All around the world mental health care tends to get marginalised - and globally Africa always gets marginalised - so the combination of mental health and Africa must be one of the most neglected subjects imaginable! But there are encouraging signs: Dr. Cathy Abbo, from the Department of Psychiatry at Uganda's Makerere University, has just summarised her PhD studies on mental health in Uganda in the open-access journal Global Health Action.
Cathy's work is particularly interesting because she looked at a range of mental health problems both in terms of modern psychiatric understandings and in the hands of traditional healers. Right across Africa one finds a complex mix of modern and traditional approaches to medicine - and not only in mental health - but rigorous work that objectively considers both the modern and the traditional in parallel is rare. Traditional healers in Africa are often closer and more accessible to the community than more formal health services. Combining this accessibility with traditional spiritual beliefs, it's not surprising that most people in Uganda are said to use traditional healers for their health care needs, including mental health problems. African traditional healers often apply a combination of herbal and spiritual approaches for mental disorders. Frequently people seek traditional and more formal sources of care in parallel for the same problem.
Prof. Vikram Patel of the London School of Hygiene and Tropical Medicine, who was Cathy's PhD examiner, noted the striking similarities between traditional healers' understandings of severe mental disorders and the established psychiatric model, in his commentary on this work. Despite common stereotypes of African witchdoctors, what comes through here is much more a sense of established and thoughtful practitioners. Perhaps not surprisingly, therefore, one of Cathy's main conclusions was that Ugandans with serious mental disorders who consulted both biomedical services and traditional practitioners emerged with the best outcomes.
The current popularity of complementary therapies in industrialised countries probably also points in the same direction. Biomedical approaches to mental health undoubtedly offer huge healing potential, but engaging with other long-established traditions may bring additional benefits. Twenty years ago the World Health Organization called for the integration of traditional medicine into health services as a contribution to overall health, but we still seem a long way from that goal.