1
|
Wollie AM, Usher K, Maharaj R, Islam MS. Health professionals' attitudes towards traditional healing for mental illness: A systematic review protocol. PLoS One 2024; 19:e0310255. [PMID: 39250499 DOI: 10.1371/journal.pone.0310255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/27/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Mental illness is a global problem that receives less attention, particularly in developing countries. Integrating modern treatment with traditional healing approaches has been proposed as one way to address mental health problems, especially in developing countries. Despite health professionals' participation in traditional healing being crucial to integrative approaches, their participation is limited to date. This review protocol is designed to explore the attitudes of health professionals towards traditional healing practices in mental health services. METHODS The review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searching databases, including PubMed/Medline, PsychINFO, EMBASE, Scopus, and the Web of sciences will be conducted. Additionally, Google and Google Scholar will be searched for other information, including grey literature. Moreover, a manual search of identified articles' reference lists will also be conducted to help ensure all potential papers are included in the review. Qualitative, quantitative, and mixed study methods published in English between January 2014 and April 2024 will be included. The qualities of the included studies will be assessed using the Mixed Methods Appraisal Tool (MMAT) Version 2018. A mixed-method synthesis will be used to synthesis the results. DISCUSSION It is crucial for healthcare professionals to provide culturally sensitive care to empower people to manage their health. This systematic review will summarize the attitudes of health professionals towards the adoption and delivery of traditional healing approaches to people experiencing mental illness. Therefore, the findings of this review will support integration between traditional healers and modern mental health practitioners for the treatment of mental illness. TRIAL REGISTRATION Protocol registration number: CRD42024535136.
Collapse
Affiliation(s)
- Alemayehu Molla Wollie
- Faculty of Medicine and Health, School of Health, University of New England, Armidale, NSW, Australia
- Department of Psychiatry, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Kim Usher
- Faculty of Medicine and Health, School of Health, University of New England, Armidale, NSW, Australia
| | - Reshin Maharaj
- Faculty of Medicine and Health, School of Health, University of New England, Armidale, NSW, Australia
| | - Md Shahidul Islam
- Faculty of Medicine and Health, School of Health, University of New England, Armidale, NSW, Australia
| |
Collapse
|
2
|
Soori BIP, Regmi K, Pappas Y. Factors Influencing the Integration of Traditional Medicine and Mainstream Medicine in Mental Health Services in West Africa: A Systematic Review Using Narrative Synthesis. Community Ment Health J 2024; 60:1117-1130. [PMID: 38619699 PMCID: PMC11199277 DOI: 10.1007/s10597-024-01263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/27/2024] [Indexed: 04/16/2024]
Abstract
This study explored the enablers and obstacles to the integration of traditional medicine and mainstream medicine in mental health services in West Africa. This study is a systematic review conducted in accordance with the relevant parts of the Preferred Reporting Items for Systematic reviews and Meta-analyses. Keywords searches were done in databases, and other reference lists were also searched. The Rainbow model of integrated care and a thematic analysis framework were used to account for the factors influencing the integration of traditional medicine and mainstream medicine in mental health services in West Africa. A total of 12 studies met the eligibility criteria after the evaluation of 6413 articles from databases and reference lists. The themes of: policy and implementation; different conceptualisation of mental health/referrals; trust issues, and education and training, were enablers or obstacles of integration depending on how they worked to facilitate or hinder integration. There was an indication of little integration of TM and MM at the macro, meso and micro levels in mental health services in West Africa. Though the study does cover all the West African states evenly, it is recommended that policy-makers and stakeholders interested in integration should ensure integration activities, especially policies, cut across all the levels of the rainbow model of integrated care and are planned and aligned at the macro, meso and micro levels instead of using ad hoc measures, informal initiatives or placing TM services in MM mental health services, which do not amount to integration.
