Medico-religious collaboration: a model for mental health care in a resource poor country
Background: Reducing the treatment gap for the treatment of people with psychiatric disorders (also known as the ‘mental health gap’) is of increasing importance worldwide. In Low and Middle Income Countries (LMICs) human and material resources for orthodox (‘western’) mental health care are severely inadequate. As such, alternative mental health practices tend to thrive. Such alternative systems of care could be formally linked with western services to achieve a more integrated pattern of care in order to improve access for all users of mental health services in these communities, while ensuring a reduction in harm and promoting the human rights of people with mental health problems.
Aim: To describe a medico-religious mental health care collaborative model in a rural community in Nigeria, which may be suitable for scaling up mental health care in LMICs as a whole.
Methods: This is a descriptive report of a psychiatric service in collaboration with a Christian religious settlement, based in Ogun State, Western Nigeria. Questionnaires, focus group discussions and direct observation were employed. Client records from the religious center and from the visiting psychiatric team were also examined, and all the data from all sources were synthesized.
Results: Interactions between the medical and religious mental health care providers improved consistently over the study period. Acceptance of medical services and understanding of the need for collaboration increased. Increased utilization by people with mental illness from the nearby settlement was observed. In the course of collaboration, the occurrence of harmful practices(though still much in practice), reduced considerably as evidenced by stoppage of prolonged sleep and food deprivation (in form of night vigils and fasting) and flagellation, while physical restrictions with chains, especially for newly admitted sufferers still continued unabated despite the discouragement of such practice by medical practitioners.
Conclusions: A structured collaborative arrangement between medical and religious health care practitioners offers a great possibility towards the scaling up of mental health care in a resource poor setting such as Nigeria. In addition, it offers potential benefits to services users, such as: improved access to proven reliable medical care, better continuity of care, and reduction in harmful traditional practices usually used to treat these groups of people. Challenges of fundamental human rights abuse and funding are important areas for local mental health policies to address in such settings. In addition, institutional support is still inadequate and there is need for program sustainability.
Keywords: Collaboration, Medico-religion, Mental health, Resource poor, LMIC