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Tehrani JM, Vos IA, Kisabacak R, Topper MK, Steinhorst J, Phillips RO, Abass KM, Osei-Mireku S, Anokye CO, Adu Poku JK, Stienstra Y, Amoako YA. Traditional healers' perception on scabies causation and management in Ghana. Trop Med Int Health 2024; 29:477-488. [PMID: 38599337 DOI: 10.1111/tmi.13989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Scabies is an underdiagnosed skin infestation caused by the Sarcoptes scabiei mite. The infection causes severe itching and a skin rash but can be effectively treated using topical or systemic drugs. Scabies outbreaks are commonly reported in resource-poor countries, including Ghana. Traditional healers play an important role in primary care in rural areas. The role of these traditional healers in the management of scabies has so far not been explored. The aim of this study was therefore to investigate the perceptions of traditional healers regarding the causation and management of scabies. METHODS A phenomenological qualitative approach was employed. Traditional healers in the Asante Akim North and Central districts in Ghana were approached with an interview request. Using a semi-structured interview protocol, 15 traditional healers were interviewed. The results were coded and analysed, after which seven themes were extrapolated. RESULTS Scabies infections were frequently reported by traditional healers. Itching and skin rash were unanimously regarded as the major symptoms of scabies. The majority acknowledged the infectious nature of scabies, but no participant reported the causative organism. A dichotomous disease classification was noted, consisting of 'natural' and 'spiritual' variants each with a unique disease profile and management requirements, as reported by the traditional healers. All but two traditional healers reported to treat scabies using almost exclusively herbs and spiritual rituals. CONCLUSION The majority of traditional healers were open to collaboration with allopathic healthcare providers. Collaboration could broaden the primary care network in rural areas, but mistrust and lack of transparency form potential barriers to collaboration. We, therefore, emphasise the need for additional efforts to investigate strategies for future collaboration.
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Affiliation(s)
- Jian M Tehrani
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ingmar A Vos
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
| | - Robin Kisabacak
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marten K Topper
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jonathan Steinhorst
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Samuel Osei-Mireku
- Agogo Presbyterian Hospital, Agogo, Ghana
- The Trust Hospital, Accra, Ghana
| | | | | | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Yaw Ampem Amoako
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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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 2024:10.1007/s10597-024-01263-w. [PMID: 38619699 DOI: 10.1007/s10597-024-01263-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] [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.
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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
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Baheretibeb Y, Wondimagegn D, Law S. "Trust in God, but tie your donkey": Holy water priest healers' views on collaboration with biomedical mental health services in Addis Ababa, Ethiopia. Transcult Psychiatry 2024; 61:246-259. [PMID: 38314780 PMCID: PMC10943614 DOI: 10.1177/13634615241227681] [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] [Indexed: 02/07/2024]
Abstract
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.
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Ben-Zeev D, Larsen A, Attah DA, Obeng K, Beaulieu A, Asafo SM, Gavi JK, Kadakia A, Sottie EQ, Ohene S, Kola L, Hallgren K, Snyder J, Collins PY, Ofori-Atta A. Combining mHealth Technology and Pharmacotherapy to Improve Mental Health Outcomes and Reduce Human Rights Abuses in West Africa: Intervention Field Trial. JMIR Ment Health 2024; 11:e53096. [PMID: 38619212 PMCID: PMC11017829 DOI: 10.2196/53096] [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] [Received: 09/25/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/16/2024] Open
Abstract
Background In West Africa, healers greatly outnumber trained mental health professionals. People with serious mental illness (SMI) are often seen by healers in "prayer camps" where they may also experience human rights abuses. We developed "M&M," an 8-week-long dual-pronged intervention involving (1) a smartphone-delivered toolkit designed to expose healers to brief psychosocial interventions and encourage them to preserve human rights (M-Healer app), and (2) a visiting nurse who provides medications to their patients (Mobile Nurse). Objective We examined the feasibility, acceptability, safety, and preliminary effectiveness of the M&M intervention in real-world prayer camp settings. Methods We conducted a single-arm field trial of M&M with people with SMI and healers at a prayer camp in Ghana. Healers were provided smartphones with M-Healer installed and were trained by practice facilitators to use the digital toolkit. In parallel, a study nurse visited their prayer camp to administer medications to their patients. Clinical assessors administered study measures to participants with SMI at pretreatment (baseline), midtreatment (4 weeks) and post treatment (8 weeks). Results Seventeen participants were enrolled and most (n=15, 88.3%) were retained. Participants had an average age of 44.3 (SD 13.9) years and 59% (n=10) of them were male. Fourteen (82%) participants had a diagnosis of schizophrenia and 2 (18%) were diagnosed with bipolar disorder. Four healers were trained to use M-Healer. On average, they self-initiated app use 31.9 (SD 28.9) times per week. Healers watched an average of 19.1 (SD 21.2) videos, responded to 1.5 (SD 2.4) prompts, and used the app for 5.3 (SD 2.7) days weekly. Pre-post analyses revealed a significant and clinically meaningful reduction in psychiatric symptom severity (Brief Psychiatric Rating Scale score range 52.3 to 30.9; Brief Symptom Inventory score range 76.4 to 27.9), psychological distress (Talbieh Brief Distress Inventory score range 37.7 to 16.9), shame (Other as Shamer Scale score range 41.9 to 28.5), and stigma (Brief Internalized Stigma of Mental Illness Scale score range 11.8 to 10.3). We recorded a significant reduction in days chained (1.6 to 0.5) and a promising trend for reduction in the days of forced fasting (2.6 to 0.0, P=.06). We did not identify significant pre-post changes in patient-reported working alliance with healers (Working Alliance Inventory), depressive symptom severity (Patient Health Questionnaire-9), quality of life (Lehman Quality of Life Interview for the Mentally Ill), beliefs about medication (Beliefs about Medications Questionnaire-General Harm subscale), or other human rights abuses. No major side effects, health and safety violations, or serious adverse events occurred over the course of the trial. Conclusions The M&M intervention proved to be feasible, acceptable, safe, and clinically promising. Preliminary findings suggest that the M-Healer toolkit may have shifted healers' behaviors at the prayer camp so that they commit fewer human rights abuses.
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Affiliation(s)
- Dror Ben-Zeev
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Anna Larsen
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Dzifa A Attah
- Department of Psychiatry, University of Ghana, Accra, Ghana
| | | | - Alexa Beaulieu
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Seth M Asafo
- Department of Psychiatry, University of Ghana, Accra, Ghana
| | | | - Arya Kadakia
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | | | - Sammy Ohene
- Department of Psychiatry, University of Ghana, Accra, Ghana
| | - Lola Kola
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Kevin Hallgren
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jaime Snyder
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Pamela Y Collins
- Department of Mental Health, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, United States
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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.
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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.
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Mathias K, Bunkley N, Pillai P, Ae-Ngibise KA, Kpobi L, Taylor D, Joag K, Rawat M, Hammoudeh W, Mitwalli S, Kagee A, van Rensburg A, Bemme D, Burgess RA, Jain S, Kienzler H, Read UM. Inverting the deficit model in global mental health: An examination of strengths and assets of community mental health care in Ghana, India, Occupied Palestinian territories, and South Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002575. [PMID: 38437223 PMCID: PMC10911620 DOI: 10.1371/journal.pgph.0002575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/08/2024] [Indexed: 03/06/2024]
Abstract
Global mental health [GMH] scholarship and practice has typically focused on the unmet needs and barriers to mental health in communities, developing biomedical and psychosocial interventions for integration into formal health care platforms in response. In this article, we analyse four diverse settings to disrupt the emphasises on health system weaknesses, treatment gaps and barriers which can perpetuate harmful hierarchies and colonial and medical assumptions, or a 'deficit model'. We draw on the experiential knowledge of community mental health practitioners and researchers working in Ghana, India, the Occupied Palestinian Territory and South Africa to describe key assets existing in 'informal' community mental health care systems and how these are shaped by socio-political contexts. These qualitative case studies emerged from an online mutual learning process convened between 39 academic and community-based collaborators working in 24 countries who interrogated key tenets to inform a social paradigm for global mental health. Bringing together diverse expertise gained from professional practice and research, our sub-group explored the role of Community Mental Health Systems in GMH through comparative country case studies describing the features of community care beyond the health and social care system. We found that the socio-political health determinants of global economic structures in all four countries exert significant influence on local community health systems. We identified that key assets across sites included: family and community care, and support from non-profit organisations and religious and faith-based organisations. Strengthening community assets may promote reciprocal relationships between the formal and informal sectors, providing resources for support and training for communities while communities collaborate in the design and delivery of interventions rooted in localised expertise. This paper highlights the value of informal care, the unique social structures of each local context, and resources within local communities as key existing assets for mental health.
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Affiliation(s)
- Kaaren Mathias
- Faculty of Health, University of Canterbury New Zealand, Christchurch New Zealand and Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, New Delhi, India
| | - Noah Bunkley
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Pooja Pillai
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, New Delhi, India
| | | | - Lily Kpobi
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Dan Taylor
- Executive Secretary, Mind Freedom, Accra, Ghana
| | - Kaustubh Joag
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Meenal Rawat
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, New Delhi, India
- School of Political and Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Weeam Hammoudeh
- Institute of Community and Public Health, Birzeit University, West Bank, Occupied Palestinian Territories
| | - Suzan Mitwalli
- Institute of Community and Public Health, Birzeit University, West Bank, Occupied Palestinian Territories
| | - Ashraf Kagee
- Stellenbosch University, Stellenbosch, South Africa
| | - Andre van Rensburg
- Centre for Rural Health, University of Kwazulu-Natal, Durban, South Africa
| | - Dörte Bemme
- Centre of Society and Mental health, King’s College London, London, United Kingdom
| | - Rochelle A. Burgess
- Institute for Global Health, University College London, London, United Kingdom
| | - Sumeet Jain
- School of Political and Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Hanna Kienzler
- Department of Global Health and Social Medicine and Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Ursula M. Read
- Warwick Medical School, University of Warwick, Warwick, United Kingdom
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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.
