“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

Abstract

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.

Traditional and faith-based healthcare in the management of psychotic disorders in Africa: in search for synergy

“…In line with previous research on general mental health [31,32], all stakeholders report serious concerns regarding shared management of psychotic patients [20 ▪ ,41 ▪ ]. In Ghana, TFH, patients and caregivers mentioned fear of disrespect and undue criticism by biomedical practitioners as important obstacles, while primary health providers mentioned the potential harm of traditional treatments [20 ▪ ].…”

“…Patients with psychotic disturbances are often ‘admitted’ in the homes of TFH until they show recovery [ 22 ▪▪ , 34 ▪ , 35 ]. In Ethiopia, individuals with severe mental illness, including psychotic disorders, may reside at holy water sites for a few months or multiple years [ 41 ▪ , 42 ▪▪ ].…”

“…In Ghana, TFH, patients and caregivers mentioned fear of disrespect and undue criticism by biomedical practitioners as important obstacles, while primary health providers mentioned the potential harm of traditional treatments [ 20 ▪ ]. As opposed to reports on general mental health [ 32 ], a study at a holy water site in Ethiopia, where mostly psychotic patients were treated, reported that incompatibility of beliefs was an important reason for resistance among some of the holy water attendants to refer patients to the psychiatric clinic [ 41 ▪ ]. Facilitators for forging partnerships, as identified in the recent studies, were the establishment of bi-directional referrals, promoting mutual respect and recognition, handling the logistical needs of TFH in order to reduce harmful practices, training of TFHs and the provision of free antipsychotic medication [ 20 ▪ , 41 ▪ , 42 ▪▪ ].…”

“…As opposed to reports on general mental health [ 32 ], a study at a holy water site in Ethiopia, where mostly psychotic patients were treated, reported that incompatibility of beliefs was an important reason for resistance among some of the holy water attendants to refer patients to the psychiatric clinic [ 41 ▪ ]. Facilitators for forging partnerships, as identified in the recent studies, were the establishment of bi-directional referrals, promoting mutual respect and recognition, handling the logistical needs of TFH in order to reduce harmful practices, training of TFHs and the provision of free antipsychotic medication [ 20 ▪ , 41 ▪ , 42 ▪▪ ]. In addition, the relevance of careful relationship building prior to initiating the collaboration was also stressed [ 41 ▪ , 49 ].…”

Mental health service utilization in a low resource setting: A qualitative study on perspectives of health professionals in Northwest Ethiopia

“…A promising avenue for increasing mental health service utilization may be to utilize the existing help-seeking pathway of religious and traditional healing places, either by providing basic mental healthcare training to key members of these places (e.g., religious leaders and traditional healers), or to encourage and educate these key members to increase referrals to health facilities. There are also reports from previous studies in Ethiopia that patients and family members expressed comfort in taking both pharmacological and religious/traditional treatments at the same time [37,38]. As such, promoting mental health services without due consideration of the importance of religious and traditional places in the help-seeking pathway may not be an effective approach.…”