A survey of traditional and faith healers providing mental health care in three sub-Saharan African countries

Esan, Oluyomi; Appiah-Poku, John; Othieno, Caleb; Kola, Lola; Harris, Brian; Nortje, Gareth; Makanjuola, Victor; Oladeji, Bibilola D.; Price, LeShawndra N.; Seedat, Soraya

doi:10.1007/s00127-018-1630-y

Cited by 38 publications

(62 citation statements)

References 26 publications

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“…Second, to minimise harmful practices, such as neglecting, restraining or physically abusing patients. A survey of 693 traditional and faith providers found that amongst people receiving care for mental illness, physical restraint was used in 4% cases in Kenya, 21% in Ghana and 63% in Nigeria (Esan et al, 2019). Third, to raise awareness amongst psychiatric practitioners of the spiritual needs of people with mental disorders (Mulatu, 1999).…”

Section: Introductionmentioning

confidence: 99%

“Medical treatments are also part of God’s gift”: Holy water attendants’ perspectives on a collaboration between spiritual and psychiatric treatment for mental illness in Ethiopia

Asher

Birhanu

Baheretibeb

et al. 2021

Transcult Psychiatry

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In Ethiopia, traditional and spiritual treatments, such as holy water, are used by people with mental disorders instead of, or alongside, psychiatric services. Collaborations between traditional and psychiatric providers may increase access to evidence-based treatments and address human rights abuses. This study aimed to explore the perspectives of holy water attendants on a novel collaboration between holy water and psychiatric care, at St Mary’s Clinic, Entoto, Ethiopia, and to characterize the users of this service. Semi-structured interviews were conducted with 14 holy water attendants, who run group houses for holy water residents and are paid by family members. A thematic analysis was conducted. Socio-demographic and clinical data were extracted from the records of all service users who had attended the clinic. A total of 174 individuals have attended the clinic in the three years since it opened. The majority were diagnosed with schizophrenia. Holy water attendants provide a partial gatekeeping role to psychiatric care, selecting which of their clients they think will benefit and, for these individuals, facilitating attendance to the clinic and antipsychotic medication adherence. Psychiatric care was felt to be compatible with holy water by some, but not all, attendants. However, family members often had the “final say” in individuals attending the clinic, in some cases putting up strong resistance to using psychiatric care. A novel collaboration is acceptable to some holy water attendants and may increase access to psychiatric care amongst people with mental illness living at a holy water site in Ethiopia.

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Section: Introductionmentioning

confidence: 99%

“Medical treatments are also part of God’s gift”: Holy water attendants’ perspectives on a collaboration between spiritual and psychiatric treatment for mental illness in Ethiopia

Asher

Birhanu

Baheretibeb

et al. 2021

Transcult Psychiatry

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“…They also have good grasps of the culturally appropriate approaches to communicate distress, and are thus available to quickly respond to changes in not only mental health but also the social, economic, and spiritual circumstances of their clientele (Iheanacho et al, 2018). Furthermore, African traditional healers have the appropriate skills to probe into the perceived social, psychological, and spiritual origins of the mental health conditions, thus ensuring the most culturally acceptable treatment (Esan et al, 2019). Consequently, most users of their service perceive African traditional medicine treatment for mental health conditions as being effective.…”

Section: Collaboration Between Traditional and Biomedical Providersmentioning

confidence: 99%

Sociocultural contexts of mental illness experience among Africans

Ojagbemi

Gureje

2021

Transcult Psychiatry

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Even though mental disorders can be found in every culture globally, the lived experience, expression of associated distress, and interpretation as evidence of deviance from acceptable norms are influenced by social and cultural context (Kirmayer, 2001). Hence, the context of mental illness experience should be a key consideration in the provision of culturally appropriate interventions. Historically, scant attention was paid to the unique sociocultural elements of mental disorders in Africa. In particular, early documentation of mental illness experience, predominantly by colonial psychiatrists, demonstrated little grasp of the social and cultural norms of the people. There were reports suggesting limited understanding of the local languages and modes of expression of distress, as well as failure to properly communicate directly with patients (Lucas & Barrett, 1995). Inferences about the experience of mental illness in Africans were thus made based on this lack of appreciation of diversity (Tooth, 1950). The studies in this issue of Transcultural Psychiatry reflect a growing body of work that is informed by the diversity and lived reality of contemporary African contexts.