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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
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Donnir GM, Asare-Doku W. Prevalence of psychiatric disorders among sentenced prisoners in a medium security prison in Ghana: Implications for mental health assessment and service. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2023; 33:354-368. [PMID: 37547935 DOI: 10.1002/cbm.2307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Extant literature has shown that there is a higher prevalence of mental disorders among prisoners compared to the general population. These findings have, however, mostly been from high-income and westernised cultures. In Ghana, little is known about the extent of psychiatric disorders among prisoners, as is consistent with the dearth of scholarly work in low and middle-income countries. AIMS Our aim was to determine the prevalence of common mental disorders among sentenced prisoners in the second largest prison in Ghana. METHODS A cross-sectional survey research design was used in one prison. The Mini International Neuro-Psychiatric Interview questionnaire was used to collect data from men and women serving prison sentences who volunteered for the study. Socio-demographic characteristics and criminal history data were collected using a questionnaire designed by the researchers. RESULTS Five hundred prisoners participated. Nearly half (246, 49.8%) had at least one psychiatric disorder. The most prevalent disorders were major depression and a range of anxiety disorders (145, 29%, 132, 26% respectively). A smaller proportion recorded high scores on the antisocial personality disorder scale (13%); just 50 (10%) reported using substances in the 12 months before interview, but this is a minimum estimate of such problems as many were already in prison during that time. None of these prisoners, regardless of disorder, had been screened, diagnosed, or treated in prison. CONCLUSIONS This study contributes to the gap in scholarly literature in low- and middle-income countries on psychiatric disorders in the prison population. It will be important to explore further the extent to which the internationally recognised screening tools used led to under-estimation of psychiatric disorders. The findings are of immediate practical importance nationally as they highlight the need to implement reforms anticipated by the new mental health legislation of 2012 and strategies for interagency working to improve health services and their uptake in the criminal justice system.
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Affiliation(s)
- Gordon M Donnir
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Department of Psychiatry, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Winifred Asare-Doku
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Sundararajan R, Ponticiello M, Birch G, Nuwagaba G, Alaiku R, Nansera D, Mwanga-Amumpaire J, Muyindike W. Adaption and pilot testing of a lay HIV supporter program for traditional healers: a mixed methods study in rural Uganda. Implement Sci Commun 2023; 4:87. [PMID: 37501077 PMCID: PMC10373386 DOI: 10.1186/s43058-023-00469-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Half of people living with HIV (PLWH) in sub-Saharan Africa default from care within two years. In Uganda, and across sub-Saharan Africa, traditional healers (TH) are ubiquitous and often serve as the first line of health care. We hypothesized that with lay support training, TH could support relinkage to HIV care and ART adherence among rural Ugandan PLWH who have defaulted from HIV care. METHODS Following the ADAPT-ITT framework, we adapted an evidence-based layperson HIV support program from South Africa for delivery by Ugandan TH. The ADAPT-ITT framework consists of (1) Assessment of needs; (2) Deciding which evidence-based interventions to adapt; (3) Adaptation of interventions; (4) Production of drafted adapted interventions; (5) Topical expert feedback; (6) Integration of expert feedback; (7) Training personnel; and (8) Testing the adapted intervention. The Testing phase was completed via a pilot mixed methods prospective cohort study. The study population included 12 TH practicing in Mbarara Township and 20 adult PLWH with suboptimal ART adherence (CASE adherence index score < 10) who received care from a participating TH and who resided in Mbarara Township. Primary outcome was re-linkage to HIV care within 14 days. Secondary outcomes were ART re-initiation, ART adherence, retention in care after 9 months, and implementation measures. Qualitative interviews were conducted with all participants. RESULTS Data from the Assessment phase indicated that logistical challenges played an important role in disengagement from care among PLWH who receive care from TH, notably geographical distance to clinics and transportation costs. Additionally, HIV-related stigma and lack of social support were identified as barriers to entering and remaining in HIV care. Two core elements of the intervention were identified during the Production phase: (1) TH facilitating rapid re-linkage to HIV care and (2) TH provision of psychosocial support. In the pilot study phase, baseline median CASE adherence score was 3; only 5% of PLWH were adherent to ART via 4-day recall. The TH-delivered support achieved 100% linkage and ART initiation within 14 days, 95% ART adherence, and 100% of PLWH were retained in HIV care after 9 months. CONCLUSIONS The ADAPT-ITT framework successfully guided the adaption of a community health worker-delivered intervention for delivery by TH. TH successfully facilitated re-linkage to HIV care, support ART adherence, and retention in care for PLWH when trained as part of a lay support person program. Future studies are needed to evaluate scale-up and long-term impact.
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Affiliation(s)
- Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA.
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA.
| | | | | | | | - Rinu Alaiku
- Weill Cornell Medical College, Weill Cornell Medicine, New York, USA
| | - Denis Nansera
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Juliet Mwanga-Amumpaire
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Winnie Muyindike
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
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Ogunwale A, Fadipe B, Bifarin O. Indigenous mental healthcare and human rights abuses in Nigeria: The role of cultural syntonicity and stigmatization. Front Public Health 2023; 11:1122396. [PMID: 37427251 PMCID: PMC10327483 DOI: 10.3389/fpubh.2023.1122396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/23/2023] [Indexed: 07/11/2023] Open
Abstract
Background Indigenous mental healthcare using traditional non-western methods termed "unorthodox approaches" has been observed in Nigeria historically. This has been largely due to a cultural preference for spiritual or mystical rather than biomedical formulations of mental disorder. Yet, there have been recent concerns about human rights abuses within such treatment settings as well as their tendency to perpetuate stigmatization. Aim The aim of this review was to examine the cultural framework for indigenous mental healthcare in Nigeria, the role of stigmatization in its utilization and interrogate the issues of human rights abuses within a public mental health context. Methods This is a non-systematic narrative review of published literature on mental disorders, mental health service utilization, cultural issues, stigma, and indigenous mental healthcare. Media and advocacy reports related to human rights abuses in indigenous mental health treatment settings were also examined. International conventions on human rights and torture, national criminal legislation, constitutional provisions on fundamental rights and medical ethics guidelines relevant to patient care within the country were examined in order to highlight provisions regarding human rights abuses within the context of care. Results Indigenous mental healthcare in Nigeria is culturally syntonic, has a complex interaction with stigmatization and is associated with incidents of human rights abuses especially torture of different variants. Three systemic responses to indigenous mental healthcare in Nigeria include: orthodox dichotomization, interactive dimensionalization, and collaborative shared care. Conclusions: Indigenous mental healthcare is endemic in Nigeria. Orthodox dichotomization is unlikely to produce a meaningful care response. Interactive dimensionalization provides a realistic psychosocial explanation for the utilization of indigenous mental healthcare. Collaborative shared care involving measured collaboration between orthodox mental health practitioners and indigenous mental health systems offers an effective as well as cost-effective intervention strategy. It reduces harmful effects of indigenous mental healthcare including human rights abuses and offers patients a culturally appropriate response to their problems.
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Affiliation(s)
- Adegboyega Ogunwale
- Neuropsychiatric Hospital, Aro, Abeokuta, Abeokuta, Nigeria
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | - Oladayo Bifarin
- School of Nursing and Advanced Practice, Faculty of Health, Liverpool John Moores University, Liverpool, North West England, United Kingdom
- Mersey Care NHS Foundation Trust, Liverpool, United Kingdom
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11
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Ayinde OO, Fadahunsi O, Kola L, Malla LO, Nyame S, Okoth RA, Cohen A, Appiah-Poku J, Othieno CJ, Seedat S, Gureje O. Explanatory models, illness, and treatment experiences of patients with psychosis using the services of traditional and faith healers in three African countries: Similarities and discontinuities. Transcult Psychiatry 2023; 60:521-536. [PMID: 34913379 DOI: 10.1177/13634615211064370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
As part of formative studies to design a program of collaborative care for persons with psychosis, we explored personal experience and lay attributions of illness as well as treatment among persons who had recently received care at traditional and faith healers' (TFHs) facilities in three cultural groups in Sub-Saharan Africa. A purposive sample of 85 individuals in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya) were interviewed. Data was inductively explored for themes and analysis was informed by the Framework Method. Across the three sites, illness experiences featured suffering and disability in different life domains. Predominant causal attribution was supernatural, even when biological causation was also acknowledged. Prayer and rituals, steeped in traditional spiritual beliefs, were prominent both in traditional faith healing settings as well as those of Christianity and Islam. Concurrent or consecutive use of TFHs and conventional medical services was common. TFHs provided services that appear to meet the therapeutic goals of their patients even when harmful treatment practices were employed. Cultural and linguistic differences did not obscure the commonality of a core set of beliefs and practices across these three groups. This similarity of core worldviews across diverse cultural settings means that a collaborative approach designed in one cultural group would, with adaptations to reflect differences in context, be applicable in another cultural group. Studies of patients' experience of illness and care are useful in designing and implementing collaborations between biomedical and TFH services as a way of scaling up services and improving the outcome of psychosis.
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Affiliation(s)
| | | | | | | | | | | | - Alex Cohen
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine
| | | | | | - Soraya Seedat
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine
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12
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Kong C, Campbell M, Kpobi L, Swartz L, Atuire C. The hermeneutics of recovery: Facilitating dialogue between African and Western mental health frameworks. Transcult Psychiatry 2023; 60:428-442. [PMID: 33761813 DOI: 10.1177/13634615211000549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The widespread use of faith-based and traditional healing for mental disorders within African contexts is well known. However, normative responses tend to fall within two camps: on one hand, those oriented towards the biomedical model of psychiatry stress the abuses and superstition of such healing, whilst critics adopting a more 'local' perspective have fundamentally challenged the universalist claims of biomedical diagnostic categories and psychiatric treatments. What seemingly emerges is a dichotomy between those who endorse more 'universalist' or 'relativist' approaches as an analytical lens to the challenges of the diverse healing strands within African contexts. In this article, we draw upon the resources of philosophy and existing empirical work to challenge the notion that constructive dialogue cannot be had between seemingly incommensurable healing practices in global mental health. First, we suggest the need for much-needed conceptual clarity to explore the hermeneutics of meaning, practice, and understanding, in order to forge constructive normative pathways of dialogue between seemingly incommensurable values and conceptual schemas around mental disorder and healing. Second, we contextualise the complex motives to emphasise difference amongst health practitioners within a competitive healing economy. Finally, we appeal to the notion of recovery as discovery as a fruitful conceptual framework which incorporates dialogue, comparative evaluation, and cross-cultural enrichment across divergent conceptualisations of mental health.
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13
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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.