Collapse
Affiliation(s)
- Batuuroh I P Soori
- Faculty of Health and Social Sciences, Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK.
| | - Krishna Regmi
- Faculty of Health and Social Sciences, Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK
| | - Yannis Pappas
- Faculty of Health and Social Sciences, Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK
| |
Collapse
|
3
|
Pigeon-Gagné É, Hassan G, Yaogo M, Saïas T. Discrimination and Social Exclusion of People Experiencing Mental Disorders in Burkina Faso: A Socio-anthropological Study. Cult Med Psychiatry 2024:10.1007/s11013-024-09860-w. [PMID: 39017776 DOI: 10.1007/s11013-024-09860-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 07/18/2024]
Abstract
Stigma has been pointed out as a barrier to mental healthcare in sub-Saharan Africa. Among the manifestations of stigma, the use of physical restraints is condemned as a form of violation of basic human rights. Research on this phenomenon is limited in West Africa and more particularly in Burkina Faso. This study explores the phenomenon of stigma of individuals experiencing mental disorders in Bobo-Dioulasso (Burkina Faso). As part of 8 months of socio-anthropological fieldwork, we interviewed 94 informants (7 focus groups and 25 individual interviews) to document exclusionary practices, their perceptions, and justifications. Exclusionary practices can be divided in five subgroups: ignoring, physically and sexually abusing, abandoning, banning, and restraining. Some practices were linked to a lack of financial and material resources, while others were justified by an inferior moral status. We observed differences in the type of exclusion experienced between men and women. Restrictive, abusive, and exclusionary measures are common in Bobo-Dioulasso. These practices can either be understood as part of families' adaptative strategies when dealing with chronic conditions, as part of security measures in the case of patients with aggressive behaviors, or as part of punitive measures when transgressions are committed. We conclude the article by addressing the tensions between local and global meanings of stigma.
Collapse
Affiliation(s)
| | - Ghayda Hassan
- Department of Psychology, Université de Québec à Montréal, Montreal, Canada
| | - Maurice Yaogo
- Université Catholique de l'Afrique de l'Ouest, Bobo-Dioulasso, Burkina Faso
| | - Thomas Saïas
- Department of Psychology, Université de Québec à Montréal, Montreal, Canada
| |
Collapse
|
4
|
Daliri DB, Aninanya GA, Laari TT, Abagye N, Dei-Asamoa R, Afaya A. Exploring the barriers to mental health service utilization in the Bolgatanga Municipality: the perspectives of family caregivers, service providers, and mental health administrators. BMC Health Serv Res 2024; 24:278. [PMID: 38443928 PMCID: PMC10916073 DOI: 10.1186/s12913-024-10567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/05/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Mental health service utilization remains a challenge in developing countries, with numerous barriers affecting access to care. Albeit data suggest poor utilization of mental health services in the Bolgatanga Municipality in Ghana, no studies have explored the barriers to the utilization of mental health services. Therefore, this study explored the perspectives of family caregivers, service providers, and mental health service administrators on the barriers to mental health service utilization in the Bolgatanga Municipality, Ghana. METHODS A qualitative descriptive design was employed for the study. Nineteen participants were purposively sampled from two hospitals including fifteen family caregivers, two service providers, and two mental health administrators. Data were collected through individual in-depth interviews using a semi-structured interview guide. Audio-recorded interviews were transcribed verbatim and thematically analyzed using NVivo 12 pro software. RESULTS Five main themes emerged including individual-level barriers, interpersonal barriers, community-level barriers, organizational-level barriers, and policy-level barriers. At the individual level, lack of insight, poor treatment compliance, and financial challenges were prominent barriers. Interpersonal barriers included family pressure influenced by cultural and spiritual beliefs. At the community level, stigma and mental health illiteracy were identified as significant barriers. At the organizational level, barriers encompassed inadequate staffing, limited space, and staff attitudes. Policy-level barriers included the neglect of mental health in policies and the non-inclusion of mental health services in the National Health Insurance Scheme. CONCLUSION This study highlights the complexity of barriers to mental health service utilization and underscores the need for a comprehensive approach to address them. Collaborative efforts involving healthcare providers, policymakers, communities, and families are essential to mitigate these barriers. It is imperative to consider these barriers when developing strategies to improve the utilization of mental health services in Ghana.
