The Lived Experience of Adult Women with Psychosocial Disability in Uganda

The term psychosocial disability refers to people who have received a diagnosis for a mental health condition and have as a result of the diagnosis experienced different types of social exclusion, rights violations, discrimination, and barriers to meaningful participation in society (Kleintjes et al., 2013; Mathias et al., 2017). Psychosocial disability is hinged on the social model of disability, which highlights the disabling aspects of social norms and results in the lack of fit between the individual and their social environment (Van der Heijden et al., 2016), further resulting in experiences of barriers to community participation and social inclusion due to one’s mental health condition (Anthony, 2020). Women with psychosocial disability face more challenges than their male counterparts. Women with psychosocial disability are at risk of physical, emotional, and sexual abuse because predators view them as asexual, ineligible for intimate relationships, and implausible witnesses incapable of reporting abuse (van der Heijden et al., 2016; Heifetz et al., 2019; Mutahi et al., 2022; Neille & Penn, 2015).

Although mental health challenges are common in limited resource countries, there is limited research, understanding, and documentation of the experience of people with lived experience of psychosocial disability in those settings (Allan et al., 2018; Fernandes et al., 2018). According to Arjadi et al. (2015), between 76 and 85% of people with mental health challenges in countries with limited resource settings receive no treatment. In the study on the lived experience of women with psychosocial disability (PSD) and their families in Afghanistan, Allan et al. (2018) found that lack of access to mental health services was a significant barrier for social inclusion for people with psychosocial disability and the presence of mental health services were a significant enabler. Additionally, Gitonga et al. (2021) conducted a pilot study in Kenya aimed at improving employment opportunities for women with PSD and reported that high unemployment rates among women with PSD were attributed to stigma and lack of awareness on PSD.

Furthermore, in India, Shrivastava et al. (2011) showed that 42% of people with schizophrenia reported discrimination from family and this affected their access to treatment. In Nepal, Fernandes et al. (2018) highlighted the negative impact of poverty on mental health and the importance of livelihood opportunities in improving quality of life for people with psychosocial disability. In Mozambique, Sweetland et al. (2014) found that access to treatment for mental health conditions was hampered by stigma, lack of awareness, insufficient research and limited human and material resources. In South Africa, Kleintjes et al. (2013) revealed three barriers that hinder people with PSD from participating in mental health policy development. The barriers included stigma and low priority accorded to mental health, poverty, and insufficient community support. In Girma et al. (2022) showed that widespread stigma and discrimination contributed to the underutilization of available mental health services in the country. Also, the basic building blocks for mental health systems featuring mental health financing, governance frameworks, and human resources were found to be weak in the limited resource countries of India, Nepal, Ethiopia, Nigeria, and Uganda (Petersen et al., 2017).

Uganda was the first country on the African continent to develop a country-level peer-led advocacy group for people with psychosocial disability in 1999 (Adame & Leitner, 2008). While studies on the lived experience of people with psychosocial disability have been conducted in India (Shrivastava et al., 2011), South Africa (Kleintjes et al., 2013), Mozambique (Sweetland et al., 2014), Kenya (Gitonga et al., 2021), Ethiopia (Girma et al., 2022), Nepal (Fernandes et al., 2018), and Afghanistan (Allan et al., 2018), the experience of adult women living with psychosocial disability in Uganda has not been explored. In reference to the differences in which varied countries conceptualized and responded to mental health issues, the experiences of other countries cannot be generalized to the Ugandan context. Lived experience was used because it provides the link between the service providers and service users. This translates into opportunities for the research to be relevant to the people that are most affected (Byrne & Wykes, 2020).

This study aimed to describe the lived experiences of adult women,18 years and above, with psychosocial disability in Uganda. This encompasses women who were facing societal barriers because of receiving a mental health condition diagnosis. The study explored the following research question: What are the lived experiences of women with psychosocial disability in the limited resource setting of Uganda?

Research Design

The study aimed to understand the experiences of living with psychosocial disability (PSD) in the limited resource setting of Uganda. To achieve this aim, a phenomenological approach was deemed appropriate to explore the lived experience of adult women with psychosocial disability in Uganda. The phenomenological approach was chosen because it allows for the uncovering and explication of the deeper human aspects of the lived experience of psychosocial disability capturing the sensations, cognitions, and emotions (Wilson, 2015). The phenomenological approach allows for the comprehension and in-depth knowledge of a specific phenomenon capturing the description of the experience from the reflection of the person in question (Creswell & Creswell, 2018; Moustakas, 1994).

