The treatment outcome of psychotic disorders by traditional healers in central Sudan

Application of cognitive remediation in the world: new experiences from two schizophrenia rehabilitation centers in Togo and Benin

PURPOSE

People with schizophrenia in Sub-Saharan Africa often live in very difficult conditions, suffer important social isolation and usually do not receive any kind of treatment. In this context, some non-governmental initiatives have come to light, providing accommodation, food, primary healthcare, medications and, in some cases, education and rehabilitation. The aims of this study were to assess feasibility, effects, and acceptability of a Cognitive Remediation Therapy (CRT) intervention in the particular context of psychiatric rehabilitation in Togo and Benin.

METHODS

Patients diagnosed with schizophrenia accessing the "Saint Camille" association rehabilitation centers in Togo and Benin during the enrollment period were allocated consecutively with a 1:1 proportion to receive a manualized CRT intervention (46 one-hour sessions over 14 weeks) or continuing Treatment As Usual (TAU). The assessment included validated measures of cognitive performance and real-world functioning and was performed at baseline and at the conclusion of treatment.

RESULTS

All subjects that were invited into the study agreed to participate and completed the intervention, for a total of 36 participants. CRT produced greater improvements than TAU in processing speed, working memory, verbal memory, cognitive flexibility, and executive functions measures, with moderate to large effect sizes, in particular in processing speed and working memory domains.

CONCLUSIONS

CRT represents a feasible and effective psychosocial intervention that can be implemented even in contexts with very limited resources, and could represent an important instrument to promote the rehabilitation process of people living with schizophrenia in low-income countries.

Traditional healing practices, factors influencing to access the practices and its complementary effect on mental health in sub-Saharan Africa: a systematic review

OBJECTIVES

In areas with limited and unaffordable biomedical mental health services, such as sub-Saharan Africa (SSA), traditional healers are an incredibly well-used source of mental healthcare. This systematic review synthesises the available evidence on traditional healing practices, factors to access it and its effectiveness in improving people's mental health in SSA.

DESIGN

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach.

DATA SOURCES

PubMed, MEDLINE, CINAHL and Scopus studies published before 1 December 2022.

ELIGIBILITY CRITERIA

Qualitative and quantitative studies reported traditional healing practices to treat mental health problems in SSA countries published in English before 1 December 2022.

DATA EXTRACTION AND SYNTHESIS

Data were extracted using Covidence software, thematically analysed and reported using tables and narrative reports. The methodological quality of the included papers was evaluated using Joanna Briggs Institute quality appraisal tools.

RESULTS

In total, 51 studies were included for analysis. Traditional healing practices included faith-based (spiritual or religious) healing, diviner healing practices and herbal therapies as complementary to other traditional healing types. Objectively measured studies stated that people's mental health improved through collaborative care of traditional healing and biomedical care services. In addition, other subjectively measured studies revealed the effect of traditional healing in improving the mental health status of people. Human rights abuses occur as a result of some traditional practices, including physical abuse, chaining of the patient and restriction of food or fasting or starving patients. Individual, social, traditional healers, biomedical healthcare providers and health system-related factors were identified to accessing traditional healing services.

CONCLUSION

Although there is no conclusive, high-level evidence to support the effectiveness of traditional healing alone in improving mental health status. Moreover, the included studies in this review indicated that traditional healing and biomedical services collaborative care improve people's mental health.

PROSPERO REGISTRATION NUMBER

CRD42023392905.

"Trust in God, but tie your donkey": Holy water priest healers' views on collaboration with biomedical mental health services in Addis Ababa, Ethiopia

This exploratory qualitative study examines holy water priest healers' explanatory models and general treatment approaches toward mental illness, and their views and reflections on a collaborative project between them and biomedical practitioners. The study took place at two holy water treatment sites in Addis Ababa, Ethiopia. Twelve semi-structured interviews with holy water priest healers found eight notable themes: they held multiple explanatory models of illness, dominated by religious and spiritual understanding; they emphasized spiritual healing and empathic understanding in treatment, and also embraced biomedicine as part of an eclectic healing model; they perceived biomedical practitioners' humility and respect as key to their positive views on the collaboration; they valued recognition of their current role and contribution in providing mental healthcare; they recognized and appreciated the biomedical clinic's effectiveness in treating violent and aggressive patients; they endorsed the collaboration and helped to overcome patient and family reluctance to the use of biomedicine; they lamented the lack of spiritual healing in biomedical treatment; and they had a number of dissatisfactions and concerns, particularly the one-way referral from religious healers to the biomedical clinic. The study results show diversity in the religious healers' etiological understanding, treatment approaches and generally positive attitude and views on the collaboration. We present insights and explorations of factors affecting this rare, but much needed collaboration between traditional healers and biomedical services, and potential ways to improve it are discussed.

