MHM Magazine

to the formal professional mental health care services. Given the scarcity of mental health services, especially in the rural and underserved parts of South Africa with fewer psychiatrists and psychologists, traditional healers are used even more so. Furthermore, consultation with formal mental health care practitioners seems uncomfortable due to fear of a formal psychiatric / psychological diagnosis. Particularly in the African communities, people suffering from mental health conditions are stigmatised. The aetiology and treatment of mental illness is understood in a variety of ways including possession by spirits in some conditions. Witchcraft and ancestor spirits are common cultural beliefs thought to have caused mental health illness and this guides the African’s health seeking behaviours. According to several studies, there seems to be increasing evidence that supports the contention that traditional healers can deliver effective psycho-sociocultural solutions, facilitating social engagement and improving coping mechanisms. The following case scenario demonstrates how traditional healing can be integrated holistically in treatment. “Mabel* (pseudonym) is a 54-year-old African lady who was brought by her husband to an academic hospital a month back following multiple complaints including back pains, walking difficulties, worry, exhaustion, and insomnia. After medical examinations and tests, she had been admitted in the spinal unit with a diagnosis of TB of the spine and was due for a corrective surgical procedure. Two weeks into admission, a referral to the psychologist and psychiatrist were made for multidisciplinary management following Mabel’s depressive and anxiety symptoms and subsequent deterioration. The treating orthopaedic surgeon mentioned that Mabel had not been herself and was unresponsive to treatment. Specifically, she stopped attending physiotherapy, slept a lot and has had difficulty eating. She lost weight, inquired a lot about the anticipated surgery, was uncooperative in the ward, and her mood was relatively sad and irritable. When questioned by the psychologist Mabel acknowledged that she was exhausted and in pain. She further explained that she feared for her life and lost hope when her doctor refused her ‘a discharge’ to go home and consult the family’s traditional healer. She believed that she needed her traditional healer’s opinion concerning the diagnosis but most importantly whether to go ahead with the planned surgical treatment. She suspected witchcraft because, according to her she started experiencing problems after her son bought a new car. She also questioned how come the hospital allowed a priest to pray and counsel patients (without her consent) but refused her a visit to her ‘ngaka’ (traditional healer) Through the psychologist’s intervention, a weekend leave of absence pass was arranged for Mabel to benefit from some time outside of the hospital while still an inpatient. Being with family and having consulted the traditional healer seemed to have reassured and informed her healing process. She mentioned that the traditional healer ruled out witchcraft and acknowledged that spinal tuberculosis was a family disease. As stated by Mabel, she understood that she inherited the medical condition from her ancestors. She was encouraged to undergo the surgical procedure as proposed by the medical team. She came back optimistic and uplifted to continue with the hospital treatment.” Insight into the relationship between cultural beliefs, perceptions, and mental health may inform interventions that could enhance the understanding of the causes of mental illness, fast track commencement of treatment and reduce the duration and the severity of the condition. As seen in the case study above, Mabel* was slowly drowning into depression due to her own perception of her condition. She felt misunderstood and needed her traditional healer’s intervention. Denying her a consultation with her trusted source of care would have possibly delayed and complicated her healing process in more ways including physically (TB spine) and mentally (depression). Concerns about harmful practices associated with traditional healing and the absence of scientific evidence on safety and effectiveness of traditional mental health care have been raised. On the other hand, traditional healers continue to play a significant role in mental health care. What is more concerning is the increase of mental health conditions taking a huge toll and causing suffering especially in the poorer communities. Given the scarcity of (western) trained mental health care practitioners in state facilities and the large quantity of traditional healers in both urban and rural areas, there seems to be a demand for integration of traditional healing into mainstream health care system in South Africa. The previous Minister of Health, Dr Manto Tshabalala-Msimang supported and advocated for the need to have such a collaboration to alleviate pressure carried by the health care system. This will also help regulate the traditional healing system. Traditional healers should not be overlooked when it comes to holistic mental health. As an alternative, they should be engaged gainfully to promote better understanding of mental illnesses, diagnosis, and possible referral, while at the same time discouraging harmful practices. This can be done through efforts to formalise and standardise traditional healing, integratively, into mainstream health care system through development and implementation of policies, training programmes, research, and regulatory methods. References available on request. 2 | MENTAL HEALTH MATTERS | 2023 | Issue 6 MHM