Participants and Procedures

After IRB approval was obtained, participants were selected using purposive sampling. Purposive sampling was selected because it catered for the identification of specific kinds of people, in this case, women with lived experience of psychosocial disability, who were most suited to provide appropriate and useful information (Kelly, 2010) regarding the phenomenon of living with PSD. The purposively selected sample allowed for the identification of a trustworthy sample in providing information-rich cases regarding the phenomenon of PSD (Palinkas et al., 2015). The purposive sampling techniques facilitated the strategic recruitment of participants that were able to provide meaningful data (Hearn , 2021).

The inclusion criteria included women who had a mental health diagnosis verified by a diagnostic report provided by a qualified mental health practitioner and reported to experience social exclusion because of the diagnosis. They were also 18 years and above, members of My Story Initiative (an organization formed by and for people with psychosocial disability) lived in Jinja municipality, and could communicate in English. The diversity in the group was based on age, marital status, number of years of living with PSD, diagnosis, and education status. The diversity of the participants provided a range of experience and their insights featured in the data and were appropriate to the research question. The exclusion criteria included women with PSD who at the time of data collection were admitted at mental health treatment facilities. Also, participants who were experiencing manic and/or psychotic episodes during the time of data collection were excluded. Participants were recruited from My Story Initiative (MSI), a nonprofit organization that was started by and works exclusively with and for people with psychosocial disability. The purpose of the organization is to promote the rights, mental health, social and economic well-being of people with psychosocial disability.

The invitation to participate in the study was made through phone calls made by MSI to its members informing them about the study and requesting them to volunteer to participate. The phone call included information about the study, emphasis on voluntary participation, and proposed interview dates. Phone calls were made over a period of 2 weeks. Eleven women between the ages of 18 and 56 agreed to participate.

A week before the interview, the interview guide was shared with the participants to alleviate any anxiety and to allow participants to have prior knowledge of the questions. Before the interview commenced, participants were invited to ask any questions and provide verbal consent. To ensure confidentiality, participants were assigned a code consisting of a letter and a number to protect their identity. The identification codes and corresponding names were securely kept by the first author.

Trustworthiness

Trustworthiness was established following the three categories of trustworthiness proposed by Williams and Morrow (2009). This included (1) data integrity, (2) balance between reflexivity and subjectivity, and (3) clear communication of the findings.

Data Integrity

To get adequate and dependable data, the data were collected from a sample that featured diversity in demographics to capture data from different viewpoints (Williams & Morrow, 2009). The sample was diverse in terms of age (18–56 years); marital status (single, married, separated); level of education (2nd grade–college); social economic status; nature of diagnosis, and years of living with PSD (2 years–over 40 years). Data saturation was determined when there were repetitions and significant overlap in the participants’ responses.

Subjectivity and Reflexivity

The first author is a woman and comes from the country where the study was conducted. Therefore, her biases being integrated into the study was a distinct possibility. To manage her biases, the first author maintained a self-reflective stance during the process by identifying her biases in advance and keeping a self-reflective journal during the research process. During the data collection process, the researcher regularly asked for participants’ feedback to ensure that there was a balance between the “participants’ voices (subjectivity) and the researchers’ interpretation of meaning (reflexivity)” (Williams & Morrow, 2009, p.579). The second author played the role of peer debriefer because he comes from a different continent from the first author. The third author, due to his position of seniority, served as supervisor and debriefer.

Communication of the Findings

The researchers attempted to communicate the findings in a way that promoted social validity. Cross analysis of the findings by the first and second authors to identify the frequency of categories reinforced by participant quotes as examples was used to provide appropriate interpretations of the data (Williams & Morrow, 2009). Efforts were made to use literature from previous studies to provide context and comparisons.