Collapse
Affiliation(s)
- Dennis Bomansang Daliri
- Presbyterian Psychiatric Hospital, Bolgatanga, Ghana
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Gifty Apiung Aninanya
- Department of Health Services Policy Planning Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana
| | | | - Nancy Abagye
- Department of Midwifery, School of Nursing and Midwifery, University of Ghana, Legon, Ghana
| | - Richard Dei-Asamoa
- Department of Psychiatry, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Psychiatry, University of Ghana Medical School, Accra, Ghana
| | - Agani Afaya
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana.
| |
Collapse
|
5
|
Kpobi L, Read UM, Selormey RK, Colucci E. 'We are all working toward one goal. We want people to become well': A visual exploration of what promotes successful collaboration between community mental health workers and healers in Ghana. Transcult Psychiatry 2024; 61:30-46. [PMID: 37801486 PMCID: PMC10903112 DOI: 10.1177/13634615231197998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
The practices of traditional and faith-based healers in low- and middle-income countries in Africa and elsewhere have come under intense scrutiny in recent years owing to allegations of human rights abuses. To mitigate these, there have been calls to develop collaborations between healers and formal health services to optimise available mental health interventions in poorly resourced contexts. For various reasons, attempts to establish such partnerships in a sustainable manner in different countries have not always been successful. In this article, we present findings from the Together for Mental Health visual research project to showcase examples of healer-health worker collaborations in Ghana that have been largely successful and discuss the barriers and facilitators to establishing these partnerships. Data reported in this article were collected using visual ethnography and filmed individual interviews with eight community mental health workers, six traditional and faith-based healers and two local philanthropists in the Bono East Region. The findings suggest that successful collaborations were built through mutually respectful interpersonal relationships, support from the health system and access to community resources. Although these facilitated collaboration, resource constraints, distrust and ethical dilemmas had to be overcome to build stronger partnerships. These findings highlight the importance of dedicated institutional and logistic support for ensuring the successful integration of the different health systems in pluralistic settings.
Collapse
Affiliation(s)
- Lily Kpobi
- Regional Institute for Population Studies, University of Ghana
- Department of Psychology, University of Ghana
| | - Ursula M. Read
- Centre for Mental Health & Wellbeing Research, Warwick Medical School, University of Warwick
| | | | | |
Collapse
|
6
|
Mukala Mayoyo E, Criel B, Sow A, Coppieters Y, Chenge F. Understanding the mix of services for mental health care in urban DR Congo: a qualitative descriptive study. BMC Health Serv Res 2023; 23:1206. [PMID: 37925407 PMCID: PMC10625694 DOI: 10.1186/s12913-023-10219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Mental health workers (MHWs) are exposed to conflicts of competence daily when performing tasks related to the provision of mental health services. This may be linked to a lack of understanding of their tasks as caregivers and providers. Furthermore, in most low-income settings, it is unclear how the available services are organized and coordinated to provide mental health care. To understand the above, this study aimed to identify the current mix of services for mental health care in the urban Democratic Republic of the Congo (DRC). METHODS A qualitative descriptive study was carried out in Lubumbashi from February to April 2021. We conducted 7 focus group discussions (FGDs) with 74 key informants (family members, primary care physicians, etc.) and 13 in-depth interviews (IDIs) with key informants (traditional healers, psychiatrists, etc.). We performed a qualitative content analysis, guided by an analytical framework, that led to the development of a comprehensive inventory of MHWs from the household level to specialized facilities, exploring their tasks in care delivery, identifying existing services, and defining their current organization. RESULTS Analysis of transcripts from the FGDs and IDIs showed that traditional healers and family caregivers are the leading providers in Lubumbashi. The exploration of the tasks performed by MHWs revealed that lifestyle, traditional therapies, psychotherapy, and medication are the main types of care offered/advised to patients. Active informal caregivers do not currently provide care corresponding to their competencies. The rare mental health specialists available do not presently recognize the tasks of primary care providers and informal caregivers in care delivery, and their contribution is considered marginal. We identified five types of services: informal services, traditional therapy services, social services, primary care services, and psychiatric services. Analyses pointed out an inversion of the ideal mix of these services. CONCLUSIONS Our findings show a suboptimal mix of services for mental health and point to a clear lack of collaboration between MHWs. There is an urgent need to clearly define the tasks of MHWs, build the capacity of nonspecialists, shift mental health-related tasks to them, and raise awareness about collaborative care approaches.
