‘We are all working toward one goal. We want people to become well’: A visual exploration of what promotes successful collaboration between community mental health workers and healers in Ghana

The practices of traditional and faith-based healers in low- and middle-income countries in Africa and elsewhere have come under intense scrutiny in recent years owing to allegations of human rights abuses. To mitigate these, there have been calls to develop collaborations between healers and formal health services to optimise available mental health interventions in poorly resourced contexts. For various reasons, attempts to establish such partnerships in a sustainable manner in different countries have not always been successful. In this article, we present findings from the Together for Mental Health visual research project to showcase examples of healer–health worker collaborations in Ghana that have been largely successful and discuss the barriers and facilitators to establishing these partnerships. Data reported in this article were collected using visual ethnography and filmed individual interviews with eight community mental health workers, six traditional and faith-based healers and two local philanthropists in the Bono East Region. The findings suggest that successful collaborations were built through mutually respectful interpersonal relationships, support from the health system and access to community resources. Although these facilitated collaboration, resource constraints, distrust and ethical dilemmas had to be overcome to build stronger partnerships. These findings highlight the importance of dedicated institutional and logistic support for ensuring the successful integration of the different health systems in pluralistic settings

It takes a village: what lessons can the UK learn from rural community mental health services in Ghana?

Purpose This paper aims to provide new insights into and offer potential solutions to the challenges encountered by mental health services working with remote, rural or underserved communities in the UK. Design/methodology/approach In this paper, the authors reflect on the utility of integrating conventional clinical approaches, with preventive care and empowering work within the community, to provide culturally sensitive and accessible mental health services. The authors describe an example of community intervention from a mental health service in Ghana designed to enhance reach within remote and rural communities and identify potential lessons for practice in the UK. Findings The partnership between community mental health services and the rural communities, including families and existing social frameworks, applies collaborative care to overcome the lack of resources and facilitate the acceptability of mental health services to the local population. There are a series of important lessons from this experience including the importance of understanding the culture of a community to optimise reach and the importance of working IN the community and WITH the community. Originality/value This paper is novel because it provides learning from a model of care applied in the global south that has potential for implementation with underserved populations in the UK. The authors suggest a reframing of the notion of community care to encompass existing frameworks of community, not merely a biomedical conceptualisation

The hermeneutics of recovery

The widespread use of faith-based and traditional healing for mental disorders within African contexts is well known. However, normative responses tend to fall within two camps: on one hand, those oriented towards the biomedical model of psychiatry stress the abuses and superstition of such healing, whilst critics adopting a more ‘local’ perspective have fundamentally challenged the universalist claims of biomedical diagnostic categories and psychiatric treatments. What seemingly emerges is a dichotomy between those who endorse more ‘universalist’ or ‘relativist’ approaches as an analytical lens to the challenges of the diverse healing strands within African contexts. In this article, we draw upon the resources of philosophy and existing empirical work to challenge the notion that constructive dialogue cannot be had between seemingly incommensurable healing practices in global mental health. First, we suggest the need for much-needed conceptual clarity to explore the hermeneutics of meaning, practice, and understanding, in order to forge constructive normative pathways of dialogue between seemingly incommensurable values and conceptual schemas around mental disorder and healing. Second, we contextualise the complex motives to emphasise difference amongst health practitioners within a competitive healing economy. Finally, we appeal to the notion of recovery as discovery as a fruitful conceptual framework which incorporates dialogue, comparative evaluation, and cross-cultural enrichment across divergent conceptualisations of mental health

The hermeneutics of recovery: facilitating dialogue between African and Western mental health frameworks