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“…Traditional and faith-based care is not uniform and may vary dramatically across healers [12][13][14]. Healers often share the belief that psychopathology is spiritual in nature, and therefore, they may provide spiritual consultation, prescribe prayer, engage in sacrifices, or administer various ceremonial or herbal remedies [12][13][14]18,19]. In addition to these strategies that may have psychosocial benefits (eg, preaching helps address feelings of fear and offers patients a sense of hope and optimism [13]), healers may also use practices that constitute human rights abuses (eg, flogging, keeping patients in overcrowded enclosures or cages, forced fasting, shackling, exposure to the elements, and chaining patients to trees or concrete slabs for weeks or months) [7,18,19].…”

Section: Introductionmentioning

confidence: 99%

“…Chaining or similar forced mechanical restraining of people with SMI occurs in Africa, Asia, Europe, the Middle East, and the Americas [20]. These practices are psychologically damaging and physically dangerous [7,[18][19][20].…”

Section: Introductionmentioning

confidence: 99%

A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study

et al. 2021

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Background The resources of West African mental health care systems are severely constrained, which contributes to significant unmet mental health needs. Consequently, people with psychiatric conditions often receive care from traditional and faith healers. Healers may use practices that constitute human rights violations, such as flogging, caging, forced fasting, and chaining. Objective The aim of this study is to partner with healers in Ghana to develop a smartphone toolkit designed to support the dissemination of evidence-based psychosocial interventions and the strengthening of human rights awareness in the healer community. Methods We conducted on-site observations and qualitative interviews with healers, a group co-design session, content development and prototype system build-out, and usability testing. Results A total of 18 healers completed individual interviews. Participants reported on their understanding of the causes and treatments of mental illnesses. They identified situations in which they elect to use mechanical restraints and other coercive practices. Participants described an openness to using a smartphone-based app to help introduce them to alternative practices. A total of 12 healers participated in the co-design session. Of the 12 participants, 8 (67%) reported having a smartphone. Participants reported that they preferred spiritual guidance but that it was acceptable that M-Healer would provide mostly nonspiritual content. They provided suggestions for who should be depicted as the toolkit protagonist and ranked their preferred content delivery modality in the following order: live-action video, animated video, comic strip, and still images with text. Participants viewed mood board prototypes and rated their preferred visual design in the following order: religious theme, nature motif, community or medical, and Ghanaian culture. The content was organized into modules, including an introduction to the system, brief mental health interventions, verbal de-escalation strategies, guided relaxation techniques, and human rights training. Each module contained several scripted digital animation videos, with audio narration in English or Twi. The module menu was represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. In total, 12 participants completed the M-Healer usability testing. Participants commented that they liked the look and functionality of the app and understood the content. The participants reported that the information and displays were clear. They successfully navigated the app but identified several areas where usability could be enhanced. Posttesting usability measures indicated that participants found M-Healer to be feasible, acceptable, and usable. Conclusions This study is the first to develop a digital mental health toolkit for healers in West Africa. Engaging healers in user-centered development produced an accessible and acceptable resource. Future field testing will determine whether M-Healer can improve healer practices and reduce human rights abuses.

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A survey of traditional and faith healers providing mental health care in three sub-Saharan African countries

Cited by 38 publications

References 26 publications

“Medical treatments are also part of God’s gift”: Holy water attendants’ perspectives on a collaboration between spiritual and psychiatric treatment for mental illness in Ethiopia

“Medical treatments are also part of God’s gift”: Holy water attendants’ perspectives on a collaboration between spiritual and psychiatric treatment for mental illness in Ethiopia

Sociocultural contexts of mental illness experience among Africans

A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study

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