Data Collection

Data were collected using semi-structured online interviews conducted via Zoom. Eleven interviews were conducted. The interview approach was chosen because it allowed for the exploration of individual perceptions of psychosocial disability and experiences of the women with lived experiences of psychosocial disability in detail (Patton, 2015). The interview questions were arrived at based on findings from literature. The literature among others highlighted (1) the nature of psychosocial disability which entails the presence of a mental health condition triggering social exclusion (Kleintjes et al., 2013; Mathias et al., 2017); (2) the unique of the impact of psychosocial disability to women (van der Heijden et al., 2016; Heifetz et al., 2019; Mutahi et al., 2022; Neille & Penn, 2015); and (3) the dynamics of mental health care in limited resource settings (Allan et al., 2018; Arjadi et al., 2015; Girma et al., 2022; Gitonga et al., 2021; Kleintjes et al., 2013; Sweetland et al., 2014). Based on the literature, the interview questions were informed by the need to provide an opportunity to each of the participants to use reflection to reconstruct the constitutive elements of their experience of living with psychosocial disability as women in the limited resource setting of Uganda (Seidman, 2019).

To obtain expert input, the interview guide was shared with two professors who have expertise in teaching and research in qualitative methodology. One professor is female, she has been a counselor educator for over 20 years with extensive international experience as an educator, counselor, and psychologist in India and Australia. She has a wealth of experience in research with over 30 publications. The other professor identifies as male, Caucasian, he has been a counselor educator for 7 years. He has experience as a clinical and rehabilitation counselor with a research interest in evidence-based practices for improving the quality of life of people with disabilities. Both the professors provided edits to the interview guide separately and the first author merged their feedback to arrive at the final interview guide. The interviews were conducted by the first author and transcribed by an individual who is an expert in transcribing. The interview protocol had the following questions: (1) How has your experience of living with psychosocial disability in Uganda been? (2) What challenges have you experienced in relation to your disability? (3) What suggestions do you offer to those providing interventions to people with psychosocial disability? Data saturation was identified when the women’s narratives significantly overlapped sharing several characteristics and when the lines of inquiry became repetitive (Morse, 2015).

Author Characteristics

Our research team consisted of a doctoral candidate, a doctoral student, and a counselor educator. The doctoral candidate is an African female who has completed the qualitative research course and has conducted qualitative research before, the doctoral student is a South Asian male, and the counselor educator is a White male with experience in teaching and research.

Data Analysis

The first step was to organize the data and prepare them for analysis. This involved transcribing the interviews (Creswell, 2018). The interviews were video recorded and transcribed verbatim. The second step involved reading through the transcripts to obtain a general sense of the information and reflect on the overall meaning of the transcripts (Creswell, 2018). This was done by the first and second authors. Initially, the first and second authors read the transcripts separately to fulfill investigator triangulation (Patton, 2015). The third step of analysis involved coding the data. Codes were developed with the aid of the MAXQDA 2020 data analysis software. This involved bracketing chunks of information and developing words or phrases that represented the various categories of information gathered (Creswell, 2018). The next step involved developing themes through an analysis of significant statements and generating meaning units to capture the essence of the description of the lived experiences (Moustakas, 1994). Subsequent meetings between the first and second authors were then conducted which resulted in the harmonization of emerging themes and subthemes. Significant statements which reflected the participants’ description of their experiences were identified as part of the process to mark the horizontalization phase of the analysis process (Moustakas, 1994). In line with Moustakas (1994), the list of significant statements was reviewed to establish consistency in coding, develop titles for the themes, and group the data in thematic clusters. The titles for the themes and subthemes were discussed until consensus was achieved. After agreeing on the themes and subthemes, participant quotations that effectively represented each theme were identified (Creswell, 2018). The information was condensed into textural descriptions highlighting what the participants experienced and structural descriptions highlighting how the participants experienced psychosocial disability in terms of context, condition, and situation (Creswell & Poth, 2018). The third author served as the peer debriefer because of his position of seniority in terms of research expertise and teaching both master’s and doctoral-level counseling courses. His primary role was to read the raw data analysis, scrutinize themes, and highlight discrepancies.

Demographic Information

Demographic information featuring age, marital status, education level, number of children, work status, and years with psychosocial disability (PSD) was collected. The summary of the demographic information is presented in Table 1.

The findings are presented in two broad themes and under each theme are sub-sections of the aspects that featured in the interviews with the participants. These are summarized in Table 2.

Risk Factors

Risk factors highlighted the aspects that exposed the participants to the likelihood of negatively affecting the prognosis of their mental health conditions. These included the following subthemes.

Stigma and Discrimination

All participants reported having gone through experiences of stigma and discrimination. Stigma and discrimination emanated from self, family, service providers, institutions, and the general community. Stigma and discrimination took the form of derogatory comments, outright rejection, exclusion from decision-making and social participation, exploitation, labeling, and physical assaults.