Abstract: The widespread use of faith-based and traditional healing for mental disorders within African contexts is well known. However, normative responses tend to fall within two camps: on one hand, those oriented towards Western psychiatry stress the abuses and superstition of such healing, whilst, critics adopting a more ‘local’ perspective have fundamentally challenged the universalist claims of Western diagnostic categories and psychiatric treatments. What seemingly emerges is a dichotomy between those who endorse more ‘universalist’ or ‘relativist’ approaches as an analytical lens to the challenges of the diverse healing strands within African contexts. In this paper we draw upon the resources of philosophy and existing empirical work to challenge the notion that constructive dialogue cannot be had between seemingly incommensurable healing practices in global mental health. First, we suggest the need for much needed conceptual clarity to explore the hermeneutics of meaning, practice, and understanding, in order to forge constructive normative pathways of dialogue between seemingly incommensurable values and conceptual schemas around mental disorder and healing. Second, we contextualise the complex motives to emphasise difference amongst health practitioners within a competitive healing economy. Finally, we appeal to the notion of recovery as discovery as a fruitful conceptual framework which incorporates dialogue, comparative evaluation, and cross-cultural enrichment across divergent conceptualisations of mental health

Bride Price and the State of Marriage in North-West Ghana

This paper sought to examine the role of bride price on the state of marriage among the Dagara of North-West Ghana. In the face of increasing scarcity of the items used in marriage in the study area, getting bride price has become a daunting task for many young men preparing to marry or already in marriage with consequences on the legitimacy and stability of families. Through purposive sampling, 5 FGDs and 9 personal interviews were conducted to obtain experiential information on bride price and state of marriage. The study revealed that the role of families, payback norms and incorporation (as part of bride price payment) are clear structures that have positive consequences for the stability of marriage; weakening potentially destabilising factors such as spousal abuse and the extra-marital sexual activities of men. Interestingly, the type and amount of items used for bride price have so much social and cultural significance that formal education and modernity has so far failed to completely change this practice among the people. The preceding allows us to conclude that the Dagara of Buo community are an epainogamous people, with societally supported marital norms and systems leading to marital stability. We recognise however that stability and longevity of marriage does not necessarily mean that spouses are ‘happy and content’ with their marriage. This is a relevant question that our current study did not explore. Thus, we recommend that a future quantitative study examine the relationship between marital stability and spousal ‘happiness and contentment.

Philosophical racism and ubuntu: In dialogue with Mogobe Ramose

This article discusses two complementary themes that play an important role in contemporary South African political philosophy: (1) the racist tradition in Western philosophy; and (2) the role of ubuntu in regaining an authentic African identity, which was systematically suppressed during the colonial past and apartheid. These are also leading themes in Mogobe Ramose’s African Philosophy Through Ubuntu. The first part concentrates on John Locke. It discusses the thesis that the reprehensible racism of many founders of liberal political philosophy has lethally infected liberal theory

Indigenous and faith healing in Ghana : a brief examination of the formalising process and collaborative efforts with the biomedical health system

CITATION: Kpobi, L. & Swartz, L. 2019. Indigenous and faith healing in Ghana : a brief examination of the formalising process and collaborative efforts with the biomedical health system. African Journal of Primary Health Care and Family Medicine, 11(1):a2035, doi:10.4102/phcfm.v11i1.2035.The original publication is available at https://phcfm.org/index.php/phcfmPublication of this article was funded by the Stellenbosch University Open Access Fund.Background: Health seeking in many African countries typically involves making use of multiple healing systems, including indigenous and faith systems, as well as biomedical healthcare systems. These different systems have co-existed for many years in Africa, including in Ghana. Aim: In this article, we examine the formalising processes that non-biomedical healthcare in Ghana has undergone in postcolonial times. We first present a brief historical analysis of the process of organising indigenous medical systems into formal bodies. We then conclude by exploring collaborative efforts that have been undertaken between biomedical and non-biomedical health systems in Ghana. Method: A historical analysis of formalised indigenous healing systems in Ghana was done through an examination of relevant literature. Results: Formal groups of indigenous healers in Ghana who are organised into specific categories have undergone various transformations over the years. Evidence also exists of collaborative programmes developed with traditional healers in Ghana, although these have been largely for primary health partnerships. With regard to mental health collaborations, attempts at integration have been generally unsuccessful, with various factors identified as hindering successful partnerships. Conclusion: Indigenous healing is an important component of healthcare in Ghana. Collaboration between the different healthcare systems can be strengthened through accurate understandings of how key stakeholders are situated (and indeed situate themselves) in the conversation.Publisher's versio

