New team effort may help mental patients

A collaboration between psychiatrists and traditional healers could be the spoonful of sugar needed to ensure mentally ill patients stay on their medication.

In the first study of its kind in Nelson Mandela Bay, a group of psychiatrists analysed how many patients first sought help from traditional healers for mental illness – and stumbled upon a potential collaboration to ensure compliance with treatment.

The study was led by Professor Zukiswa Zingela, the head of the department of psychiatry at Walter Sisulu University, who said their research went a long way to dispelling some myths around treatment by traditional healers.

“I noticed that a significant number of patients had a history of being mentally ill for a long time before seeking help,” she said.

“Sometimes their illness would be far advanced, with slow improvement.

“I then wondered how many of the patients we treat first went to a traditional healer before accessing doctors, nurses or psychologists for help.”

Zingela, the head of the clinical unit and associate professor of psychiatry at Walter Sisulu University, Dr Stefan van Wyk and retired Nelson Mandela University mathematician and statistical consultant Jacques Pietersen then joined forces to look into these behaviour patterns.

They asked 254 patients to report on their use of healers outside the medical fraternity.

They were asked why they chose to see such healers, how much they paid and about the interventions offered for their mental conditions.

About a third of the patients who took part in Nelson Mandela Bay consulted healers.

They reported high compliance with healers’ interventions – 80%, the study found.

Only a small percentage –5%– of healers advised patients to stop or interrupt their regular medication.

“Researching why traditional healers achieved such high adherence rates to their interventions may make it possible to develop strategies to improve medication adherence among patients with mental illness,” the study said.

There were many subjective reports of feeling better after consulting a healer and this most likely contributed to the relatively high number of patient respondents intending to reconsult with healers in future (58%), the study said.

Zingela said one disturbing finding was that patients were abused by traditional healers, including physical beatings, harmful physical restraints and sometimes sexual abuse.

She said involving healers in future strategies to ensure compliance with treatment was a very promising aspect of their research.

“Our study showed that the majority of traditional healers did not advise patients to stop their medication as we have often been led to believe.

“Only five of the 78 participants – around 6% – who had consulted healers were told to stop taking their medicine.

“Our thinking now is that if one can work with healers to actively encourage people to continue their regular medication, then we can reinforce the idea of how important it is to maintain treatment for chronic conditions, including mental health.”

Zingela said 58% of participants in the study had reported that medical interventions were more helpful and that an equal number of participants still indicated they would consult again with healers in future.

“So somehow, even though medical intervention was seen as more helpful, healer intervention was still found to be valuable to most of the participants,” she said.

In SA as much as 80% of the population is believed to make use of traditional health practitioners or THP – the official umbrella term for herbalists, faith healers, birth attendants and traditional surgeons. In recent years there has also been a growing realisation worldwide of the importance of traditional medicine. Now, thanks to a small but potentially significant study done in the Bay, there is evidence traditional healing can have a positive role to play in terms of supporting the treatment of mental conditions according to a western framework.

We report today on a group of psychiatrists who set about determining the number of patients who had first consulted traditional healers for mental illness before then turning to doctors, nurses or psychologists for help. What emerged was that the two vastly different approaches can run concurrently to the benefit of patients and that there are some promising areas for future collaboration.

Besides dispelling some of the myths around patient treatment by traditional healers, the study for instance found that these healers could actively help patients comply with their mainstream medication.

In fact, according to the patients in question, the majority of healers did encourage them to continue with their regular medication.

On a more disturbing note, however, there were still some reports of patients being abused by traditional healers, for instance in the form of beatings, harmful physical restraints and sometimes even sexual abuse.

Unfortunately there will always be unscrupulous healers who will contribute to giving those who are operating ethically a bad reputation.

That said, important gains have been made in recent years to bring some form of regulation that will ultimately achieve a greater integration of traditional health services into the formal health system.

It is particularly in the rural areas of SA, where there is often limited access to clinics and medical health practitioners, that traditional healing can play a crucial complementary role.