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Patel, Vikram (2011)
Publisher: CoAction Publishing
Journal: Global Health Action
Languages: English
Types: Article
Subjects: RA1-1270, Public aspects of medicine, PhD REVIEW, Commentary
Global mental health is primarily concerned with reducing inequalities in the access to health care and health outcomes for people with mental illness within and between countries (1). Reducing the vast treatment gap and promoting the rights of people with mental illness to live with dignity are major goals of adherents of the field such as the Movement for Global Mental Health (www.globalmentalhealth.org). In this context, the thesis by Abbo summarised in her PhD Review paper in Global Health Action (2) is a timely reminder of the role of a key player in the mental health care system in African countries where the biomedical treatment gap is notably large - the traditional healer. Her series of studies in Uganda show that a variety of indigenous labels are used by traditional healers to describe what biomedical psychiatry categorises as psychotic disorders and that these are associated with a range of explanatory models, from supernatural/spiritual causes to somatic causes such as HIV. The prevalence of any mental illness amongst patients seeking help from traditional healers is very high and, notably, the vast majority of persons with psychotic disorders were also concurrently seeking help from the biomedical sector. There was a strong association of mental illness with indicators suggestive of poverty, such as lack of food or indebtedness and, amongst those patients who had a psychotic disorder, being in debt was associated with poorer outcomes. These findings serve to replicate a rich record of evidence from several countries in the region, going back several decades that testify to three major findings: severe mental illness is clearly recognised as causes of illness and suffering by indigenous communities, poverty and mental illness frequently co-exist, and traditional healers plays a prominent role in mental health care. Each of these findings has important implications for global mental health.(Published: 2 August 2011)Citation: Global Health Action 2011, 4: 7956 - DOI: 10.3402/gha.v4i0.7956
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    • 1. Patel V, Prince M. Global mental health: a new global health field comes of age. JAMA 2010; 303: 1976 7.
    • 2. Abbo C. Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda. Global Health Action 2011; 4. DOI: 10.3402/gha.v4i0.7117.
    • 3. Patel V. Explanatory models of mental illness in sub-Saharan Africa. Soc Sci Med 1995; 40: 1291 8.
    • 4. Patel V, Lund C, Heatherill S, Plagerson S, Corrigal J, Funk M et al. Mental disorders. In: Blas E, Sivasankara Kurup A, eds. Priority public health conditions: from learning to action on social determinants of health. Geneva: World Health Organisation; 2010, 115 34.
    • 5. Lund C, De Silva M, Plagerson S, Cooper S, Chisholm D, Das J, et al. Poverty and mental disorders: breaking the cycle in lowincome and middle-income countries. Lancet. In press.
    • 6. Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet 2007; 370: 878 89.
    • 7. World Health Organisation (WHO). Traditional medicine and modern health care (Progress report by the Director General on the Forty-Fourth World Health Assembly). Geneva: WHO; 1991.
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