Mental health professionals have called for greater collaboration between Western medical specialists and African traditional healers in providing primary health care for the one in three South Africans who experience common mental health disorders, with 75% going untreated.
South Africa has only 975 registered psychiatrists serving a population of more than 60 million, the vast majority practising in urban areas and the private sector, while more than 80% of the population are reliant on the public sector with its limited mental healthcare services.
With World Mental Health Day on 10 October themed “Mental Health in an Unequal World”, the South African Society of Psychiatrists (SASOP) says that traditional and spiritual healers could play a key frontline role in improving access to treatment for common mental health conditions including anxiety, depression and substance abuse, and overcoming the stigma often attached to these.
Dr Lerato Dikobe-Kalane psychiatrist and member of SASOP said under-funding and under-resourcing of public health is particularly severe in the mental health care arena, and the inequality of access to mental health care has been worsened by the disruptions of the Covid-19 pandemic – due to restrictions on movement, as well as the public health sector having to focus its limited resources on Covid-19 cases.
“The low number of people receiving treatment for a mental health disorder is partly due to lack of resources and access, and partly due to resistance to seeking treatment because of low mental health literacy, stigma and discrimination, and perceptions that treatment is ineffective or that the problem will go away on its own.
“This points to a need for greater awareness of mental health and encouragement to seek help, and we believe traditional and spiritual healers can play a key role in early identification, referrals and sharing cultural understanding with treatment-resistant patients who could be referred to alternative treatment modes.” She said South Africa’s estimated 200,000 African traditional and spiritual healers were highly influential in their communities and often consulted as the first step in seeking advice or treatment, and that studies had shown that alternative practitioners could play an important role in addressing mental health care needs by offering culturally appropriate treatment.
“Traditional and spiritual healers have intimate knowledge of traditional medicine and cultural and spiritual practices and beliefs. They are respected in the community and their advice is sought out and respected. “There is evidence that the psychosocial role of traditional and spiritual healers – informal counselling and support in improving family, community or work relationships – can help to relieve distress and mild symptoms of common mental disorders like depression and anxiety.
Traditional and spiritual healers can play an important role in assisting people with mental health issues at a primary healthcare level,” she said. Greater collaboration between Western mental health practitioners and traditional or spiritual healers would help to educate the traditional practitioners on common mental disorders, treatment options and the resources for referral for more specialised treatment, she said.
“Although there is little evidence that traditional and spiritual healers have an impact on the treatment for severe mental illnesses such as bipolar and psychotic disorders – with appropriate education and information, they could assist in the early identification and relevant referral of patients,” Dr Dikobe-Kalane said.
She emphasised the need for mutual respect and understanding of each other’s roles and cultures, by both Western and traditional practitioners, in fostering a positive working relationship that could improve awareness of mental health disorders, reduce stigma and enable wider access to treatment.
Lifetime prevalence of common mental disorders in South Africa is 30.3%. Herman AA, et al. The South African Stress and Health (SASH) Study: 12-month and lifetime prevalence of common mental disorders. SA Medical Journal, Vol 99, No. 5. 2009. http://www.samj.org.za/index.php/samj/article/view/3374Seedat S, et al. Mental health service use among South Africans for mood, anxiety and substance use disorders. SA Medical Journal, Vol 99, No 5. 2009. http://www.samj.org.za/index.php/samj/article/view/3061/2367Health Professions Council of SA register, accessed 03 October 2021 - http://isystems.hpcsa.co.za/iregister/Stats SA. General Household Survey 2019. http://www.statssa.gov.za/?page_id=1854&PPN=P0318&SCH=72766No official figures are available but this is a widely quoted, low estimate. Seedat S, et al. See reference ii.