Indigenous and faith healing for mental health in Ghana : an examination of the literature on reported beliefs, practices and use of alternative mental health care in Ghana

CITATION: Kpobi, L. & Swartz, L. 2019. Indigenous and faith healing for mental health in Ghana : an examination of the literature on reported beliefs, practices and use of alternative mental health care in Ghana. African Journal of Primary Health Care and Family Medicine, 11(1):a1941, doi:10.4102/phcfm.v11i1.1941.The original publication is available at https://phcfm.org/index.php/phcfmPublication of this article was funded by the Stellenbosch University Open Access Fund.Background: For many people in African countries, various forms of health care are utilised for the treatment of illness. This pluralistic nature of health seeking includes the use of indigenous, faith and allopathic medicines for care. Aim: In this article, our aim was to gain insight into the existing knowledge on indigenous and faith healing in Ghana, with a particular focus on mental health care. We first examine the reported mental health beliefs and practices of Ghanaian alternative healers. Following this, we look at the use and purported preference for non-biomedical mental health care by patients. Methods: Relevant literature was examined to explore the beliefs, practices and use of non-biomedical mental health care systems in Ghana Results: Evidence for the use and preference for non-biomedical mental health care is largely anecdotal. Similarly, the mental health beliefs of alternative healers have been documented in various small-scale studies. However, such information is important if mental health services in Ghana are to be improved. Conclusion: Integration of the different healthcare systems must be built on knowledge of beliefs and methods. A clearer understanding of the work of non-biomedical healers is important if appropriate recommendations are to be made for collaboration between biomedical and non-biomedical systems in Ghana.https://phcfm.org/index.php/phcfm/article/view/1941Publisher's versio

Barriers and facilitators to the use of the mental health information system in Ghana: A qualitative study amongst users at the Accra Psychiatric Hospital