Collapse
Affiliation(s)
- Erick Mukala Mayoyo
- School of Public Health, University of Lubumbashi, Lubumbashi, DR, Congo.
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
- Department of Community Health, Institut Supérieur des Techniques Médicales de Kananga, Kananga, DR, Congo.
- National Mental Health Program, Ministry of Public Health, Hygiene and Prevention, Kinshasa, DR, Congo.
- Centre de Connaissances en Santé en RD Congo, Kinshasa, DR, Congo.
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Abdoulaye Sow
- Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Yves Coppieters
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Faustin Chenge
- School of Public Health, University of Lubumbashi, Lubumbashi, DR, Congo
- Centre de Connaissances en Santé en RD Congo, Kinshasa, DR, Congo
| |
Collapse
|
7
|
Gyimah L, Ofori-Atta A, Asafo S, Curry L. Seeking Healing for a Mental Illness: Understanding the Care Experiences of Service Users at a Prayer Camp in Ghana. JOURNAL OF RELIGION AND HEALTH 2023; 62:1853-1871. [PMID: 36066726 PMCID: PMC9986410 DOI: 10.1007/s10943-022-01643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Human rights abuses in mental health care are a global concern. Addressing the problem requires input from key stakeholders, particularly from people using mental health services. This study explored the experiences of persons with mental illness receiving care in a faith-based setting in Ghana. The study employed a qualitative design, with in-depth interviews (n = 23) and focus groups (n = 18 participants in 3 groups). The constant comparative method of analysis was used to identify themes in participants' descriptions of their experiences. The first three themes identified are consistent with human rights and coercion, and the last two themes related to service users' views on participation in spiritual practices. Themes included: decision-making around care; consent and efficacy of religious healing; experiences with chaining; views around biomedical treatment; participation in religious activities as part of healing and recognition of the need for spiritual healing. It was observed that participants with prior experience of psychiatric treatment were happy about the absence of chaining in psychiatric facilities but strongly disliked the side effects of medications. These findings underscore the need for faith-based institutions to provide care that is consistent with patient preferences, thereby helping to address the resultant human rights abuses.
Collapse
Affiliation(s)
- L Gyimah
- Pantang Hospital, P.O. Box PL81, Legon, Accra, Ghana.