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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
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14
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Osafo J, Asare-Doku W, Akotia CS. Exploring the role of religion in the recovery experiences of suicide attempt survivors in Ghana. BMC Psychiatry 2023; 23:219. [PMID: 36997934 PMCID: PMC10064783 DOI: 10.1186/s12888-023-04674-3] [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] [Received: 07/20/2022] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Religion performs a doubled edged role in a suicide crisis. On the one hand, it elicits empathic responses towards suicidal persons. On the other, it condemns and shames them. Although there is evidence that religion promotes better health and general wellbeing, little attention has been given to its role in recovery, especially after a suicide attempt. The current study explored how religion facilitated recovery among suicide attempt survivors. METHODS Using a semi-structured interview guide, we interviewed suicide attempt survivors who had attended a psychiatric unit. Thematic analysis was used to analyse the data. RESULTS Ten suicide attempters were interviewed, six females and four males. Three major themes were identified: Reasons in context, Religion in the recovery process and Renewed commitment to religious rituals/practices. CONCLUSIONS The role of religion in suicide prevention as a resource, is a complex one. Suicide preventionists need to carefully guide and gauge their prevention efforts in context where religion is rife to provide suicide attempt survivors the most effective religious resource in their recovery trajectory.
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Affiliation(s)
- Joseph Osafo
- Department of Psychology, University of Ghana, Legon, Ghana.
- Centre for Suicide and Violence Research-CSVR, Ghana, CSVR, Accra, Ghana.
| | - Winifred Asare-Doku
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Centre for Suicide and Violence Research-CSVR, Ghana, CSVR, Accra, Ghana
| | - Charity S Akotia
- Department of Psychology, University of Ghana, Legon, Ghana
- Centre for Suicide and Violence Research-CSVR, Ghana, CSVR, Accra, Ghana
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15
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Ambikile JS, Iseselo MK. Challenges to the provision of home care and support for people with severe mental illness: Experiences and perspectives of patients, caregivers, and healthcare providers in Dar es Salaam, Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001518. [PMID: 36963044 PMCID: PMC10021743 DOI: 10.1371/journal.pgph.0001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/02/2023] [Indexed: 06/18/2023]
Abstract
A balance between hospital-based and community-based services is needed to effectively provide mental health services for people with mental illness. As an essential part of community mental health services, home-based care plays an important role in meeting patients' needs, and should, therefore, be appropriately provided. To achieve this, there is a need to understand the challenges faced and take relevant actions to address them. This study aimed to explore challenges to home care and support for people with mental illness in Temeke district, Dar es Salaam. We used a descriptive qualitative study approach to explore challenges to home care and support for people with mental illness among patients, their caregivers, and healthcare providers. The purposeful sampling method was used to recruit participants at Temeke hospital, data was collected using in-depth interviews and focus group discussions, and analysis was performed using a content analysis framework. Four main themes highlighting challenges encountered in the provision of home care and support for individuals with mental illness were revealed. They include poor understanding of mental illness, abandonment of patients' care responsibilities, disputes over preferred treatment, and lack of outreach services for mental health. Participants also provided suggestions to improve home care and support for people with mental illness. Home care for people with mental illness is affected by poor knowledge of the mental illness, social stigma, and lack of outreach visits. There is a need for the provision of health education regarding mental illness, stigma reduction programs, and funding and prioritization for outreach home visits to improve home care and support for people with mental illness. Further research is needed to determine the magnitude of these challenges and factors that can facilitate the provision of support in similar settings.
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Affiliation(s)
- Joel Seme Ambikile
- Department of Clinical Nursing, Muhimbili University of Health & Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Masunga K. Iseselo
- Department of Clinical Nursing, Muhimbili University of Health & Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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16
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Pigeon-Gagné É, Vigu T, Kadio K, Bonnet E, Ridde V. Explanatory models of psychotic-like experiences in rural Burkina Faso: A qualitative study among indigents and their community. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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17
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Shoib S, Ali BE, Armiya'u AY, Swed S, Saleem SM, Jain N. Role of faith healers and spiritual leaders in suicide prevention. Int J Soc Psychiatry 2022; 69:805-807. [PMID: 36151777 DOI: 10.1177/00207640221111266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sheikh Shoib
- Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Srinagar, India
| | | | - Aishatu Yusha'u Armiya'u
- Department of Psychiatry, Forensic Unit, Jos University Teaching Hospital, Plateau State, Nigeria
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Syria
| | | | - Nikhil Jain
- Independent Researcher, Madhya Pradesh, India
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18
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Factors associated with noncompliance to diabetes medication in a rapidly urbanizing region in Ghana: a mixed-methods study. Porto Biomed J 2022; 7:e148. [PMID: 35801220 PMCID: PMC9257306 DOI: 10.1097/j.pbj.0000000000000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022] Open
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19
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Moro MF, Carta MG, Gyimah L, Orrell M, Amissah C, Baingana F, Kofie H, Taylor D, Chimbar N, Coffie M, Cole C, Ansong J, Ohene SA, Tawiah PE, Atzeni M, D’Oca S, Gureje O, Funk M, Drew N, Osei A. A nationwide evaluation study of the quality of care and respect of human rights in mental health facilities in Ghana: results from the World Health Organization QualityRights initiative. BMC Public Health 2022; 22:639. [PMID: 35366832 PMCID: PMC8976418 DOI: 10.1186/s12889-022-13102-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background In 2012, Ghana ratified the United Nations Convention on the Rights of Persons with Disabilities and enacted a Mental Health Act to improve the quality of mental health care and stop human rights violations against people with mental health conditions. In line with these objectives, Ghanaian stakeholders collected data on the quality of mental health services and respect for human rights in psychiatric facilities to identify challenges and gather useful information for the development of plans aimed to improve the quality of the services offered. This study aimed to assess psychiatric facilities from different Ghanaian regions and provide evidence on the quality of care and respect of human rights in mental health services. Methods Assessments were conducted by independent visiting committees that collected data through observation, review of documentation, and interviews with service users, staff, and carers, and provided scores using the World Health Organization QualityRights Toolkit methodology. Results This study revealed significant key challenges in the implementation of the United Nations Convention on the Rights of Persons with Disabilities principles in Ghanaian psychiatric services. The rights to an adequate standard of living and enjoyment of the highest attainable standard of health were not fully promoted. Only initial steps had been taken to guarantee the right to exercise legal capacity and the right to personal liberty and security. Significant gaps in the promotion of the right to live independently and be included in the community were identified. Conclusions This study identifies shortcomings and critical areas that the Ghanaian government and facilities need to target for implementing a human rights-based approach in mental health and improve the quality of mental health care throughout the country.
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20
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Winifred AD, Jane RL, Brian K, Amponsah-Tawiah K, Carole J. Mental health and workplace factors: comparison of the Ghanaian and Australian mining industry. BMC Health Serv Res 2022; 22:322. [PMID: 35272678 PMCID: PMC8908671 DOI: 10.1186/s12913-022-07712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background Mining is a global industry and contributes significantly to international economies. This study seeks to compare the patterns of psychological distress, job demand-control, and associated characteristics between two countries (Australia/Ghana) to increase understanding of cross-cultural factors relevant to mental health in this industry. Method A cross-sectional study design was used. Eight coal mines in Australia and five gold mines in Ghana. A total of 2622 mineworkers participated in this study. Kessler Psychological Distress Scale (K10), Job Content Questionnaire (JCQ), Alcohol Use Disorders Identification Test (AUDIT), the Berkman-Syme Social Network Index (SNI) and help-seeking questionnaire. Results Ghanaian mineworkers reported increased psychological distress compared to Australian mineworkers; Job demands outweighed control among Ghanaian mineworkers but was associated with lower risk of psychological distress compared to Australian mineworkers; Ghanaian mineworkers were significantly less likely to drink alcohol at risky levels but this was associated with higher psychological distress; Increased social network was associated with decreased psychological distress for both countries. Conclusions These findings identify cultural and geographical differences in the socio-demographics, workplace factors, psychological distress, and alcohol use in both countries. Cross-cultural occupational workplace factors and mental health issues are highlighted. Potential workplace interventions applicable in comparable settings are recommended.
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Affiliation(s)
- Asare-Doku Winifred
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia. .,Centre for Resources Health and Safety, The University of Newcastle, Callaghan, NSW, 2308, Australia. .,Centre for Brain and Mental Health Research, The University of Newcastle, Callaghan, NSW, 2308, Australia. .,National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia.
| | - Rich Louise Jane
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia.,Centre for Brain and Mental Health Research, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Kelly Brian
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia.,Centre for Resources Health and Safety, The University of Newcastle, Callaghan, NSW, 2308, Australia.,Centre for Brain and Mental Health Research, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Kwesi Amponsah-Tawiah
- Department of Organisation & Human Resource Management, University of Ghana Business School, Legon-Accra, Ghana
| | - James Carole
- Centre for Resources Health and Safety, The University of Newcastle, Callaghan, NSW, 2308, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia
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21
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Dean L, Theobald S, Nallo G, Bettee A, Kollie K, Tolhurst R. A syndemic born of war: Combining intersectionality and structural violence to explore the biosocial interactions of neglected tropical diseases, disability and mental distress in Liberia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000551. [PMID: 36962440 PMCID: PMC10021464 DOI: 10.1371/journal.pgph.0000551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/09/2022] [Indexed: 11/19/2022]
Abstract
The intersections between NTDs, disability, and mental ill-health are increasingly recognised globally. Chronic morbidity resultant from many NTDs, particularly those affecting the skin-including lymphatic filariasis (LF), leprosy, Buruli ulcer (BU) and onchocerciasis-is well known and largely documented from a medicalised perspective. However less is known about the complex biosocial interaction shaping interconnected morbidities. We apply syndemic theory to explain the biosocial relationship between NTDs and mental distress in the context of structural violence in Liberia. By advancing syndemic theory to include intersectional thought, it is apparent that structural violence becomes embodied in different ways through interacting multi-level (macro, meso and micro) processes. Through the use of in-depth qualitative methods, we explore the syndemic interaction of NTDs and mental distress from the vantage point of the most vulnerable and suggest that: 1) the post-conflict environment in Liberia predisposes people to the chronic effects of NTDs as well as other 'generalised stressors' as a consequence of ongoing structural violence; 2) people affected by NTDs are additionally exposed to stigma and discrimination that cause additional stressors and synergistically produce negative health outcomes in relation to NTDs and mental distress; and 3) the impact and experience of consequential syndemic suffering is shaped by intersecting axes of inequity such as gender and generation which are themselves created by unequal power distribution across multiple systems levels. Bringing together health systems discourse, which is focused on service integration and centred around disease control, with syndemic discourse that considers the biosocial context of disease interaction offers new approaches. We suggest that taking a syndemic-informed approach to care in the development of people-centred health systems is key to alleviating the burden of syndemic suffering associated with NTDs and mental distress currently experienced by vulnerable populations in resource-limited settings.