Social interactions within the Sudanese healthcare system: traditional healers and psychiatrists

From a cultural perspective, traditional healing has had a substantial impact on psychiatric management in rural African communities, but the services provided by traditional healers are not integrated with the mental health services provided by primary healthcare. In Sudan, modern psychiatry has seen minimal development beyond the capital city of Khartoum. In rural communities, traditional health practitioners (THPs) are the first point of entry to mental health services. Effective collaboration between THPs and consultant psychiatrists should be encouraged by the introduction of health education that targets THPs, especially in rural communities. This would facilitate the integration of mental health services into primary healthcare and help achieve universal health coverage for psychiatric disorders in Sudan.

Effectiveness of Social Inclusion Interventions for Anxiety and Depression among Adolescents: A Systematic Review

BACKGROUND

Adolescents who are socially excluded are at increased risk of mental health problems such as depression and anxiety. Promoting social inclusion could be an effective strategy for preventing and treating adolescent depression and anxiety.

METHODS

We conducted a systematic review of intervention studies which aimed to prevent or treat adolescent depression and/or anxiety by promoting social inclusion. Throughout the review we engaged a youth advisory group of 13 young people (aged 21-24) from Uganda, Turkey, Syria, South Africa, and Egypt.

RESULTS

We identified 12 studies relevant to our review. The interventions tested use a range of different strategies to increase social inclusion and reduce depression and anxiety, including social skills training, psychoeducation, teaching life skills training, and cash transfers. Pooled standardised mean differences (SMDs) based on random-effects models showed medium-to-large benefits of interventions on improving depression and anxiety symptoms (n = 8; SMD = -0.62; 95% CI, -1.23 to -0.01, p < 0.05).

CONCLUSION

Although there are not many studies, those which have been done show promising results that strongly suggest that social inclusion could be an important component of programmes to promote adolescent mental health.

Integrating Cognitive Behavioural and Islamic Principles in Psychology and Psychotherapy: A Narrative Review

Standardisation of knowledge has become a by-product of globalisation, and western-based models are often seen as the ultimate answer to expertise and development. In light of this, some professionals have debated the feasibility of employing cognitive behavioural therapy (CBT) with Muslim communities. Debates have focused on CBT's secular roots and its compatibility with a world where Islam permeates most aspects of life. This article highlights some of the theoretical dilemmas of integration and suggests ways to bridge the existing gap between secular and Islamic literature and avoid alienating those individuals who might feel uncomfortable with secular CBT teachings.

Becoming a Xhosa traditional healer: The calling, illness, conflict and belonging

Background

Traditional healers (THs) are an important part of the healthcare system in sub-Saharan Africa. Understanding their training, experiences of becoming healers and their perceived roles in society is critical.

Aim

This study aimed to explore the experience of becoming a TH, including accepting the calling, and sheds light on how the experience is conceptualised within the cultural and communitarian context of THs.

Setting

This study was conducted amongst Xhosa THs in the Western Cape, South Africa.

Methods

In-depth phenomenological interviews (n = 4) were conducted with Xhosa THs and analysed using Giorgi's descriptive pre-transcendental Husserlian phenomenological analysis.

Results

The experience of becoming a TH can be summarised in the context of three units of significance: (1) the gift of healing as an illness; (2) the experience of conflict (including with their families, the church and self-conflict); and (3) the experience of belonging. Familial conflict, specifically, was fuelled by the financial burden of becoming a TH and a lack of understanding of the process.

Conclusion

To develop a workable model of collaboration in the future, it is crucial that mental healthcare providers develop a better understanding of the experiences of THs in becoming care providers. The findings highlight an appreciation of the challenging process of becoming a TH. Finally, further research and culturally appropriate psychoeducation can provide trainee THs and their family members with the skills and knowledge to support each other through a difficult process.

Role of traditional healers in the pathway to care of patients with schizophrenia in Egypt

BACKGROUND

Traditional healers are considered one of the important stages in the pathway to care of schizophrenia patients because of the confidence in the system, affordability and accessibility of the service, exposing patients to hazardous management, delay in seeking psychiatric help and bad prognosis.

AIM

To assess the pathway to care of schizophrenia patients and role of traditional healers into it, the sociodemographic and clinical correlates of those patients.

METHODS

We assessed 232 patients with schizophrenia after confirmation of diagnosis with Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I) research version using a questionnaire designed by authors to assess help seeking behavior in schizophrenia patients and its sociodemographic and clinical correlates. Positive and Negative Syndrome Scale to identify the presence and severity of symptoms.