Thesis (MA)--Stellenbosch University, 2015ENGLISH ABSTRACT : One of the most successful modes of record-keeping and data collection is the use of health management information systems, where patient information and management plans are uniformly entered into a database to streamline the information and for ease of further patient management. For mental healthcare, a mental health information system (MHIS) has been found most successful. A properly established and operational MHIS is crucial in developing equitable and appropriate mental health care systems. Despite the obvious benefits of having a well-structured MHIS, its existence does not guarantee efficient use. There are a number of potential problems which may arise in the implementation of the MHIS, especially in poorly-resourced contexts. All of these problems may result in poor quality data being generated through the system, thereby compromising the use and efficiency of the MHIS. Staff motivation to provide accurate data for entry will also be affected. Until 2010, the system of keeping patient records and information in the Accra Psychiatric Hospital was old and outdated. In light of this and other factors, the Mental Health and Poverty Project (MHaPP) undertook a complete reforming of the mental health information systems in three psychiatric hospitals in Ghana in 2010. Although much was written on the implementation of the information systems, little is known about the current state of the system in Ghana four years after it was implemented. In view of this the present study sought to explore the experiences of users at the Accra Psychiatric Hospital in using the new MHIS, and to ascertain what their perceptions are of areas for improvement in the current system. A mixed methods approach was adopted. First, an audit was undertaken of usage of the MHIS. Second, participants‘ knowledge of the system and its use, as well as the influence of institutional processes on work were explored through the use of observations and semi-structured in-depth interviews. Data was analyzed using an interpretative phenomenological approach. Participants in the study were in three categories: prescriber, administrator, and records clerk. The final sample consisted of seven prescribers, one administrator and one records clerk. Participants reported increased workload, inadequate logistic support and staff shortages as the barriers to the effective use of the MHIS. Recommendations for improving the system included revising the form and migrating to a fully computerized system. These are discussed with reference to both micro and macro level institutional structures.AFRIKAANSE OPSOMMING : Een van die mees suksesvolste metodes van rekordhouding en data-insameling is die gebruik van gesondheidbestuur inligtingstelsels, waar pasiënt inligting en bestuursplanne eenvormig ingevoer word in 'n databasis om die inligting te vereenvoudig en vir die gemak van verdere pasiënt bestuur. Vir geestelike gesondheidsorg, word 'n geestesgesondheid inligtingstelsel (GGIS) as meer suksesvol beskou. 'n Goed gevestigde en operasionele GGIS is van kardinale belang in die ontwikkeling van billike en gepaste geestesgesondheidsorg stelsels. Ten spyte van die ooglopende voordele van 'n goed-gestruktureerde GGIS, sal bloot sy bestaan nie noodwendig doeltreffende gebruik waarborg nie. Daar is 'n aantal potensiële probleme wat mag ontstaan in die implementering van die GGIS, veral in swak toegeruste kontekste. Al hierdie probleme kan lei daartoe dat swak gehalte data gegenereer word deur die stelsel en daardeur die gebruik en doeltreffendheid van die GGIS affekteer. Personeel motivering om toepaslike data in te voer, sal ook geraak word. Tot en met 2010 was die sisteem vir die behoud van pasiënt rekords en inligting in die Accra Psigiatriese Hospitaal verouderd. In die lig van hierdie en ander faktore, het die Mental Health and Povert Project (MHaPP) onderneem om 'n volledige hervorming van die geestesgesondheid inligtingstelsels in drie psigiatriese hospitale in Ghana in 2010 te voltooi. Hoewel baie geskryf is oor die implementering van die inligtingstelsels, is min bekend oor die huidige toestand van die stelsel in Ghana vier jaar nadat dit geïmplementeer is. In die lig hiervan het die huidige studie gepoog om die ervarings van gebruikers van die nuwe GGIS by die Accra Psigiatriese Hospitaal te ondersoek, en om te bepaal wat hul persepsies is van areas vir verbetering in die huidige stelsel. 'n Gemengdemetodebenadering word gevolg. Eerstens, was 'n oudit onderneem oor die gebruik van die GGIS. Tweedens, is deelnemers se kennis van die stelsel en die gebruik daarvan, asook die invloed van institusionele prosesse op werk ondersoek deur gebruik te maak van waarnemings en semi-gestruktureerde in-diepte onderhoude. Data is geanaliseer deur gebruik te maak van 'n interpreterende fenomenologiese benadering. Deelnemers aan die studie was in drie kategorieë: voorskrywer, administrateur, en rekords klerk. Die finale steekproef het bestaan uit sewe voorskrywers, een administrateur en een rekords klerk. Deelnemers het verhoogde werklas, onvoldoende logistieke ondersteuning en personeeltekorte as hindernisse tot die effektiewe gebruik van die GGIS rapporteer. Aanbevelings vir die verbetering van die stelsel het ingesluit die hersiening van die vorm en migrasie na 'n volle gerekenariseerde stelsel. Hierdie aanbevelings word bespreek met verwysing na beide mikro- en makrovlak institusionele strukture

Indigenous and faith healing for mental disorders : an exploratory study of healers in Accra, Ghana