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Affiliation(s)
- Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Gartee Nallo
- University of Liberia Pacific Institute for Research and Evaluation, Monrovia, Monsterrado, Liberia
| | - Anthony Bettee
- Neglected Tropical Disease Programme, Ministry of Health, Government of Liberia, Monrovia, Monsterrado, Liberia
| | - Karsor Kollie
- Neglected Tropical Disease Programme, Ministry of Health, Government of Liberia, Monrovia, Monsterrado, Liberia
| | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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22
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Pullen SJ, Herman AR, Lange BC, Christian-Brathwaite N, Ulloa M, Kempeh MP, Karnga DG, Fallah MP, Menyongai J, Harris B, Alonso Y, Henderson DC, Borba CP. Towards a better understanding of attitudes and beliefs held by traditional healers and recipients of traditional medicine concerning mental health conditions in post-conflict Liberia: a qualitative investigation. Afr Health Sci 2021; 21:1396-1409. [PMID: 35222605 PMCID: PMC8843300 DOI: 10.4314/ahs.v21i3.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background A better understanding of attitudes and beliefs held by traditional healers and utilizers of traditional medicine concerning mental health conditions in Liberia is important as Liberia seeks to improve its delivery of mental healthcare in the context of scarce resources and recovery from civil war. Methods A qualitative research design was used to collect data from 24 Liberian traditional healers, and 11 utilizers of Liberian traditional medicine. Participants were queried about mental health problems in Liberia, treatments, and attitudes towards modern healthcare. Qualitative data were probed and aggregated using content analysis. Results Mental health problems described by study participants included: Open Mole, African Science, Epilepsy, Depression and Mental Illness (trauma/substance use). Mental health problems were often associated with socioeconomic distress, and participants described their attitudes and beliefs concerning mental healthcare, traditional medicine, and modern healthcare. Conclusion Traditional medicine is an important part of mental healthcare in Africa. Mental illness, social factors, and healthcare access were important problems in Liberia. Mental health problems blended local cultural beliefs with Westernized nosology and social factors. Traditional healer's attitudes towards Western medicine reflected ambivalence. There is a desire for collaboration with ‘modern’ health care providers, but this will require reciprocal trust-building.
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Affiliation(s)
- Samuel J Pullen
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Child and Family Mental Health and Community Psychiatry, Durham, NC.,Johns Hopkins Bloomberg School of Public Health, Baltimore
| | | | - Brittany Cl Lange
- University of Oxford - Department of Social Policy and Intervention, Oxford, England
| | | | - Melissa Ulloa
- New York University Steinhardt School of Culture, Education, and Human Development, 82 Washington Square E, New York, NY 10003
| | - Michael P Kempeh
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, College of Medicine University of Liberia, Monrovia, Liberia, West Africa
| | - Dyujay G Karnga
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, College of Medicine University of Liberia, Monrovia, Liberia, West Africa
| | - Mosoka P Fallah
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, College of Medicine University of Liberia, Monrovia, Liberia, West Africa.,National Public Health Institute of Liberia, Monrovia, Liberia
| | | | - Benjamin Harris
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, College of Medicine University of Liberia, Monrovia, Liberia, West Africa
| | - Yadira Alonso
- Boston University School of Medicine, Department of Psychiatry, Boston Medical Center, Boston, MA
| | - David C Henderson
- Boston University School of Medicine, Department of Psychiatry, Boston Medical Center, Boston, MA
| | - Christina Pc Borba
- Boston University School of Medicine, Department of Psychiatry, Boston Medical Center, Boston, MA
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23
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Adu P, Jurcik T, Dmitry G. Mental health literacy in Ghana: Implications for religiosity, education and stigmatization. Transcult Psychiatry 2021; 58:516-531. [PMID: 34165347 DOI: 10.1177/13634615211022177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research on Mental Health Literacy (MHL) has been growing internationally. However, the beliefs and knowledge of Ghanaians about specific mental disorders have yet to be explored. This vignette study was conducted to explore the relationships between religiosity, education, stigmatization and MHL among Ghanaians using a sample of laypeople (N = 409). The adapted questionnaire presented two vignettes (depression and schizophrenia) about a hypothetical person. The results revealed that more participants were able to recognize depression (47.4%) than schizophrenia (15.9%). Religiosity was not significantly associated with recognition of mental disorders but was positively associated with both social and personal stigma for depression, and negatively associated with personal and perceived stigma for schizophrenia. Moreover, education was found to be positively associated with disorder recognition, and negatively with perceived stigma. Finally, perceived stigma was positively associated with disorder recognition, whereas personal stigma for schizophrenia related negatively to recognition of mental disorders. In conclusion, education but not religiosity predicted identification accuracy, but both predictors were associated with various forms of stigma. Findings from this study have implications for MHL and anti-stigma campaigns in Ghana and other developing countries in the region.
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Affiliation(s)
- Peter Adu
- 68192National Research University Higher School of Economics, Moscow, Russia
| | - Tomas Jurcik
- 68192National Research University Higher School of Economics, Moscow, Russia
| | - Grigoryev Dmitry
- 68192National Research University Higher School of Economics, Moscow, Russia
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24
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Ben-Zeev D, Meller S, Snyder J, Attah DA, Albright L, Le H, Asafo SM, Collins PY, Ofori-Atta A. 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. JMIR Ment Health 2021; 8:e28526. [PMID: 34255712 PMCID: PMC8285751 DOI: 10.2196/28526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/19/2021] [Accepted: 05/06/2021] [Indexed: 01/20/2023] Open
Abstract
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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Affiliation(s)
- Dror Ben-Zeev
- BRiTE Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Suzanne Meller
- BRiTE Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jaime Snyder
- Information School, University of Washington, Seattle, WA, United States
| | - Dzifa A Attah
- Department of Psychiatry, University of Ghana, Legon, Ghana
| | - Liam Albright
- Information School, University of Washington, Seattle, WA, United States
| | - Hoa Le
- Information School, University of Washington, Seattle, WA, United States
| | - Seth M Asafo
- Department of Psychiatry, University of Ghana, Legon, Ghana
| | - Pamela Y Collins
- Department of Global Health, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Barrow LFM, Faerden A. Barriers to accessing mental health services in The Gambia: patients’/family members’ perspectives. BJPsych Int 2021; 19:38-41. [PMID: 35532422 PMCID: PMC9046828 DOI: 10.1192/bji.2021.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/01/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
This paper concerns mental health services in The Gambia. It describes local concepts, experiences and knowledge about mental illness and the implications of such beliefs and attitudes for access to mental health services. A pretested questionnaire and interview guide were administered to a sample of patients/family members. Barriers to accessing mental health services were identified. These included beliefs about the causes of mental illness; family decision-making; the scarcity and high cost of services. Obtaining access to mental health services in The Gambia is currently challenging. Importantly, increased community and family education about the causes and treatment of mental illnesses will be required to address these issues.
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Ngobe A, Semenya S, Sodi T. Psychological ailments and their treatment protocols: a case study of Swati traditional healers in Mpumalanga Province, South Africa. Afr Health Sci 2021; 21:884-895. [PMID: 34795748 PMCID: PMC8568258 DOI: 10.4314/ahs.v21i2.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Evidence suggests that South African traditional healers (THs) treat various mental complaints. However, there is little literature on Swati THs' accounts on this subject. The current study therefore, sought to address this gap. METHODS Data was gathered using qualitative research methods, namely semi-structured interviews with 10 purposely sampled Swati THs practicing in the Kanyamazane peri-urban township (Mpumalanga Province, South Africa). Data was thematically analysed. RESULTS Results showed that THs treat seven psychological aliments, viz. adjustment disorders, depression, mental illness due to ancestral calling, mental illness due to bewitchment, mental illness due to breaking of taboos, psychotic disturbance and substance induced mental illness. Generally, an integrated treatment protocol was utilised by THs to treat and manage these disorders. Most of these procedures are acceptable from either folkloric or scientific viewpoint, and have demonstrated certain level of efficacy in treating mental illness. CONCLUSION Taken together, the evidence presented indicates that Swati THs use different traditional methods to manage various mental complaints. In doing so, they carry a large share of the community caseload for mental health, whilst admitting patients in their homes for extended periods of time, and also referring some (patients) for additional care within the Western health sector.
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Affiliation(s)
- Anastasia Ngobe
- University of Limpopo, Research Administration and Development
| | - Sebua Semenya
- University of Limpopo, Research Administration and Development
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Nyame S, Adiibokah E, Mohammed Y, Doku VC, Othieno C, Harris B, Gureje O, Soraya S, Appiah-Poku J. Perceptions of Ghanaian traditional health practitioners, primary health care workers, service users and caregivers regarding collaboration for mental health care. BMC Health Serv Res 2021; 21:375. [PMID: 33892697 PMCID: PMC8063486 DOI: 10.1186/s12913-021-06313-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In low- and middle-income countries, the paucity of conventional health services means that many people with mental health problems rely on traditional health practitioners (THPs). This paper examines the possibility of forging partnerships at the Primary Health Care (PHC) level in two geopolitical regions of Ghana, to maximize the benefits to both health systems. METHODS The study was a qualitative cross-sectional survey. Eight (8) focus group discussions (FGDs) were conducted between February and April 2014. The views of THPs, PHC providers, service users (i.e. patients) and their caregivers, on the perceived benefits, barriers and facilitators of forging partnerships were examined. A thematic framework approach was employed for analysis. RESULTS The study revealed that underlying the widespread approval of forging partnerships, there were mutual undertones of suspicion. While PHC providers were mainly concerned that THPs may incur harms to service users (e.g., through delays in care pathways and human rights abuses), service users and their caregivers highlighted the failure of conventional medical care to meet their healthcare needs. There are practical challenges to these collaborations, including the lack of options to adequately deal with human rights issues such as some patients being chained and exposed to the vagaries of the weather at THPs. There is also the issue of the frequent shortage of psychotropic medication at PHCs. CONCLUSION Addressing these barriers could enhance partnerships. There is also a need to educate all providers, which should include sessions clarifying the potential value of such partnerships.
