability of affording their own accommodation, the lack o f recreation facilities, the absence o f counselling services for them selves and their families, and their desire for enhanced levels of sexual satisfaction.

Limitations of the research project
The generalisation o f the research results are bound by the following limitations of the research project: • The research focussed only on persons suffering from schizophrenia staying in Mogoto Village and who received treatment at Mogoto clinic, thus the results might not be generalisable to other persons with schizophrenia living in other communities.

•
The questionnaire was too long as the respondents became impatient towards the end of the interviews -something which should have been anticipated with schizophrenic patients who have limited con centration spans.

•
The research proved to be very broad in scope.
Community resources and support systems could be studied in more depth in future.

Recommendations
Counselling is o f vital importance for persons suffering from schizophrenia as it could provide them with friend ship, encouragement and practical advice.Community re sources on how to develop a more active social life, voca tional counselling, suggestions for minimising friction with family members should be provided so that the person's life-style can be improved.A psychiatric nurse could pro vide such counselling services, even if only on a weekly or a monthly basis.Establishing support groups for the re spondents themselves and for their family members might considerably enhance their coping capabilities and enable them to support each other during times o f crises.Rehabilitation, treatment of acute psychiatric episodes, appropriate medication, monitoring, m aintaining o f nutri tion and general health, provision o f shelter, community participation, provision o f crisis support, and enhancing a person's capabilities through continuing education efforts need to be considered if these respondents are to achieve and maintain their maximum levels o f functioning within their community.Vocational training, job opportunities and sheltered workshops are also needed to realise this ideal.
Rehabilitative services require great expenditures, but the benefits in terms of reduced hospitalisation can potentially become a cost saving exercise and provide a better quality o f life for the rehabilitated persons.Rehabilitation also requires motivating persons to participate in whatever the community offers.
The rehabilitation of persons with schizophrenia in any community, requires that the community should also be developed to sustain these persons within their midst.Rubin and Rubin's (1992:44) definition is most appropriate in this connection, namely: "Com m unity development in volves local em powerment through organised groups of people acting collectively to control decisions, projects, programmes and policies that affect them as a community" .

Table 2 :
Services which the respondents would like to have available in M ogoto Village.