Thesis (PhD)--Stellenbosch University, 2018.ENGLISH ABSTRACT: Mental health care in Ghana is not limited to biomedical care. A large number of service users are believed to utilise non-biomedical avenues in the pathway to health seeking. These non-biomedical treatments include indigenous and faith healing methods. Although some studies in Ghana have examined the reasons for and use of alternative mental health care methods, not many have examined the beliefs about mental illness and the treatment methods of the healers themselves. In this qualitative study, my aim was to examine how indigenous and faith healers conceptualised mental disorders, providing rich data on their perspectives and experiences. In particular, I questioned the perceived homogeneity of non-biomedical practitioners in Ghana by examining the nuances in mental health notions between different categories of non-biomedical healers. Thus, the objectives were to assess the beliefs and methods of different types of healers about different types of disorders, as well as to examine their views on collaboration with biomedical service providers. Using Kleinman’s Explanatory Models of Illness concept as a guiding framework, individual, semi-structured interviews using case vignettes were conducted with thirty-six indigenous and faith healers who lived and/or worked in the Greater Accra Region of Ghana. The healers comprised herbalists, Pentecostal Christian faith healer, Muslim healers, and traditional medicine men/priests. The findings of this research suggest that unlike the perceptions of homogenous conceptualisation of mental disorders by non-biomedical practitioners, differences exist in the way different disorders are understood and treated by indigenous and faith healers, including differences in classification, perceived best treatments and perceived impact of the disorder. Although there were some similarities to biomedical concepts as well as between the healers, there were also important differences across the different types of healers. With respect to integration of services, the healers’ views on collaboration with biomedicine varied based on their own perceptions of power and position. These findings present further perspectives on the fluid, dynamic and often multifaceted nature of mental health care provision in a country such as Ghana, and provide a lens to understanding the work of indigenous and faith healing in a pluralistic health care setting. The study concludes by outlining some potential next steps for developing dialogues on integration of mental health care services in Ghana.AFRIKAANSE OPSOMMING: In Ghana word geestesgesondheidsorg nie tot biomediese sorg beperk nie. Daar word vermoed dat ‘n groot getal diensgebruikers nie-biomediese weë in die soeke na gesondheid benut. Hierdie nie-biomediese behandelings sluit inheemse en geloofsgenesingsmetodes in. Alhoewel die redes vir en gebruik van alternatiewe geestesgesondheidsorgmetodes al in sommige studies in Ghana ondersoek is, is daar nog nie veel ondersoek ingestel na die oortuigings rakende geestesgesondheid en die behandelingsmetodes van die genesers nie. In hierdie kwalitatiewe studie was my doel om die manier waarop inheemse en geloofsgenesers geestesgesondheid konseptualiseer te ondersoek, ten einde ryk data oor hul perspektiewe en ervarings te bied. In besonder het ek die waargenome gelyksoortigheid van nie-biomediese praktisyns in Ghana bevraagteken deur die nuanses in geestesgesondheidsopvattings tussen verskeie kategorieë van nie-biomediese genesers te ondersoek. Die doelwitte was om die oortuigings en metodes van verskillende genesers oor verskillende tipes siektetoestande te evalueer asook om hulle sieninge oor samewerking met biomediese diensverskaffers te ondersoek. Individuele, semi-gestruktureerde onderhoude, waartydens gevalle-vignettes gebruik is, is gevoer met ses-en-dertig inheemse -en geloofsgenesers, wat in die groter Accra-gebied in Ghana gewoon of gewerk het. Kleinman se Verduidelikende Modelle van Siekte-konsep is as rigtende raamwerk met die voer van die onderhoude gebruik. Die genesers het bestaan uit kruiedokters, pinkster-christelike geloofsgenesers, Moslem-genesers en tradisionele toordokters/priesters. Die bevindinge van hierdie studie dui daarop dat, in teenstelling met die waargenome homogene konseptualisering van geestessiektetoestande deur nie-biomediese praktisyns, daar verskille bestaan in die maniere waarop verskillende siektetoestande verstaan en behandel word deur inheemse en geloofsgenesers, insluitend verskille in klassifikasie, waargenome beste behandelings en waargenome impak van die siektetoestand. Alhoewel daar sommige ooreenkomste met biomediese konsepte asook tussen genesers bestaan het, was daar ook belangrike verskille tussen die verskillende tipes genesers. Wat die integrasie van dienste aanbetref, het die genesers se sieninge oor samewerking met biomedisyne gevarieër gebaseer op hul eie oortuiginge oor mag en posisie. Hierdie bevindinge bied verdere perspektiewe op die vloeibare en dinamiese aard van geestesgesondheidsorgvoorsiening, wat dikwels uit veelvuldige fasette bestaan, in ‘n land soos Ghana en bied ‘n lens op die verstaan van die werk van inheemse en geloofsgenesing in ‘n pluralistiese gesondheidsorgomgewing. Die studie word afgesluit deur ‘n paar potensiële volgende stappe vir die ontwikkeling van ‘n dialoog oor die integrasie van geestesgesondheidsorgdienste in Ghana uit te lig