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Affiliation(s)
- Solomon Nyame
- Kintampo Health Research Centre, Box 200, Kintampo, Bono East Region, Ghana.
| | | | - Yasmin Mohammed
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | | | - John Appiah-Poku
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Muhorakeye O, Biracyaza E. Exploring Barriers to Mental Health Services Utilization at Kabutare District Hospital of Rwanda: Perspectives From Patients. Front Psychol 2021; 12:638377. [PMID: 33828506 PMCID: PMC8019821 DOI: 10.3389/fpsyg.2021.638377] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Abstract
Barriers to mental health interventions globally remain a health concern; however, these are more prominent in low- and middle-income countries (LMICs). The barriers to accessibility include stigmatization, financial strain, acceptability, poor awareness, and sociocultural and religious influences. Exploring the barriers to the utilization of mental health services might contribute to mitigating them. Hence, this research aims to investigate these barriers to mental health service utilization in depth at the Kabutare District Hospital of the Southern Province of Rwanda. The qualitative approach was adopted with a cross-sectional study design. The participants were patients with mental illnesses seeking mental health services at the hospital. Ten interviews were conducted in the local language, recorded, and transcribed verbatim and translated by the researchers. Thematic analysis was applied to analyze the data collected. The results revealed that the most common barriers are fear of stigmatization, lack of awareness of mental health services, sociocultural scarcity, scarcity of financial support, and lack of geographical accessibility, which limit the patients to utilize mental health services. Furthermore, it was revealed that rural gossip networks and social visibility within the communities compounded the stigma and social exclusion for patients with mental health conditions. Stigmatization should be reduced among the community members for increasing their empathy. Then, the awareness of mental disorders needs to be improved. Further research in Rwanda on the factors associated with low compliance to mental health services with greater focus on the community level is recommended.
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Affiliation(s)
- Oliviette Muhorakeye
- Department of Clinical Psychology, School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda
| | - Emmanuel Biracyaza
- Department of Community Health, School of Public Health, University of Rwanda, Butare, Rwanda.,Sociotherapy Programme, Prison Fellowship Rwanda (PFR), Member of Prison Fellowship International, Kigali, Rwanda
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Demissie M, Hanlon C, Ng L, Fekadu A, Mayston R. Why doesn't God say "enough"? Experiences of living with bipolar disorder in rural Ethiopia. Soc Sci Med 2021; 270:113625. [PMID: 33373775 DOI: 10.1016/j.socscimed.2020.113625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/04/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
RATIONALE Little is known about the specific experience people living with bipolar disorder in rural, low resource settings, where conditions that disrupt normal social interactions are often highly stigmatized and evidence-based treatments are rare. OBJECTIVE To explore illness experience, coping strategies, help-seeking practices, and consequences of illness among people with bipolar disorder (PBD) and their family members in rural Ethiopia as an initial step for developing psychosocial intervention grounded by the experiences of PBD. METHOD A qualitative methods using in-depth interviews were carried out with 27 individuals (15 PBD and 12 caregivers). The participants were identified on the basis of previous community-based research among people with severe mental illness. Interviews were carried out in Amharic, audio-recorded, transcribed, and translated into English. Data were analyzed using thematic analysis. Our approach was informed by phenomenological theory. RESULT Three major themes emerged: expressions and experiences of illness, managing self and living with otherness, and the costs of affliction. PBD and caregivers were concerned by different forewarnings of illness. Stigma and social exclusion were entwined in a vicious cycle that shaped both illness experience and the economic health and social life of the household. Nonetheless, PBD and caregivers learned from their experiences, developed coping strategies, and sought relief from trusted relationships, spirituality, and medication. CONCLUSION Our findings suggest that psychosocial intervention could be used to strengthen existing resources, in order to improve the lives of PBD and their family members. However, pervasive stigma may be a barrier to group and peer support approaches.
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Affiliation(s)
- Mekdes Demissie
- Department of Psychiatry, Addis Ababa University, Ethiopia; School of Nursing and Midwifery, College of Health and medical Sciences, Haramaya University, Ethiopia.
| | - Charlotte Hanlon
- Department of Psychiatry, Addis Ababa University, Ethiopia; Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research, King's College London, UK
| | - Lauren Ng
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Abebaw Fekadu
- Department of Psychiatry, Addis Ababa University, Ethiopia; Centre for Innovative Drug Development and Therapeutic Studies for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia; Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK; Center for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, UK
| | - Rosie Mayston
- Global Health & Social Medicine/King's Global Health Institute, King's College London, NE Wing Bush House, 30 Aldwych, London WC2B 4BJ, UK
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Essien B, Asamoah MK. Reviewing the Common Barriers to the Mental Healthcare Delivery in Africa. JOURNAL OF RELIGION AND HEALTH 2020; 59:2531-2555. [PMID: 32691189 DOI: 10.1007/s10943-020-01059-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The current paper sought to thematically present common challenges associated with mental healthcare services in Africa. We largely limited our search for literature materials to studies published from 2003 to 2019 in African countries from which the findings showed that there are common challenges confronting mental healthcare services in Africa. The challenges include: inadequate mental healthcare facilities, funding constraints, shortage of professional healthcare workers, inadequate training and development scheme for mental health workers and weak mental healthcare policies. Implications for policy and practice are disclosed and recommendations are stated to trigger actions to remedy the situation. This information is beneficial for researchers, policymakers, mental healthcare providers and community members who are interested in mental healthcare issues. It was concluded that in order for Africa to enjoy successful mental healthcare service, critical and enduring attention must focus on sound and enforceable government policy on mental healthcare service, provision of adequate and regular funding, availability of adequate mental healthcare facilities, provision of training and development facilities for the mental health professionals and collaboration of mental healthcare providers.
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Tuffour I. "There is anointing everywhere": An interpretative phenomenological analysis of the role of religion in the recovery of Black African service users in England. J Psychiatr Ment Health Nurs 2020; 27:352-361. [PMID: 31913535 DOI: 10.1111/jpm.12589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/21/2019] [Accepted: 01/06/2020] [Indexed: 01/04/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Religion plays important role in recovery from mental illness. Religion can have both positive and negative effects on recovery. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: It is conceivable for Black African service users (BASUs) to engage with the mainstream mental health services at the onset of their symptoms. BASUs see mental illness and recovery through the lens of religion. They mostly use Pentecostalism and traditional African healing systems to aid their recovery. The mainstream mental health system and the traditional African healing system exist in harmony for BASUs who are open to simultaneously access both services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a need to recognize that most Black Africans have unique ways of practising their Christianity. Thus, broad changes are needed in the services to support religious coping tailored to the individual persons in their recovery journey. There is a need for service providers and healthcare professionals to integrate Pentecostalism and traditional African healing systems into the recovery processes. It should equally be recognized that such changes could trigger confusion, dilemmas and paradoxes. Service providers and healthcare professionals must build partnership and collaborative working with cultural practitioners and the clergy from the Black African communities to facilitate recovery and address any misunderstandings. ABSTRACT: Introduction Religion is an important impetus for recovery. However, there has been little work examining the role of religion in recovery for Black African service users (BASUs) in England. Aim The aim of this study was to explore how religion influences recovery from mental illness for BASUs in England. Method Twelve Black African service users were purposively selected and interviewed using face-to-face semi-structured interviews. Data were analysed using interpretative phenomenological analysis (IPA). Results The study generates fascinating insights that BASUs views about mental illness and recovery are influenced by Pentecostalism and traditional African healing systems. Discussion The participants' perceptions of their mental illness experiences and recovery which are characterized by the pragmatism of Pentecostalism and cultural beliefs are consistent with what is reported in the literature. Implications for practice The findings of the study show that broad changes are needed to accommodate the religious coping of BASUs in their recovery journey.
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Adams B, Vallières F, Duncan JA, Higgins A, Eaton J. Stakeholder perspectives of Community Mental Health Forums: a qualitative study in Sierra Leone. Int J Ment Health Syst 2020; 14:50. [PMID: 32670401 PMCID: PMC7350667 DOI: 10.1186/s13033-020-00382-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Mental health is the leading cause of disability worldwide. In the wake of both a civil war and an Ebola outbreak, Sierra Leone ranks as one of the lowest ranked countries on the Human Development Index (UNDP. Human Development Report 2015, Work for Human Development. The United Nations Development Programme; 2015). The WHO identified Sierra Leone among its priority countries for the piloting of its Mental Health Gap Action Programme (mhGAP). Aligned to these efforts, CBM and their affiliated partners employed the use of Community Mental Health Forums (CMHFs), facilitated by Mental Health Nurses (MHNs), as a sensitive and practical way of engaging key community stakeholders to discuss and address issues of mental health. This study sought firstly, to identify factors that affect the successful implementation of CMHFs, as identified by programme participants. Second, the study sought to identify what changes participants perceived as having taken place as a result of their participation in CMHFs. Methods 10 MHNs and 52 forum participants were purposely selected to take part in key informant interviews and focus group discussions, conducted across eight districts in Sierra Leone. Interview transcripts were analysed across four rounds of coding, using a mixture of deductive and inductive approaches. Results Results identified three themes, Traditional Beliefs and Culture; Health System; and Inclusive Approaches as affecting the implementation of CMHFs in their districts. Participants further perceived that their participation in the Community Mental Health Forums resulted in changes taking place across the themes of Awareness and beliefs, Behaviours towards people experiencing psychological distress, and as leading to greater Collaboration and cooperation between formal and informal mental health practitioners. Conclusions Results are discussed in the context of the extant literature and a novel framework, that incorporates multiple best practice recommendations and factors which influence the successful implementation of CMHFs is put forward.