Participants experienced stigma and discrimination from health facilities especially when they went to seek services that were not related to mental health. Medical personnel tended to be dismissive of the issues raised by the participants and attributed their issues to emanating from an unsound mind. P2 said, “When I asked him (doctor) what the cause of the [menstrual cycle problems] could be, he said this thing, (pointing at the head) can confuse us, it’s what is making you think like that.” In other instances, stigma and discrimination were experienced in the workplace. Some participants found it difficult to find employment. P1 said, “I had just graduated from the teacher training college, and it was difficult to get a job because wherever I would go, they would refer to me as a mad person.”

Stigma and discrimination also emanated from community members. This involved labeling, social exclusion, accusations of having done something abominable, violence, and the exertion of pressure on families to disown the participants. P2 said, “One of the members who started the church together with my husband kept saying our pastor should get another wife, his wife is mad and is useless.” The negative community attitude arising from stigma affected some participants’ chances of forming intimate relationships. P1 said, “I used to get suitors but whenever I would tell them my history of a mental illness, they would just terminate the relationship.” Hostility from family sometimes resulted in families breaking up. P7 said, “My children were fearing me, they hated me and were telling me to go away from their home, and yet they are big children.” Physical assaults prompted by community stigma in some incidences resulted in fatalities. This caused fear, trauma, and a heightened sense of insecurity among the women regarding their safety and the safety of their children. P3 said, “This week a boy who had a (mental health) crisis was walking and saw bananas displayed for sale and began eating. They beat him claiming that he was a thief, and he was killed.”

Furthermore, stigma and discrimination came from the self. Self-stigma manifested through internalized shame and self-devaluation which impeded social engagement. The underlying fear of rejection made participants hesitant to disclose their disability status. P1 said, “I remember when I had just come from the hospital, I did not want anyone who had ever gone to school with me or worked with me to meet me.”

Participants expressed challenges in meeting their basic needs due to the stigma and discrimination. Those who were initially working lost their jobs after their employers discovered that they had mental health challenges. Some were even terminated without being paid what was due to them. Some participants were forced to survive on handouts from well-wishers and sometimes go without food. The situation was compounded among the women who also had to fend for their children, yet they did not have any source of income. P1 said, “When I tried to demand payment for the months I had worked, my employer had men bundle me up, pushed me into a car, and took me to hospital forcefully, claiming that I was mad.”

Treatment Challenges

Almost all the participants (10/11) reported treatment challenges. Due to limited awareness in society regarding mental health issues coupled with the strong association of mental illness with evil spirits, families tended to initially seek treatment from places like spirit mediums. This exacerbated their mental distress and resulted in emotional and physical abuse. P7 said,

I stayed in that shrine for about one week, they shaved off all my hair, cut my body, and put herbs, they also gave me herbs to drink, and bathe, that chasing madness away from me. I grew thin and emaciated. It failed, so he [husband] took me to another shrine, meanwhile, he would dump me at the shrine and go away yet all those witch doctors were men.

Participants who accessed medical help had to deal with the side effects of the drugs. The medication requires good feeding and an adequate amount of rest, which some participants could not afford. P1 said, “When I take medicine, I keep dozing all the time; prompting me to sleep all the time.”

All the participants expressed that it took some time before a diagnosis of a mental health condition could be made. For some, it took several years before a correct diagnosis could be made. Community attitudes, beliefs, and knowledge about mental illness played a significant role in predicting help-seeking behavior. P3, who has lived with depression and bipolar disorder for over 40 years, said, “These days when I explain to the doctors what I went through as a child, they say you were undergoing depression, but it was undiagnosed and the people around you could not understand.” Delays in proper diagnosis affected the support that the participants ought to have received. P3 said, “When I was at University, I was suicidal but did not receive any diagnosis so no one would take me for support.”

Experiences that presented with auditory or visual hallucinations were initially attributed to evil spirits sent by witches and help was sought either from witch doctors or religious leaders, depending on the belief system of the significant family member. P8 describing her experience said, “I could see cats that others were not seeing, and people thought it was witchcraft, so they connected my dad to a witch doctor. He wore a black gown with a cross and only worked at night.”

Support Challenges

Most participants’ (7/11) situations were made worse when they did not get appropriate support from immediate family members and the community. During times of sickness, the participants depended on others for almost everything including food, clothing, shelter, medicine, and emotional support. It was common for family members to be initially supportive and later abandon them. P1 said, “…my husband decided to get another woman… When I returned [from the hospital], I found that my husband had locked the house and went to the other woman’s house. I had to rent a room for myself and my children.”

