MHM Magazine

2 | MENTAL HEALTH MATTERS | 2022 | Issue 6 MHM It’s within this context of diversity that mental health care practitioners need to be mindful of cultural factors impacting on mental health. The following scenario illustrates how religion and culture may have an impact in the assessment, diagnosis and treatment of mental health issues. ‘A 24-year-old *Lerato (pseudonym) was brought to the hospital casualty unit, accompanied by the Emergency Medical Services (EMS) practitioner and her university room-mate. She appeared agitated, aggressive, and uncooperative. She was preaching loudly and praying, holding a Bible and a glass of water. The doctor on-call sedated and admitted her for psychiatric management including diagnosis and prescription of medication for Brief Psychotic Disorder (BPD). Upon investigation, the room-mate reported that Lerato told her that she saw a black cat sitting by the window of her room the previous week. Lerato seemed preoccupied, disturbed and worried about the said cat. She called her mother and they prayed together on the phone. The morning of the incident under investigation, on her way to class, Lerato saw another black cat crossing in front of her and she started praying, pacing around, and talking so fast her room-mate couldn’t understand what Lerato was saying. Lerato ran back to her room and started sprinkling water in the room and under her bed, praying loudly whilst holding a Bible in her hand. The following morning in the ward, Lerato appeared calm with a cooperative attitude showing no symptoms of psychosis as previously ‘assessed and diagnosed’. She gave the background that when she visited her church during the previous university recess, she was told that something bad was about to happen to her due to jealousy from her community about her studies. The pastor told her that she needed to pray, a lot. She had been praying so much that she wasn’t sleeping adequately. She was also instructed to mix salt with water and sprinkle in her room. Lerato explained that seeing the black cat twice, caused fear and panic on her part. She believed that a black cat was a symbol of bad luck and suspected witchcraft. She remembered what her church pastor said and engaged in intense prayer to get rid of the bad luck. The routine blood tests were normal. Lerato reported no history of mental illness before this incident. She was discharged home to her residence after a week.’ There are so many people experiencing and identifying with Lerato’s psychosocial and cultural woes. Some have been found ‘paralysed’ and others ‘blind’ without biomedical reasons. These stories seem to have psychiatric similarities of ‘madness’ according to the medical diagnostic model and cultural and belief systems. In practice, similar cases are being referred for mental health attention with possible diagnostic challenges. Contextually, Lerato belongs and subscribes to certain cultural and religious views which can be misdiagnosed as core psychiatric conditions. In her culture, witchcraft is common and specific rituals are practiced to heal and get rid of the evil spirits. If not mindful and understanding of influencing factors such as culture, practitioners can easily misdiagnosed Lerato with delusions and psychotic presentation. Consequently resulting in treatment being inappropriate and ineffective. The continuous revision of the Diagnostic and Statistical Manual of Mental Disorders , now on fifth edition (DSM-5) is an effort to bring up-to-date and advance the assessment and diagnosis of mental health issues. For comprehensive and all-inclusive assessment and diagnosis, it’s often helpful for practitioners to assess the V and/or Z codes of the DSM- 5 to integrate psychosocial and cultural problems into psychiatric diagnosis. Seemingly, both V and Z codes are not used appropriately and effectively by practitioners with the reported lack of mindfulness about these codes. These codes aid in the formulation of mental health problems and their treatment. Mental health care practitioners are reminded to assess, diagnose and treat mental health issues in the context of what is considered ‘normal’ behaviour within a particular culture and setting. Equally, teaching and learning programmes on mental health and illness have to be aligned to the current context. Updated and revised teaching material will also assist to locate training to be relevant and suitable to the communities and individuals receiving mental health care services. In the context of training, mental health care practitioners and trainers need to be mindful of cultural dynamics of healing and mental health, to integrate to the curriculum. Well trained practitioners will then be competent to address mental health issues. Further to teaching and practice, more research and studies are needed to update knowledge on the current trends related to mental health and illness. This will add value to diagnostic processes and treatment procedures to be used to manage mental health. So, mental health care practitioners’ inclusion and mindfulness of bio-psycho- sociocultural factors in assessing and diagnosing mental health issues in Africa may result in best treatment outcomes. Therefore, improving mental health and wellness of the African people. Let’s be mindful - mindful of our context.