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Affiliation(s)
- Ben Adams
- School of Nursing and Midwifery/Trinity Centre for Global Health, Trinity College Dublin and CBM Global, Dublin, Ireland
| | | | | | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine and CBM Global, London, UK
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Gyamfi N, Badu E, Mprah WK, Mensah I. Recovery services and expectation of consumers and mental health professionals in community-based residential facilities of Ghana. BMC Psychiatry 2020; 20:355. [PMID: 32631367 PMCID: PMC7339466 DOI: 10.1186/s12888-020-02768-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/29/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND In the past decades, considerable global attention has been drawn to recovery services that seek to promote the personal recovery journey of consumers with mental illness. However, in most settings, including Ghana, limited empirical studies have attempted to explore, from the perspectives of Mental Health Professionals (MHPs) and consumers, the effectiveness of recovery services and expectation towards the recovery. This study, therefore, explored consumers' and MHPs perspectives concerning recovery services and expectations towards recovery in two community-based residential facilities in Ghana. METHODS A qualitative method, involving in-depth interviews and observations, were used to collect data from 24 participants (5 MHPs and 19 consumers). Thematic analysis was used to analyze the data. RESULTS The study identified three global themes and nine organizing themes. The global themes were recovery services offered to consumers, expectation regarding personal recovery and challenges in achieving recovery. The study found that recovery services were expected to improve the internal and external recovery processes of consumers. The internal recovery process was independent living whilst the external recovery process were management of illness, economic empowerment and social inclusion. Several systemic and consumer-related factors influenced consumers' and MHPs expectation concerning the recovery journey. CONCLUSION The study concludes that the government should prioritize the use of recovery services through policies, financial incentives, infrastructure support, and adequate training of MHPs.
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Affiliation(s)
- Naomi Gyamfi
- grid.9829.a0000000109466120Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana ,grid.1020.30000 0004 1936 7371School of Health, University of New England, Armidale, Australia
| | - Eric Badu
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. .,School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia.
| | - Wisdom Kwadwo Mprah
- grid.9829.a0000000109466120Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Mensah
- Department of Special Education, University of Education, Winneba, Ghana
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Badu E, O’Brien AP, Mitchell R, Osei A. Mediation and moderation effects of health system structure and process on the quality of mental health services in Ghana - structural equation modelling. PLoS One 2020; 15:e0233351. [PMID: 32442192 PMCID: PMC7244180 DOI: 10.1371/journal.pone.0233351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/04/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Incorporating consumers' perspectives into the quality of mental health service measurement is a growing priority among mental health professionals' and policymakers. Despite this, there is limited empirical evidence related to consumer perspectives of quality of mental health services. This study, therefore, aims to measure the mediation and moderation effects of health system structure and process on mental health quality in Ghana. METHODS A random sample of 510 consumers were recruited to complete the Verona Satisfaction Scale (54-items), together with the WHO Disability Assessment Instrument (36 items) using the Redcap application. Confirmatory factor analysis (CFA) and Structural Equation Modelling were used to test the hypothesised theory using STATA 15. RESULTS The CFA showed that the hypothesised model had a good fit to the data. The findings confirmed the hypothesis that the process constructs mediate the relationship between the health system structure and the outcome of mental health services. Specifically, the health system structure had a positive and significant causal relationship with the mediator-process (β = 0.60; p<0.01) and outcome (β = 0.47; p<0.01). Additionally, the mediator-process had a positive causal relationship with the outcome of the mental health services (β = 0.32; p<0.01). Insurance status (β = 0.07; p>0.05) and type of services (β = 0.025; p>0.05) had a positive moderating effect on the relationship between health system structure and outcome but were not significant. CONCLUSION Improvements to mental health system structure and the process could promote the quality of services as experienced by consumers. Government stakeholders are encouraged to accordingly strengthen health systems with the aim of improving the mental health outcomes for consumers.
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Affiliation(s)
- Eric Badu
- School of Nursing and Midwifery, Faculty Health and Medicine, The University of Newcastle, Newcastle, Australia
- * E-mail: ,
| | - Anthony Paul O’Brien
- School Nursing and Midwifery, Faculty Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Rebecca Mitchell
- Macquarie Business School, Macquarie University, Sydney, Australia
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Farley E, Bala HM, Lenglet A, Mehta U, Abubakar N, Samuel J, de Jong A, Bil K, Oluyide B, Fotso A, Stringer B, Cuesta JG, Venables E. 'I treat it but I don't know what this disease is': a qualitative study on noma (cancrum oris) and traditional healing in northwest Nigeria. Int Health 2020; 12:28-35. [PMID: 31504549 PMCID: PMC6964223 DOI: 10.1093/inthealth/ihz066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/06/2019] [Accepted: 06/25/2019] [Indexed: 11/12/2022] Open
Abstract
Background Noma, a neglected disease mostly affecting children, with a 90% mortality rate if untreated, is an orofacial gangrene that disintegrates the tissues of the face in <1 wk. Noma can become inactive with early stage antibiotic treatment. Traditional healers, known as mai maganin gargajiya in Hausa, play an important role in the health system and provide care to noma patients. Methods We conducted 12 in-depth interviews with caretakers who were looking after noma patients admitted at the Noma Children's Hospital and 15 traditional healers in their home villages in Sokoto state, northwest Nigeria. We explored perceptions of noma, relationship dynamics, healthcare practices and intervention opportunities. Interviews were audiorecorded, transcribed and translated. Manual coding and thematic analysis were utilised. Results Traditional healers offered specialised forms of care for specific conditions and referral guidance. They viewed the stages of noma as different conditions with individualised remedies and were willing to refer noma patients. Caretakers trusted traditional healers. Conclusions Traditional healers could play a crucial role in the early detection of noma and the health-seeking decision-making process of patients. Intervention programmes should include traditional healers through training and referral partnerships. This collaboration could save lives and reduce the severity of noma complications.
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Affiliation(s)
- Elise Farley
- Médecins Sans Frontières, Médecins Sans Frontières, Noma Children's Hospital, Mamarun Nufawa, Sokoto, Nigeria Sokoto, Nigeria.,Department of Public Health Medicine, University of Cape Town, Anzio Rd, Observatory, Cape Town, South Africa
| | - Hussaina Muhammad Bala
- Médecins Sans Frontières, Médecins Sans Frontières, Noma Children's Hospital, Mamarun Nufawa, Sokoto, Nigeria Sokoto, Nigeria
| | - Annick Lenglet
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands.,Department of Medical Microbiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Ushma Mehta
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Anzio Rd, Observatory, Cape Town, South Africa
| | - Nura Abubakar
- Médecins Sans Frontières, Médecins Sans Frontières, Noma Children's Hospital, Mamarun Nufawa, Sokoto, Nigeria Sokoto, Nigeria
| | - Joseph Samuel
- Médecins Sans Frontières, Médecins Sans Frontières, Noma Children's Hospital, Mamarun Nufawa, Sokoto, Nigeria Sokoto, Nigeria
| | - Annette de Jong
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands
| | - Karla Bil
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands
| | - Bukola Oluyide
- Médecins Sans Frontières, Médecins Sans Frontières, Noma Children's Hospital, Mamarun Nufawa, Sokoto, Nigeria Sokoto, Nigeria
| | - Adolphe Fotso
- Médecins Sans Frontières, Médecins Sans Frontières, Noma Children's Hospital, Mamarun Nufawa, Sokoto, Nigeria Sokoto, Nigeria
| | - Beverley Stringer
- Médecins Sans Frontières, Lower Ground Floor, Chancery Exchange, 10 Furnival Street, London, UK
| | - Julita Gil Cuesta
- Médecins Sans Frontières-Operational Centre Brussels, Medical Department, 68 Rue de Gasperich, 1617, Luxembourg Operational Research Unit (LuxOR)
| | - Emilie Venables
- Médecins Sans Frontières-Operational Centre Brussels, Medical Department, 68 Rue de Gasperich, 1617, Luxembourg Operational Research Unit (LuxOR).,Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
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Anum A, Washington-Nortey M, Dzokoto V. Strategic planning in LAMIC mental health research: A Ghana case study. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2020.1719621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Adote Anum
- Department of Psychology, University of Ghana, Accra, Ghana
| | | | - Vivian Dzokoto
- Department of African American Studies, Virginia Commonwealth University, Richmond, Virginia, USA
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Sancho TN, Larkin M. “We need to slowly break down this barrier”: understanding the barriers and facilitators that Afro-Caribbean undergraduates perceive towards accessing mental health services in the UK. JOURNAL OF PUBLIC MENTAL HEALTH 2020. [DOI: 10.1108/jpmh-12-2019-0099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Undergraduates are highly susceptible to the development of mental health difficulties. Afro-Caribbean students are particularly vulnerable to the pressures of university yet are less likely than other ethnic groups to receive early intervention. This paper aims to understand the barriers and facilitators that Afro-Caribbean undergraduates perceive towards accessing mental health services in the UK.
Design/methodology/approach
Critical Incident Technique was used as the qualitative method because it explores the critical factors that contribute to or detract from a specific experience. Seventeen Afro-Caribbean undergraduates participated in five focus groups. This involved engaging in a novel psychosocial activity that incorporated vignettes to encourage the identification of barriers and facilitators to service access. The data were analysed thematically to generate categories of critical incidents and wish-list items.
Findings
Analysis revealed rich data from a sub-group rarely researched within UK literature. Fifteen barriers, eleven facilitators and five wish-list items were identified. The importance of mental health literacy, social networks, cultural sensitivity and concerns surrounding services underpinned many categories.
Originality/value
Findings provide a new perspective on barriers reported in previous literature. Novel facilitators were highlighted where, although psychological and sociocultural factors were deemed valuable, structural changes were most desired. Recommended changes illustrate innovative interventions that could make services accessible for young adult Afro-Caribbean populations. Future research should explore the barriers and facilitators identified by Afro-Caribbean undergraduates across various universities who have successfully accessed and engaged with services. This could provide a holistic perspective on viable facilitators enabling access despite the presence of barriers.
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Green B, Colucci E. Traditional healers' and biomedical practitioners' perceptions of collaborative mental healthcare in low- and middle-income countries: A systematic review. Transcult Psychiatry 2020; 57:94-107. [PMID: 31937197 DOI: 10.1177/1363461519894396] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Access to mental healthcare in low- and middle-income countries (LMICs) is one of the greatest challenges in public health today. One suggestion for improving accessibility is through collaboration between biomedical practitioners and traditional healers. This paper reviews studies of traditional healers' and biomedical practitioners' perceptions of collaboration. We conducted a systematic review of online databases, selected journals, and reference lists for relevant studies. Eligible papers were assessed using a tool designed for this review for quality and study characteristics, and qualitative data demonstrating participants' views were extracted. A total of 14 papers from seven countries were included. The published literature on this topic is relatively homogenous and studies are of variable quality. The findings suggest that, despite differing conceptualisations of mental illness causation, both traditional healers and biomedical practitioners recognise that patients can benefit from a combination of both practices and demonstrate a clear willingness to work together. There are concerns about patients' safety and human rights regarding traditional methods and some healers are sceptical about the effectiveness of Western psychiatric medication. Despite keeping the inclusion criteria open to all LMICs, 13 of the studies were conducted in Africa, seven of which were in South Africa. This limits the applicability of the findings of this review to the wider LMIC context. The paper concludes with recommendations for research and practice.