| | - A Ofori-Atta
- Department of Psychiatry, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - S Asafo
- Department of Psychiatry, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - L Curry
- Yale University, New Haven, USA
| |
Collapse
|
8
|
van der Zeijst MCE, Veling W, Makhathini EM, Mbatha ND, Shabalala SS, van Hoeken D, Susser E, Burns JK, Hoek HW. Course of psychotic experiences and disorders among apprentice traditional health practitioners in rural South Africa: 3-year follow-up study. Front Psychiatry 2022; 13:956003. [PMID: 36245859 PMCID: PMC9558832 DOI: 10.3389/fpsyt.2022.956003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Culture is inevitably linked with the experience, interpretation and course of what modern biomedicine understands to be psychotic symptoms. However, data on psychoses in low- and middle-income countries are sparse. Our previous study showed that psychotic and mood-related experiences, symptoms and disorders are common among individuals who had received the ancestral calling to become a traditional health practitioner (THP) in rural KwaZulu-Natal, South Africa. Our related ethnographic study suggested that ukuthwasa (the training to become a THP) may positively moderate these calling-related symptoms. As far as we know, no research has been conducted into the course of psychiatric symptoms among apprentice THPs. Objective We studied the course of psychotic experiences, symptoms and disorders among apprentice THPs. We also assessed their level of functioning and expanded our knowledge on ukuthwasa. Materials and methods We performed a 3-year follow-up of a baseline sample of apprentice THPs (n = 48). Psychiatric assessments (CAPE, SCAN), assessment of functioning (WHODAS) and a semi-structured qualitative questionnaire were completed for 42 individuals. Results At 3-year follow-up, psychotic experiences were associated with significantly less distress and there was a reduction in frequency of psychotic symptoms compared to baseline. The number of participants with psychotic disorders had decreased from 7 (17%) to 4 (10%). Six out of seven participants (86%) with a psychotic disorder at baseline no longer had a psychiatric diagnosis at follow-up. Although the mean level of disability among the (apprentice) THPs corresponded with the 78th percentile found in the general population, 37 participants (88%) reported no or mild disability. Forty-one participants (98%) reported that ukuthwasa had positively influenced their psychiatric symptoms. Conclusion In rural KwaZulu-Natal, psychotic experiences, symptoms and disorders have a benign course in most individuals who are undergoing the process of becoming a THP. Ukuthwasa may be an effective, culturally sanctioned, healing intervention for some selected individuals, potentially because it reframes distressing experiences into positive and highly valued experiences, reduces stigma, and enhances social empowerment and identity construction. This implies that cultural and spiritual interventions can have a positive influence on the course of psychosis.
Collapse
Affiliation(s)
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Elliot M. Makhathini
- Department of Nursing, Durban University of Technology, Pietermaritzburg, South Africa
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ndukuzakhe D. Mbatha
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sinethemba S. Shabalala
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Jonathan K. Burns
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Hans W. Hoek
- Parnassia Psychiatric Institute, The Hague, Netherlands
- Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| |
Collapse
|
9
|
Okafor IP, Oyewale DV, Ohazurike C, Ogunyemi AO. Role of traditional beliefs in the knowledge and perceptions of mental health and illness amongst rural-dwelling women in western Nigeria. Afr J Prim Health Care Fam Med 2022; 14:e1-e8. [PMID: 36226933 PMCID: PMC9575354 DOI: 10.4102/phcfm.v14i1.3547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/30/2022] [Accepted: 05/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Globally, the public health importance of mental health has gained significant attention in recent years. In Africa, many traditional belief systems impact the perceptions, attitude and management of mental illness. Women are usually the primary caregivers of mentally ill persons, but they have lower mental health literacy. Aim To assess rural women’s knowledge, perceptions and attitudes regarding mental illnesses and the role of traditional beliefs in their management. Setting Epe Local Government Area of Lagos State, Nigeria. Methods This was a cross-sectional study with a total of 295 rural women recruited through a multistage sampling method. A pretested interviewer-administered questionnaire was used to collect data. Summary and inferential statistics were measured using Epi Info version 7. The level of significance was predetermined at 5%. Results A total of 253 questionnaires were adequately filled and analysed. Overall, just over one-third (35%) of respondents had good knowledge and only 26% had positive attitudes towards mental health and illness. About 45% reported that mental illness should first be treated in ‘the traditional way’, whilst 47% felt that there was no need for collaboration between orthodox and unorthodox healthcare for mental illness. Sociodemographic variables were significantly associated with knowledge (educational level p = 0.001) and attitude (marital status p = 0.001 and ethnicity p = 0.001). Conclusion Respondents had poor knowledge of and attitude towards mental health, and traditional beliefs played a role in their perception and management of mental illness. We recommend community-based health education programmes to improve knowledge and help-seeking for mental illness amongst rural women.
Collapse
Affiliation(s)
- Ifeoma P Okafor
- Department of Community Health and Primary Care, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Mushin.
| | | | | | | |
Collapse
|