Authored by Janice L Cooper* and CC Benedict Dossen
Commentary
I bring to your attention an issue in mental health that gets
scarce attention in the peer- reviewed literature: the use of
traditional and religious healing in mental health. Funding for
mental health services and consequently mental health services
research in low-and income countries remains low compared to
other health funding. Funding to examine the role of traditional
and religious healing in mental health is even smaller. A systematic
review of research involving religious and traditional healing in
mental health included 8 studies from Sub-Saharan Africa spanning
from 1999-2013 [1]. The number of participants in these studies
ranged from 59-129. Recently, the National Institute of Mental
Health of the United States government funded a study under the
direction of Dr. Oye Gureje that examines training and supports
for religious and traditional providers who address mental illness
and epilepsy [2]. The PAM-D study, a NIMH initiative, examined the
integration of mental health treatment options from a combined
bio-medical, traditional and faith-healing perspective [3].
A World Bank-funded project in Liberia through the Carter
Center Mental Health Program with which I have been engaged
was a post-Ebola initiative that sought to address the immediate
mental health and psychosocial impact of the epidemic in Liberia
from 2015-2018. The program “Supporting Psychosocial Health
and Resilience” included training of health care providers and an
anti-stigma program. The role that traditional and religious leaders
played in the Ebola outbreak, has been recognized both in terms
of reducing and even stopping the spread, as well as, sometimes,
particularly initially, as potential drivers of the spread of the
epidemic [4]. One component The Carter Center’s work with the
Ministry of Health was to enlist religious and traditional leaders
in primary mental health identification, referral and anti- stigma
work. The program sought to support 200 religious and traditional
leaders in two highly EVD-affected counties with: i) education on
mental health and mental illness in Liberia; ii) information on how
to identify acute mental illness and where to refer for communitybased
mental health services; iii) which mental health specialists
could be contacted in mental health emergencies and referral
points; and, iv) training on how to reduce stigma. We conducted
a study with a subset of those leaders. The thirty-five respondents
who participated in the study were religious and traditional leaders.
Each respondent provided informed consent.
Participants were trained in skills to identify acute mental
illness and referrals to community mental health services, how
to differentiate between different types of mental illness, how
to collaborate with mental health provirus, how to mobilize
communities to support persons with mental illness and how
to train and work to reduce stigma against persons with mental
illness and epilepsy. Trainers were mental health clinicians, social
workers and managers of county mental health and social work
services. Trainees received training on common mental health
conditions, anti-stigma, human rights of persons with mental
illness, and on the referral pathway. This training was augmented
with monthly group meetings, and planning meetings for World
Mental Health Awareness Day. We conducted a study on the
intervention’s effectiveness. Key informants, who were a selected
from the trained faith/religious and traditional leaders, perceived
mobilization (30%), counseling (30%) and stigma reduction (20%)
as the most effective factors in addressing mental health during the
Ebola outbreak and the country’s recovery. The vast majority of
referrals to county health authorities were from religious leaders
(78%) compared to traditional leaders (21%). The University of
Liberia UL-PIRE IRB approved this study.
Studies like this and others that report on programs that seek
the bridge the gap between religious and traditional healing and
public health and bio-medically-based mental health treatment and
supports may significantly increase access to care for persons with
mental health conditions, diminish stigma and reduce suffering and
the burden of care.
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