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Abrams AL, Falkenberg T, Rautenbach C, Moshabela M, Shezi B, van Ellewee S, Street R. Legislative landscape for traditional health practitioners in Southern African development community countries: a scoping review. BMJ Open 2020; 10:e029958. [PMID: 31915157 PMCID: PMC6955546 DOI: 10.1136/bmjopen-2019-029958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Globally, contemporary legislation surrounding traditional health practitioners (THPs) is limited. This is also true for the member states of the Southern African Development Community (SADC). The main aim of this study is to map and review THP-related legislation among SADC countries. In order to limit the scope of the review, the emphasis is on defining THPs in terms of legal documents. METHODS This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews methods. Two independent reviewers reviewed applicable legal definitions of THPs by searching the Southern African Legal Information Institute (SAFLII) database in April 2018 for legislation and bills. To identify additional legislation applicable in countries not listed on SAFLII and/or further relevant SADC legislation, the search engines, Google and PubMed, were used in August 2018 and results were reviewed by two independent reviewers. Full texts of available policy and legal documents were screened to identify policies and legislation relating to the regulation of THPs. Legislation was deemed relevant if it was a draft of or promulgated legislation relating to THPs. RESULTS Four of 14 Southern African countries have legislation relating to THPs. Three countries, namely South Africa, Namibia and Zimbabwe, have acknowledged the roles and importance of THPs in healthcare delivery by creating a council to register and formalise practices, although they have not operationalised nor registered and defined THPs. In contrast, Tanzania has established a definition couched in terms that acknowledge the context-specific and situational knowledge of THPs, while also outlining methods and the importance of local recognition. Tanzanian legislation; thus, provides a definition of THP that specifically operationalises THPs, whereas legislation in South Africa, Namibia and Zimbabwe allocates the power to a council to decide or recognise who a THP is; this council can prescribe procedures to be followed for the registration of a THP. CONCLUSIONS This review highlights the differences and similarities between the various policies and legislation pertaining to THPs in SADC countries. Legislation regarding THPs is available in four of the 14 SADC countries. While South Africa, Tanzania, Namibia and Zimbabwe have legislation that provides guidance as to THP recognition, registration and practices, THPs continue to be loosely defined in most of these countries. Not having an exact definition for THPs may hamper the promotion and inclusion of THPs in national health systems, but it may also be something that is unavoidable given the tensions between lived practices and rigid legalistic frameworks.
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Affiliation(s)
- Amber Louise Abrams
- Environment and Health, South African Medical Research Council, Durban, South Africa
- Future Water institute, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Torkel Falkenberg
- Department of Neurobiology, Caring Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Busisiwe Shezi
- Environment and Health, South African Medical Research Council, Durban, South Africa
| | - Suné van Ellewee
- Faculty of Law, North-West University, Potchefstroom, South Africa
| | - Renee Street
- Environment and Health, South African Medical Research Council, Durban, South Africa
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The treatment of mental illness in faith-based and traditional healing centres in Ghana: perspectives of service users and healers. Glob Ment Health (Camb) 2020; 7:e28. [PMID: 33123375 PMCID: PMC7576926 DOI: 10.1017/gmh.2020.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/07/2020] [Accepted: 09/17/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The maltreatment of people with mental illness in Ghana's traditional and faith-based healing centres, including shackling, flogging, and forced fasting, has been documented by numerous sources. Such treatment is potentially traumatising and may exacerbate mental health problems. Despite widespread use, few studies have focused on experiences and characteristics of people who seek traditional healing for mental illness or healers' perspectives treatment of these conditions. METHOD Purposeful sampling was used to recruit 82 individuals who were treated in healing centres and 40 traditional healers; all took part in semi-structured interviews. Those treated were asked about experiences in centres and assessed for prior trauma exposure, posttraumatic stress, and functional impairment. Healers were asked about beliefs and practices related to the treatment of mental illness. RESULTS Individuals treated in centres and healers generally believed that mental illness has a spiritual cause. Approximately 30.5% of those treated in centres were exposed to maltreatment; despite this, half would return. Individuals with a history of trauma were more likely to report maltreatment in the centre and had higher symptoms of posttraumatic stress. Most participants had impaired functioning. Healers who used practices like shackling believed they were necessary. Most healers were willing to collaborate with the official health structure. CONCLUSION Results provide insight into the treatment of mental illness by traditional healers in Ghana and the need for trauma-informed mental health services. Findings also highlight the importance of considering cultural beliefs when attempting to implement mental health interventions in the region.
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Pillay D, Serooe T. Shifting and transforming the practice of audiology: The inclusion of traditional healing. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2019; 66:e1-e9. [PMID: 31793314 PMCID: PMC6890569 DOI: 10.4102/sajcd.v66i1.635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 11/24/2022] Open
Abstract
Background Societal diversity encompasses an array of cultural, religious and spiritual beliefs that influence an individual’s perspective of illness and diseases. Healthcare providers are challenged with the task of considering these diversities in clinical practice. The symbiotic relationship between the healthcare provider and the traditional healer in any healthcare field is rare. Objectives The aims were to determine the perspectives of audiologists with regard to traditional healing in South Africa (SA) and to document if and how the audiologist engages with traditional healing in practice. Method A questionnaire containing closed and open-ended questions was utilised. Thematic analysis was conducted on the qualitative data, and the quantitative data were displayed using tables and figures. Results Forty-one audiologists working at public and private hospitals and clinics in SA were included in this study. The personal experiences of audiologists resulted in varying definitions of a traditional healer. Audiologists reported that patients utilised traditional healing methods such as pouring urine or motor oil into the ear. Strategies of accommodation included being culturally appropriate during conversations, respecting and acknowledging the individual’s cultural and religious beliefs. Twenty-seven audiologists were willing to collaborate with traditional healers to support the patient. Conclusion There is a need for an integral holistic model of care in Audiology. There is a lack of communication structures to facilitate the implementation of a collaborative model of care in the current medical model of practice of Audiology. The global trend of holistic and person-centred care is evident, and the field of Audiology cannot negate the role of traditional healers as alternate healthcare providers in SA.
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Affiliation(s)
- Dhanashree Pillay
- Department of Speech-Language Pathology and Audiology, University of the Witwatersrand, Johannesburg.
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Koduah AO, Leung AYM, Leung DYL, Liu JYW. "I Sometimes Ask Patients to Consider Spiritual Care": Health Literacy and Culture in Mental Health Nursing Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193589. [PMID: 31557871 PMCID: PMC6801491 DOI: 10.3390/ijerph16193589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 11/16/2022]
Abstract
While health literacy influences better outcomes of mental health patients, sociocultural factors shape the nature of the relationship. On this matter, little is known about how sociocultural factors affect health literacy practices of nurses, especially in low-income countries. This paper examines how local precepts, within culture and language, shape mental health nurses’ (MHNs) practice and understanding of patients’ health literacy level in Ghana. The study used a qualitative descriptive design involving 43 MHNs from two psychiatric hospitals. Conventional content analysis was used to analyze the data. Although the MHNs acknowledged the importance of health literacy associated with patients’ health outcomes, their practice was strongly attributed to patients’ substantial reliance on cultural practices and beliefs that led to misinterpretation and non- compliance to treatments. MHNs shared similar sociocultural ideas with patients and admitted that these directed their health literacy practice. Additionally, numerous health system barriers influenced the adoption of health literacy screening tools, as well as the MHNs’ low health literacy skills. These findings suggest MHNs’ direct attention to the broader social determinants of health to enhance the understanding of culture and its impact on health literacy practice.
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Affiliation(s)
- Adwoa Owusuaa Koduah
- Centre of Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong.
| | - Angela Y M Leung
- Centre of Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong.
| | - Doris Y L Leung
- Centre of Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong
| | - Justina Y W Liu
- Centre of Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong
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Badu E, Mitchell R, O'Brien AP. Pathways to mental health treatment in Ghana: Challenging biomedical methods from herbal- and faith-healing perspectives. Int J Soc Psychiatry 2019; 65:527-538. [PMID: 31277557 DOI: 10.1177/0020764019862305] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The clinical pathways for treating mental illness have received global attention. Several empirical studies have been undertaken on treatment pathways in Ghana. No study, however, has systematically reviewed the literature related to the pathways of mental health treatment in Ghana. AIM This article aims to identify the pathways used to treat mental illnesses; examine the evidence about the possibility of collaboration between biomedical, faith and traditional healing pathways; and draw attention to the barriers hindering such collaboration. METHODS A search of the published literature was conducted using Medline, Embase, PsycINFO, CINAHL (EBSCO), Web of Science and Scopus databases. The search was limited to the articles that were published in English and released between 2000 and June 2018. The review synthesises both qualitative and quantitative data. RESULTS The findings showed that mental illnesses in Ghana are treated using a mixture of biomedical and faith-based and traditional healing services. Faith and traditional healing pathways are typically used as a preliminary source of cultural assessment before seeking biomedical treatment. There is an increasing desire for collaboration between biomedical, faith and traditional healing pathways. However, several individual factors (attitude or stigma, the perceived efficacy of treatment and differences in the treatment process) and health system factors (a lack of policy and regulation, a limited number of biomedical service providers, limited financial support and geographical isolation of services) jointly contribute to barriers precluding establishing such collaboration. CONCLUSION This review recommends that policies, regulations, educational support and financial incentives should be developed to facilitate collaboration between biomedical, faith and traditional healing service provision.