P2, whose mental health challenges started when she was in a boarding school, shared how she hardly had any form of support from the school. When she would have a mental breakdown, the teachers would ask the boys to restrain her, and the experience left her emotionally distressed. She said, “When the boys came, they held me tight, and were touching me and it was uncomfortable. It was so embarrassing. I started having nightmares. I always woke up thinking they were coming again to grab me.”

Protective Factors

Protective factors featured the resources that mitigated the impact of the risk factors on the participant’s mental health and experience of living with psychosocial disability. The following were identified as protective factors.

Social and Family Support

Almost all participants (10/11) reported social and family support as a protective factor. Social support emanated from family, friends, institutions working with people with psychosocial disability, peer support groups, and networking and collaboration with other organizations. Family support entailed helping participants in seeking medical help, providing medicine, ensuring that the medication was taken on time, providing food, and drinks, and being physically and emotionally present at home and in the hospital. P2 said, “The support from my husband was outstanding… I don’t remember any time when he was not by my side… he could not leave me alone, so I just thank God for my husband… he is a hero, some men run away.”

Friends were instrumental in providing support both at home and out-of-home settings. As participants interacted with different people, they would disclose their mental health status, and this elicited empathy and appropriate support from their friends. P6, who would get epileptic seizures, said, “One time my friend noticed that I had a seizure. She took away my papers, put my head on the desk, and covered me. When I woke, she gave me back my papers and I continued with the exam.”

Participants mentioned support coming from organizations working with people with psychosocial disabilities. Specifically, My Story Initiative, Triumph Uganda, and ATANEKONTOLA were identified as being there for them. These institutions bring people with psychosocial disabilities to forums where they share challenges, coping strategies, information on care and medication, and brainstorm solutions for the issues they are facing. The institutions are involved in spearheading programs aimed at educating the masses about mental health issues, building networks, advocating for the rights of people with psychosocial disability, and empowering women to advocate for themselves. The institutions also provide social economic empowerment to help the women establish income-generating activities. P5 said, “Triumph Uganda and My Story Initiative have given me exposure, when we meet, we share challenges and brainstorm on solutions.”

Peer support groups were identified by participants as having helped enhance their ability to cope with the experience of living with psychosocial disability. During the peer support group meetings, the women share experiences, empathize with each other, get encouragement from the fact that they are not alone, and they get inspiration from listening to the stories of other survivors. In the peer support groups, they also learn more about mental health, and self-management and acquire practical skills that are used to make a living. Some of the skills taught include soap making, crafts, making bags, weaving, and crocheting. Within the peer support groups, the participants identified mentors who have inspired them to develop a positive attitude as they live with psychosocial disability. P2 shared, “…hearing what others are going through, I have been encouraged. When you hear about others then you say, I am not alone, there are other people.” P3 said, “sharing my lived experience with others gives hope, I share my experience with others to give them hope.”

Networking and collaborating with other organizations enabled the participants to connect with different stakeholders and get varied forms of support. Through the networks, the women have been able to access economic empowerment opportunities, more exposure to share their experiences, access information that has enhanced their mental health literacy, and access to different treatment options. They have also been able to access funding that has enabled them to design and implement activities that are specific to the needs of people with psychosocial disability. P3 shared, “We came up with an initiative and formed an organization which is a platform for many people to know us.”

Access to Treatment

Access to the right treatment contributed to the reversal of symptoms of illness. The frequency of relapses was reported to be greatly reduced by most participants (8/11) when they had access to the right medication. The mental health care institutions were identified as being significant in providing continuous, coordinated care and treatment for the participants. P2 said, “Taking medicine is vital, every time I would get off medication, I would have a terrible attack and break down.” P1 said, “… it is now six years I have not had any relapse; I just keep getting the medicine they prescribed for me, and I am fine.”

Engagement in Meaningful Activities

Many participants (6/11) reported that keeping themselves engaged in meaningful activities helped them to cope with their experiences. Some of the meaningful activities included taking care of others, employment, managing income-generating activities, engaging in relaxation activities like singing and dancing, and engaging in advocacy activities. These activities made the participants find a sense of value and reason for living. P3 shared, “… taking care of others brought joy and strength to me. I would visit those in psychiatric units and at home; the more I did that, the more joy I began feeling and even getting better.”

