How can mental health and faith-based practitioners work together? A case study of collaborative mental health in Gujarat, India

Abstract

Despite the knowledge that people with mental illness often seek care from multiple healing systems, there is limited collaboration between these systems. Greater collaboration with existing community resources could narrow the treatment gap and reduce fragmentation by encouraging more integrated care. This paper explores the origins, use, and outcomes of a collaborative programme between faith-based and allopathic mental health practitioners in India. We conducted 16 interviews with key stakeholders and examined demographic and clinical characteristics of the user population. Consistent with previous research, we found that collaboration is challenging and requires trust, rapport-building, and open dialogue. The collaboration reached a sizeable population, was reviewed favourably by key stakeholders-particularly on health improvement and livelihood restoration-and perhaps most importantly, views the client holistically, allowing for both belief systems to play a shared role in care and recovery. Results support the idea that, despite differing practices, collaboration between faith-based and allopathic mental health practitioners can be achieved and can benefit clients with otherwise limited access to mental health care.

Traditional healers’ and biomedical practitioners’ perceptions of collaborative mental healthcare in low- and middle-income countries: A systematic review

“…Instead, healers’ localised cultural insight and status in the community should be utilised, as it has been in the Ebola epidemics (Maclean, 2016). This is supported by the documentation of a successful collaboration in Shields et al.’s (2016) paper, in which there was no attempt to impose ideological change onto healers. The programme instead focused on recognising symptoms of mental distress without requiring of healers that they subscribe to the biomedical paradigm of disease aetiology.…”

“…Given the widespread and continued use of traditional healers, some doctors felt that they may as well work together, as explained by this doctor: “Traditional healers have been part of our societies for a very long time and whether we like it or not people with mental problems are going to go to them” (Ae-Ngibise, et al., 2010, p.560). However, some biomedical practitioners seemed genuinely enthusiastic to work with healers because of their position as “gatekeepers of care” in the local community (Shields, et al., 2016, p. 10).…”

“…Both biomedical and traditional practitioners suggested strategies to improve the likelihood of successful collaboration, with capacity building and the establishment of a referral system to co-manage patients emerging as the strongest factors (Agara, Makanjuola & Morakinyo, 2008; Jansen Van Rensburg, Poggenpoel, Szabo & Myburgh, 2014; Kayombo, Uiso, Mbwambo, Mahunnah, Moshi & Mgonda, 2007; Kahn & Kelly, 2001; Musyimi, Mutiso, Nandoya & Ndetei, 2016; Shields et al., 2016). These were largely in line with existing research and guidance on the topic.…”

“…In regards to what form collaboration would take, a system of co-referral seemed preferable (Bulbulia & Laher, 2013; Campbell-Hall, 2010; Janse van Rensburg, et al., 2014; Kahn & Kelly, 2001; Musyimi, et al., 2016; Ovuga, 1999; Shields, et al., 2016; Teuton, et al., 2007). Healers tended to want a more integrated system, suggesting that access to rooms in health centres and hospitals would facilitate collaboration (Ovuga, 1999, p. 278).…”

“…As one doctor described, “we train faith-based healers how to identify, who to refer, when to refer, and made clear that it is not a compulsion for them to refer. It is their own free will to refer a person” (Shields, et al., 2016, p. 376).…”