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Affiliation(s)
- Eric Badu
- 1 School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia
| | - Rebecca Mitchell
- 2 Faculty of Business and Economics, Macquarie University, Sydney, NSW, Australia
| | - Anthony Paul O'Brien
- 3 Faculty of Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia
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Bitta MA, Kariuki SM, Gona J, Abubakar A, Newton CRJC. Priority mental, neurological and substance use disorders in rural Kenya: Traditional health practitioners' and primary health care workers' perspectives. PLoS One 2019; 14:e0220034. [PMID: 31335915 PMCID: PMC6650073 DOI: 10.1371/journal.pone.0220034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/07/2019] [Indexed: 11/21/2022] Open
Abstract
Background Over 75% of people with mental neurological and substance use disorders (MNSD) live in low and middle-income countries with limited access to specialized care. The World Health Organization’s Mental Health Gap Action Program (mhGAP) aims to address the human resource gap but it requires contextualization. Aims We conducted a qualitative study in rural coastal Kenya to explore the local terms, perceived causes and management modalities of priority MNSD listed in the mhGAP, to inform implementation in this setting. Methods We conducted 8 focus group discussions with primary health care providers and traditional health practitioners and used the framework method to conduct thematic analysis. We identified local terms, perceived causes and treatment options for MNSD. We also explored possibilities for collaboration between the traditional health practitioners and primary health care providers. Results We found local terms for depression, psychoses, epilepsy, disorders due to substance use and self-harm/ suicide but none for dementia. Child and adolescent mental and behavioral problems were not regarded as MNSD but consequences of poor parenting. Self-harm/suicide was recognized in the context of other MNSD. Causes of MNSD were broadly either biological or supernatural. Treatment options were dependent on perceived cause of illness. Most traditional health practitioners were willing to collaborate with primary health care providers mainly through referring cases. Primary health care providers were unwilling to collaborate with traditional health practitioners because they perceived them to contribute to worsening of patients’ prognoses. Conclusions Local terms and management modalities are available for some priority MNSD in this setting. Community level case detection and referral may be hindered by lack of collaboration between traditional health practitioners and primary health care providers. There is need for training on the recognition and management of all priority MNSD.
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Affiliation(s)
- Mary A. Bitta
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Symon M. Kariuki
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Joseph Gona
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Amina Abubakar
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Aga Khan University, Nairobi, Kenya
| | - Charles R. J. C. Newton
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Kpobi L, Swartz L. Indigenous and faith healing in Ghana: A brief examination of the formalising process and collaborative efforts with the biomedical health system. Afr J Prim Health Care Fam Med 2019; 11:e1-e5. [PMID: 31368322 PMCID: PMC6676929 DOI: 10.4102/phcfm.v11i1.2035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 11/03/2022] Open
Abstract
Background Health seeking in many African countries typically involves making use of multiple healing systems, including indigenous and faith systems, as well as biomedical healthcare systems. These different systems have co-existed for many years in Africa, including in Ghana. Aim In this article, we examine the formalising processes that non-biomedical healthcare in Ghana has undergone in postcolonial times. We first present a brief historical analysis of the process of organising indigenous medical systems into formal bodies. We then conclude by exploring collaborative efforts that have been undertaken between biomedical and non-biomedical health systems in Ghana. Method A historical analysis of formalised indigenous healing systems in Ghana was done through an examination of relevant literature. Results Formal groups of indigenous healers in Ghana who are organised into specific categories have undergone various transformations over the years. Evidence also exists of collaborative programmes developed with traditional healers in Ghana, although these have been largely for primary health partnerships. With regard to mental health collaborations, attempts at integration have been generally unsuccessful, with various factors identified as hindering successful partnerships. Conclusion Indigenous healing is an important component of healthcare in Ghana. Collaboration between the different healthcare systems can be strengthened through accurate understandings of how key stakeholders are situated (and indeed situate themselves) in the conversation.
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Affiliation(s)
- Lily Kpobi
- Department of Psychology, Stellenbosch University, Stellenbosch.
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Kpobi L, Swartz L. Indigenous and faith healing for mental health in Ghana: An examination of the literature on reported beliefs, practices and use of alternative mental health care in Ghana. Afr J Prim Health Care Fam Med 2019; 11:e1-e5. [PMID: 31368321 PMCID: PMC6676964 DOI: 10.4102/phcfm.v11i1.1941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/16/2018] [Accepted: 01/24/2019] [Indexed: 11/25/2022] Open
Abstract
Background For many people in African countries, various forms of health care are utilised for the treatment of illness. This pluralistic nature of health seeking includes the use of indigenous, faith and allopathic medicines for care. Aim In this article, our aim was to gain insight into the existing knowledge on indigenous and faith healing in Ghana, with a particular focus on mental health care. We first examine the reported mental health beliefs and practices of Ghanaian alternative healers. Following this, we look at the use and purported preference for non-biomedical mental health care by patients. Methods Relevant literature was examined to explore the beliefs, practices and use of non-biomedical mental health care systems in Ghana Results Evidence for the use and preference for non-biomedical mental health care is largely anecdotal. Similarly, the mental health beliefs of alternative healers have been documented in various small-scale studies. However, such information is important if mental health services in Ghana are to be improved. Conclusion Integration of the different healthcare systems must be built on knowledge of beliefs and methods. A clearer understanding of the work of non-biomedical healers is important if appropriate recommendations are to be made for collaboration between biomedical and non-biomedical systems in Ghana.
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Affiliation(s)
- Lily Kpobi
- Department of Psychology, Stellenbosch University, Stellenbosch.
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Kpobi LNA, Swartz L. Muslim Traditional Healers in Accra, Ghana: Beliefs About and Treatment of Mental Disorders. JOURNAL OF RELIGION AND HEALTH 2019; 58:833-846. [PMID: 29992474 DOI: 10.1007/s10943-018-0668-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Traditional and faith healing is a common practice in many low- and middle-income countries due to resource limitations and belief systems, particularly for disorders such as mental disorders. We report on the beliefs about mental illness from the perspective of one category of alternative healers in Ghana-the Muslim faith healers. We also report on their methods of diagnoses and treatment for mental disorders. Results show that the healers' beliefs about mental illness revolved around the notion of Jinn as causing most mental illness. Emerging themes are discussed with reference to their potential implications for patients' care and health-seeking behaviour.
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Affiliation(s)
- Lily N A Kpobi
- Department of Psychology, Stellenbosch University, 2nd Floor RW Wilcocks Building, Stellenbosch, South Africa.
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, 2nd Floor RW Wilcocks Building, Stellenbosch, South Africa
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Nartey AK, Badu E, Agyei-Baffour P, Gyamfi N, Opoku MP, O'Brien AP, Mitchell R. The predictors of treatment pathways to mental health services among consumers in Ghana. Perspect Psychiatr Care 2019; 55:300-310. [PMID: 30648278 DOI: 10.1111/ppc.12350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/29/2018] [Accepted: 12/24/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To explore factors influencing treatment pathways to mental health services among consumers in Ghana. DESIGN AND METHODS Cross-sectional design using quantitative method. FINDINGS Treatment pathways for mental illness were general hospitals/clinics, psychiatric hospitals, and faith-based practices. The predisposing (age, household size, primary occupation, ethnicity, marital status, religion, and geographic location, as well as attitudes and beliefs), enabling (affordability), and need factors (severity of mental illness) were significant predictors of treatment pathways. PRACTICE IMPLICATIONS Current advocacy and awareness for mental health services in Ghana should consider the predisposing, enabling, and need factors of consumers. Policy initiatives on mental health services should ensure adequate financing mechanisms and further establish collaboration between biomedical and faith-based services.
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Affiliation(s)
- Anna Korley Nartey
- Techiman Municipal Health Directorate/Ghana Health Services, Techiman, Ghana
| | - Eric Badu
- Faculty of Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia
| | - Peter Agyei-Baffour
- Department of Health Policy, Management and Economics/School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Naomi Gyamfi
- Department of Health Promotion and Disability Studies, Centre for Disability and Rehabilitation Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Rebecca Mitchell
- Faculty of Business and Economics, Macquarie University, Sydney, Australia
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A survey of traditional and faith healers providing mental health care in three sub-Saharan African countries. Soc Psychiatry Psychiatr Epidemiol 2019; 54:395-403. [PMID: 30456425 DOI: 10.1007/s00127-018-1630-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Traditional and faith healers constitute an important group of complementary and alternative mental health service providers (CAPs) in sub-Sahara Africa. Governments in the region commonly express a desire to integrate them into the public health system. The aim of the study was to describe the profile, practices and distribution of traditional and faith healers in three sub-Saharan African countries in great need for major improvements in their mental health systems namely Ghana, Kenya and Nigeria. MATERIALS AND METHODS A mapping exercise of CAPs who provide mental health care was conducted in selected catchment areas in the three countries through a combination of desk review of existing registers, engagement activities with community leaders and a snowballing technique. Information was collected on the type of practice, the methods of diagnosis and the forms of treatment using a specially designed proforma. RESULTS We identified 205 CAPs in Ghana, 406 in Kenya and 82 in Nigeria. Most (> 70%) of the CAPs treat both physical and mental illnesses. CAPs receive training through long years of apprenticeship. They use a combination of herbs, various forms of divination and rituals in the treatment of mental disorders. The use of physical restraints by CAPs to manage patients was relatively uncommon in Kenya (4%) compared to Nigeria (63.4%) and Ghana (21%). CAPs often have between 2- to 10-fold capacity for patient admission compared to conventional mental health facilities. The profile of CAPs in Kenya stands out from those of Ghana and Nigeria in many respects. CONCLUSION CAPs are an important group of providers of mental health care in sub-Saharan Africa, but attempts to integrate them into the public health system must address the common use of harmful treatment practices.
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Kpobi LNA, Swartz L, Omenyo CN. Traditional herbalists' methods of treating mental disorders in Ghana. Transcult Psychiatry 2019; 56:250-266. [PMID: 30284964 DOI: 10.1177/1363461518802981] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of traditional medicine for the treatment of various disorders is not a new practice. Indeed, various categories of traditional healers form a large part of the healthcare workforce in many low- and middle-income countries, and given the paucity of mental health professionals in these countries, traditional and complementary medicine practitioners are utilised even more so for mental disorders. In Ghana, efforts have been made to formalise and standardise the work of traditional medicine practitioners. This goal is still mostly unmet, partly due to the lack of scientific knowledge of their beliefs, methods, and practices in mental healthcare. Very few studies have documented this knowledge. In this article, we report on some of the methods that are used by traditional Ghanaian herbalists in treating mental disorders. Eight herbalists working within the Greater Accra Region, who specialised in mental health, were interviewed through individual semi-structured interviews. Thematic analysis showed that traditional herbalists' work in treating mental disorders revolved around four key themes: the method of diagnosis; the treatment methods used; the mode of administering the treatment; and the purpose of the specific treatment. These themes are discussed with reference to their potential implications for patients' care and outcomes.
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