RESULTS

A total of 41.8% sought traditional healers first, 58.1% sought a psychiatric consultation first, main symptoms related to traditional healers seeking were hallucinations in 51.5%, delusions 29.9%, 9.28% bizarre behavior and 9.28% formal though disorder. Main causes of traditional healers' preference were society acceptance 30.39%, affordability 24.74% and accessibility 16.49%.

CONCLUSION

This study shows that a significant percentage of the patients suffering from schizophrenia prefer to approach faith healers first due to their own beliefs, society acceptance, affordability and easy accessibility.

The importance of faith-based mental healthcare in African urbanized sites

PURPOSE OF REVIEW

This review highlights what current research says about how local beliefs and norms can facilitate expansion of mental healthcare to meet the large unmet need for services in Africa.

RECENT FINDINGS

In contemporary Africa, religious beliefs exert important influences on mental health as well as the way people with mental illnesses are viewed and cared for. Mental healthcare practices based on traditional and other religious beliefs, and offered by complementary and alternative health providers (CAPs), reflect the people's culture and are often preferentially sought by a majority of the population. Despite important differences in the worldviews of CAPs and biomedical mental healthcare practitioners in regard to causal explanations, there are nevertheless overlaps in the approaches of both sectors to the management of mental health conditions. These overlaps may provide a platform for collaboration and facilitate the scaling-up of evidence-based mental health services to underserved African populations, especially those residing in ever-expanding urban centres.

SUMMARY

Faith-based mental healthcare is an important but informal component of the mental health system in much of Africa. Collaboration between its practitioners and biomedical practice may help to bridge the large treatment gap for mental health conditions on the continent.

Faith healers are taking over the role of psychiatrists in Iraq

Background: Due to lack of education and awareness, faith healing has become a popular way of treating psychiatric patients. Objective: To ascertain the role of faith healers in the treatment of psychiatric illnesses by exploring the percentage of patients attending those healers. Methods: A semi-structured questionnaire was applied through a direct face-to-face interview with the patients and their companions; it inquired whether the patient has ever visited faith healers, the method of treatment the patients were subjected to, and their opinion about the benefit they got regarding improvement in their condition. Results: Among the total 482 cases; 279 (57%) reported going to faith healers (FHs) at any time before, during, or after a psychiatric consultation. Of those, 84.6% reported visiting FHs less than 10 times, while 15.4% went 10 times or more; 36.9% still believe that the treatment of FHs is accepted or even good (21.5%), while 30.9% realized that it is useless, and 10.7% think it is bad. No association was found between going to FHs and patient age or gender, while there was a significant association with marital status (p < 0.02) and with education (p < 0.001). Patients with schizophrenia/psychosis or bipolar disorders visited FHs significantly more often than those with other diagnoses. Conclusion: Faith healing is prevalent in Iraq and FHs may overwhelm the role of psychiatrists in treating mental illnesses. Sincere efforts are needed to help build public awareness and to improve accessibility and utilization of mental health services for this vulnerable group.

Spiritual Explanatory Models of Mental Illness in West Nile, Uganda

Integrating indigenous cultural knowledge into conceptualizing mental illness offers highly valuable insights to better contextualize mental health. The meaning given to symptoms determines what is abnormal and requiring treatment. In Uganda, the formal health care system is neither the only nor the most widespread treatment provider. Help is often sought from traditional and religious healers, too. Despite numerous calls for cooperation between the healing systems, this has translated into reality only to a very limited degree. The purpose of this study was to gain insight into local explanatory models of mental illness, to gain an understanding of the different patients’ needs, and to develop a more comprehensive system of care. We used an ethnographic investigation approach, which allowed for a more holistic view of the research field. This was geographically delimited to the West Nile subregion in Northern Uganda. We conducted a total of 56 semistructured interviews with traditional healers ( n = 5), Christian religious healers ( n = 3), psychiatric patients ( n = 16), their attendants ( n = 16), and community members ( n = 16). In addition, we used the method of participant observation. The data collected were analyzed using Qualitative Content Analysis and Grounded Theory methodology. For the purpose of this article, we exclusively extracted the spiritual explanatory models. These were spirit possession and curse. Both were traditional concepts with a religious reinterpretation involving the action of spirits.