The process of deliberately enjoying the natural environment helped some of the participants. This entailed looking at flowers, enjoying the sunrise and sunset, listening to the sound of birds, walking barefoot on the soil, and doing gardening. During the time of the COVID-19 pandemic lockdown, one of the things that helped the women was engaging in growing vegetables and flowers. The experience of working with the soil and watching vegetables grow and flowers blossom was emotionally nurturing, and the consumption of the vegetables was fulfilling. P3, who found value in connecting with nature, said, “I would stay there quietly in the shades and listen to the birds singing and get refreshed and get the energy to continue with life.”

The participants are engaged in advocating for themselves and the rights of other people living with psychosocial disability. This has given them exposure and confidence to challenge the status quo and speak out regarding any attempts to violate their rights. Their advocacy ranges from local levels to international levels including forums hosted by the United Nations. Advocacy initiatives have focused on increasing participation, promoting reasonable accommodation that is specific for people with psychosocial disability, and engaging government to review laws that demean people with psychosocial disability. They have done this through concerted efforts and articulated their voices through different platforms. P3, who is engaged in advocacy initiatives, said, “People with disabilities have already received affirmative action but people with psychosocial disability are a marginalized group within the disability group. Therefore, people with psychosocial disability standing for leadership positions need affirmative action within affirmative action.”

Faith in God

Many participants (6/11) identified faith in God as a major contributor to building hope and resilience. The participants valued their relationship with God whom they viewed as a friend they reach out to and ask for help. Articulating their needs to God through prayer, meditation, and sharing bible verses was identified as a source of comfort, hope, and encouragement. P3 said,

I went into a very deep depression, I became suicidal…in the Bible, I read, ‘he who overcomes will enter paradise. God, from today, I prayed, give me strength to face life as an overcomer. I had taken 3 days without eating. The appetite came back, I began eating; and got energy into my body.

P7 said, “…stick to God and trust him. God gave me life. I spent five days without eating except water from the borehole. Sometimes I would be in my full understanding but often I was not understanding.”

Self-awareness, Self-acceptance, and Self-care

Getting to know oneself and accepting yourself for who you are was described as one of the things that helped some of the participants (4/11) live through their experiences. Participants had learned to monitor their moods and connect with environments and people that would not dampen their spirits. Sometimes they would keep off certain activities when they felt the activities would affect their mental health. P3 said, “I have discovered how to manage my life. When I am depressed, I avoid traumatizing environments, where somebody has died and people are crying. I do not go there even if they are close relatives.” As part of the self-care process, some participants disclosed details regarding their mental health status including symptoms and the different forms of support that they need at various times with their significant others. This empowered their significant others to know when to step in and help. P1 said, “I have trained my eldest child (10 years old) to do household chores like cooking and taking care of his siblings when I am unwell.”

Resilience and Personal Resolve

A few participants (3/11) reported that the experience of living with a psychosocial disability created a sense of determination to keep moving on with life despite the challenges they faced. P1 commented about the impact of her experience of psychosocial disability, “… it has given me inner strength; I know that I can survive in whatever situation.” Other participants also had similar sentiments. P3 drew strength from focusing on her strengths and what she has been able to accomplish in life despite living with a psychosocial disability. She said, “… when you look at our good side you benefit a lot; this mental health is a small thing to our big life.”

The narratives obtained from the interviews underscore the importance of enhancing protective factors and mitigating risk factors associated with exacerbating psychosocial disability. The proposed interventions amplify the voices of the perspectives of people with lived experience regarding their choice of solutions to their needs. The risk factors identified by the participants are consistent with psychosocial disability in Nepal, India, and Afghanistan (Allan et al., 2018; Fernandes et al., 2018). The combination of the role of the family, mental health care facilities, transport availability, economic opportunities, and community attitude in access to treatment reiterates the importance of designing culturally appropriate and context-specific interventions to mitigate the mental health risk factors (Allan et al., 2018; Arjadi et al., 2015). Treatment options should be generated based on the context and participation of the people with lived experience of psychosocial disability (Eaton, 2018).

This study found that economic challenges compounded the mental health condition of the participants. This finding is consistent with literature highlighting the negative impact of poverty on mental health (Fernandes et al., 2018; Lund et al., 2013). Livelihood opportunities mean enhancing social connections, increasing self-worth, and providing resources for meeting basic needs (Fernandes et al., 2018; Lund et al., 2013).

