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      Mental health treatment in Kenya: task-sharing challenges and opportunities among informal health providers

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          Abstract

          Background

          The study was conducted to explore challenges faced by trained informal health providers referring individuals with suspected mental disorders for treatment, and potential opportunities to counter these challenges.

          Methods

          The study used a qualitative focus group approach. It involved community health workers, traditional and faith healers from Makueni County in Kenya. Ten Focus Group Discussions were conducted in the local language, recorded and transcribed verbatim and translated. Using a thematic analysis approach, data were entered into NVivo 7 for analysis and coding.

          Results

          Results demonstrate that during the initial intake phase, challenges included patients’ mistrust of informal health providers and cultural misunderstanding and stigma related to mental illness. Between initial intake and treatment, challenges related to resource barriers, resistance to treatment and limitations of the referral system. Treatment infrastructure issues were reported during the treatment phase. Various suggestions for solving these challenges were made at each phase.

          Conclusions

          These findings illustrate the commitment of informal health providers who have limited training to a task-sharing model under difficult situations to increase patients’ access to mental health services and quality care. With the identified opportunities, the expansion of this type of research has promising implications for rural communities.

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          Most cited references30

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          The role of global traditional and complementary systems of medicine in the treatment of mental health disorders

          Traditional and complementary systems of medicine include a broad range of practices, which are commonly embedded in cultural milieus and reflect community beliefs, experiences, religion, and spirituality. Two major components of this system are discernible: complementary alternative medicine and traditional medicine, with different clientele and correlates of patronage. Evidence from around the world suggests that a traditional or complementary system of medicine is commonly used by a large number of people with mental illness. Practitioners of traditional medicine in low-income and middle-income countries fill a major gap in mental health service delivery. Although some overlap exists in the diagnostic approaches of traditional and complementary systems of medicine and conventional biomedicine, some major differences exist, largely in the understanding of the nature and cause of mental disorders. Treatments used by providers of traditional and complementary systems of medicine, especially traditional and faith healers in low-income and middle-income countries, might sometimes fail to meet widespread understandings of human rights and humane care. Nevertheless, collaborative engagement between traditional and complementary systems of medicine and conventional biomedicine might be possible in the care of people with mental illness. The best model to bring about that collaboration will need to be established by the needs of the extant mental health system in a country. Research is needed to provide an empirical basis for the feasibility of such collaboration, to clearly delineate its boundaries, and to test its effectiveness in bringing about improved patient outcomes.
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            'Whether you like it or not people with mental problems are going to go to them': a qualitative exploration into the widespread use of traditional and faith healers in the provision of mental health care in Ghana.

            Limited research has been conducted to explore the factors that support or obstruct collaboration between traditional healers and public sector mental health services. The first aim of this study was to explore the reasons underpinning the widespread appeal of traditional/faith healers in Ghana. This formed a backdrop for the second objective, to identify what barriers or enabling factors may exist for forming bi-sectoral partnerships. Eighty-one semi-structured interviews and seven focus group discussions were conducted with 120 key stakeholders drawn from five of the ten regions in Ghana. The results were analysed through a framework approach. Respondents indicated many reasons for the appeal of traditional and faith healers, including cultural perceptions of mental disorders, the psychosocial support afforded by such healers, as well as their availability, accessibility and affordability. A number of barriers hindering collaboration, including human rights and safety concerns, scepticism around the effectiveness of 'conventional' treatments, and traditional healer solidarity were identified. Mutual respect and bi-directional conversations surfaced as the key ingredients for successful partnerships. Collaboration is not as easy as commonly assumed, given paradigmatic disjunctures and widespread scepticism between different treatment modalities. Promoting greater understanding, rather than maintaining indifferent distances may lead to more successful co-operation in future.
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              Optimizing mental health services in low-income and middle-income countries.

              Against the backdrop of a large burden and treatment gap for mental disorders in low-income and middle-income countries (LMICs), recently published articles were reviewed to assess strategies and actions for optimizing mental health services in LMICs. Key strategies and actions are as follows: (i) the adoption of a decentralized stepped care approach embracing task shifting to nonspecialists for those disorders for which it has been shown to be effective; (ii) ensuring adequate numbers of mental health specialists to provide a supportive supervisory framework and referral pathways; (iii) ensuring adequate infrastructure to support decentralized care; (iv) promoting mental health literacy; (v) adoption of a social inclusion and developmental model of disability in caring for people with chronic mental illness; and (vi) embracing a multisectoral community collaborative approach. Optimizing mental health services in LMICs requires legislation, policies and plans that are enabling of the above strategies and actions. Studies demonstrating the cost-effectiveness of integrated stepped packages of care embracing a task-shifting approach, and best practices for strengthening mental health literacy and collaborative arrangements with community caregivers and other sectors, can assist this process. Specialist mental health training programmes in LMICs also need to be responsive to the changing demands on service providers, incorporating a public health approach and equipping specialists for diversification of their roles within the task shifting model.
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                Author and article information

                Contributors
                christine.musyimi@amhf.or.ke
                vmutiso@amhf.or.ke
                +254 020 2651360 , dmndetei@amhf.or.ke
                iunanue@paloaltou.edu
                ddesai@paloaltou.edu
                spatel@paloaltou.edu
                abednego.musau@amhf.or.ke
                David.Henderson@bmc.org
                erick.nandoya@amhf.or.ke
                j.g.f.bunders-aelen@vu.nl
                Journal
                Int J Ment Health Syst
                Int J Ment Health Syst
                International Journal of Mental Health Systems
                BioMed Central (London )
                1752-4458
                1 August 2017
                1 August 2017
                2017
                : 11
                : 45
                Affiliations
                [1 ]Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya
                [2 ]ISNI 0000 0004 1754 9227, GRID grid.12380.38, , Vrije Universiteit, ; De Boelelaan 1105, 1081 HV Amsterdam, Netherlands
                [3 ]ISNI 0000 0001 2019 0495, GRID grid.10604.33, , University of Nairobi, ; P.O Box 30197, Nairobi, 00100 Kenya
                [4 ]ISNI 0000 0004 0526 6385, GRID grid.261634.4, , Palo Alto University, ; 1791 Arastradero Road, Palo Alto, CA 94304 USA
                [5 ]ISNI 0000 0004 0367 5222, GRID grid.475010.7, , Boston University School of Medicine, ; 72 E. Concord St, Boston, MA 02118 USA
                [6 ]ISNI 000000041936754X, GRID grid.38142.3c, , Harvard Medical School, ; 25 Shattuck Street, Boston, MA 02115 USA
                Article
                152
                10.1186/s13033-017-0152-4
                5540195
                28096897
                3557d70a-d68c-445b-bc92-4fcd82085b60
                © The Author(s) 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 May 2017
                : 20 July 2017
                Funding
                Funded by: Grand Challenges Canada (GCC)
                Award ID: (grant number 0739-05)
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2017

                Neurology
                informal health providers,task sharing,mental health,challenges,kenya
                Neurology
                informal health providers, task sharing, mental health, challenges, kenya

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