"We are like co-wives": Traditional healers' views on collaborating with the formal Child and Adolescent Mental Health System in Uganda

BACKGROUND

Early identification and management of mental illness in childhood and adolescence helps to avert debilitating mental illness in adulthood but the attention given to Child and Adolescent Mental Health (CAMH) has until recently been low. Traditional healers are often consulted by patients with mental illness and in Uganda, up to 60% of patients attending traditional healers have moderate to severe mental illness. Poor access to CAMH care in Uganda creates a treatment gap that could be met through enhanced collaboration between traditional healers and biomedical health systems. The aim of this study was to explore traditional healers' views on their collaboration with biomedical health systems so as to inform the implementation of strategies to improve access to CAMH services in Uganda.

METHODS

In-depth interviews with 20 purposively selected traditional healers were conducted in November 2015. A semi-structured interview guide was used to explore: 1) The experiences of traditional healers with mental ill-health in children and adolescents; 2) their willingness to collaborate with the formal health system; and 3) their perception of clinicians' willingness to collaborate with them. Interviews were conducted in local languages and tape recorded. Data were analysed using thematic analysis.

RESULTS

Traditional healers described several experiences managing children and adolescents with mental illness, which they ascribed to spiritual and physical causes. The spiritual explanations were a consequence of unhappy ancestral spirits, modern religions and witchcraft, while physical causes mentioned included substance abuse and fevers. No traditional healer had received a patient referred to them from a medical clinic although all had referred patients to clinics for non-mental health reasons. Traditional healers expressed distrust in biomedical health systems and believed their treatments were superior to medical therapies in alleviating mental suffering. They expressed willingness to collaborate with biomedical providers. However, traditional healers believe clinicians disregard them and would not be willing to collaborate with them.

CONCLUSION

Potential for collaboration between traditional healers and biomedical health systems for improving access to CAMH services in Uganda exists, but is undermined by mutual mistrust and competition between traditional healers and clinicians.

Reactions to symptoms of mental disorder and help seeking in Sabah, Malaysia

BACKGROUND

A better understanding is needed about how people make decisions about help seeking.

MATERIALS

Focus group and individual interviews with patients, carers, healthcare staff, religious authorities, traditional healers and community members.

DISCUSSION

Four stages of help seeking were identified: (1) noticing symptoms and initial labelling, (2) collective decision-making, (3) spiritual diagnoses and treatment and (4) psychiatric diagnosis and treatment.

CONCLUSION

Spiritual diagnoses have the advantage of being less stigmatising, giving meaning to symptoms, and were seen to offer hope of cure rather than just symptom control. Patients and carers need help to integrate different explanatory models into a meaningful whole.

Collaboration or renunciation? The role of traditional medicine in mental health care in Rwanda and Eastern Cape Province, South Africa

Traditional medicine (TM) and biomedicine represent parallel health systems in many developing countries; the latter dominating in public policies, while the former still retain considerable influence among the general public. This study investigates how mental health care professionals responsible for mental health care implementation comprehend and relate to the intersection between TM and biomedicine in the cases of Rwanda and the Eastern Cape Province, South Africa. The material is based on semi-structured interviews with mental health care stakeholders in Eastern Cape, South Africa and Rwanda. The findings confirm an impact of TM in the treatment of mental health issues in Rwanda and South Africa due to TM being more accessible than biomedical medicine, widespread traditional perceptions of mental illness in society, and the lack of knowledge of biomedical treatments. Furthermore, the respondents identified three strategies to manage the impact of TM; improved accessibility of biomedical facilities, outreach education about mental illness, and, in the Eastern Cape case, collaboration between traditional healers and biomedicine. The study points to the necessity to take TM into consideration as an important component of health systems and policies in the Global south.

Effectiveness of traditional healers in treating mental disorders: a systematic review

Traditional healers form a major part of the mental health workforce worldwide. Despite this, little systematic examination has been done of their effectiveness in treating mental illness or alleviating psychological distress. In this Review, we aim to fill this gap, with a focus on quantitative outcomes. We searched four databases and reference lists for papers that explicitly measured the effectiveness of traditional healers on mental illness and psychological distress. Eligible papers were assessed for quality, and outcomes and other details were extracted with the use of a standardised template. 32 eligible papers from 20 countries were included. The published literature on this topic is heterogeneous and studies are generally of poor quality, although some findings emerge more consistently. Some evidence suggests that traditional healers can provide an effective psychosocial intervention. Their interventions might help to relieve distress and improve mild symptoms in common mental disorders such as depression and anxiety. However, little evidence exists to suggest that they change the course of severe mental illnesses such as bipolar and psychotic disorders. Nevertheless, qualitative changes that are captured poorly by conventional rating scales might be as important as the quantitative changes reviewed here. We conclude by outlining the challenges involved in assessing the effectiveness of traditional healers.