The role of the family in providing support was underscored in this study. This finding is consistent with literature that identified the role of families in either supporting or disrupting the recovery process of people with psychosocial disability (Fernandes et al., 2018; Tew et al., 2012). Families influence major decisions such as choice of treatment options, treatment adherence, and life decisions like marriage and employment for the person with psychosocial disability. This requires investment in family empowerment (Rathod et al., 2017). Interventions should focus on strengthening family support and addressing factors that impede family support to build a supportive environment for the recovery process for people with psychosocial disability (Wyder & Bland, 2014; Foster et al., 2016; Price-Robertson et al., 2016; Mathias et al., 2017).

Coupled with family support, the importance of community awareness on mental health issues was emphasized as a factor in affecting the mental health status of the participants. This finding tallies with other scholars who emphasized the role of community mental health literacy in managing mental health issues (Fernandes et al., 2018). Within the community are embedded cultural and religious beliefs regarding mental health which consequently influence or complicate help-seeking behaviors (Rathod et al., 2017). When communities understand mental health issues, stigma is mitigated and appropriate help-seeking behaviors are promoted (Eaton, 2018; Mathias et al., 2017; Mehta et al., 2015). This requires the engagement of all community stakeholders in the development of community-based psychosocial interventions (Drake et al., 2014).

Participants emphasized the role of peer support as a protective factor and the need to scale up the empowerment of peer support groups. Peer support groups are reputed to provide support, a platform for sharing personal experiences, building resilience, mitigating stigma, promoting advocacy for the rights of people with psychosocial disability, and improving access to health care (Kleintjes et al., 2013). The documentation of the evidence of the role of peer support groups in delivering positive mental health outcomes should therefore be explored and expanded (Rathod et al., 2017).

Regarding future directions, people in the helping profession would do well to integrate the voices of the people with lived experience in designing interventions. Also, researchers could explore the outcomes of different interventions focused on supporting people with psychosocial disability to establish evidence-based interventions that can be replicated in other communities. Areas to focus on include interventions meant to increase community awareness on aspects related to mental health, mental health advocacy programs, economic support for people with PSD, building and strengthening peer support networks, and provision of reasonable accommodation for PSD. Furthermore, the participants in the current study were drawn from an urban area. Since there are differences in service access and delivery between rural and urban areas, researchers could explore the lived experience of women with psychosocial disabilities living in rural areas.

The results highlight the experiences of adult women living with psychosocial disability in a limited resource setting. People in the helping profession can use the results to inform the process of designing mental health interventions that are tailored to suit this population. Interventions could focus on reinforcing the protective factors and mitigating the risk factors while utilizing the proposed interventions to integrate the voices of the people who are directly affected by the impact of psychosocial disability. Mental health professionals are encouraged to work alongside women with lived experience of psychosocial disability to utilize their strengths, resourcefulness, and the self-advocacy efforts that have kept them going. Interventions could specifically utilize a positive psychotherapy approach that amplifies character strengths, values, meaning, and intrinsically motivated achievements (Rashid, 2015).

Also, the findings underscore the importance of advocacy. Advocacy is an ethical obligation for counselors to address barriers that hinder the growth of clients (ACA, 2014). The results showed that psychosocial disability affects the physical and emotional well-being of women with psychosocial disability. It is therefore imperative that mental health practitioners engage in advocacy at different levels to enhance the well-being of women with psychosocial disability. To engage in advocacy, readers can utilize the guidelines provided by the ACA Advocacy Competency framework which articulate the implementation of advocacy activities at individual, community, and public arena levels (Ratts et al., 2007).

Although the study provided a wealth of information on the experiences of women with psychosocial disability in Uganda, there were some limitations. The sample was composed of mainly literate women in urban and semi-urban areas. The sample did not represent the experiences of illiterate women living in rural areas whose context and experience are characterized by higher levels of mental illness stigma (Rasmussen et al., 2019), harsher social economic realities, and mental health service delivery challenges (Shah et al., 2017) compared to their counterparts in urban areas.

The participants in this study highlighted the risk factors and protective factors to improve the quality of their lives. The lived experience of the participants highlighted a journey of resilience and glowing strength amid social, economic, medical, and emotional obstacles they have navigated through. Their experience provides opportunities to develop efficient and culturally sensitive innovations to improve the quality of life of women with psychosocial disability in limited resource situations. Listening to the experiences of these women is an invaluable resource to start with.