Project Lead(s): Christine Musyimi
Depression is a major public health problem; access to mental health specialists in developing countries is inadequate and therefore depression is often untreated in primary healthcare settings.
While there is an acute shortage of formal mental health workers in some countries, there is a surplus of the informal faith and traditional healers who are highly patronized at the community level.
In Kenya, such healers see about 40–60% of patients with mental health disorders and about 20% suffering from depression. There is a need to train these healers to integrate screening for depression and provide adapted psychosocial interventions into their routine practice.
The Dialogue project sought to empower, supervise, support and include the informal traditional and faith healers to deliver evidence-based psychosocial interventions, to reduce the mental health treatment gap in rural Kenya (Makueni County, Kibwezi Sub-County).
Traditional healers were trained in the use of the World Health Organization's mental health Gap Action Program Intervention Guideline (mhGAP-IG) to identify and manage depression. This training involved a highly interactive experiential learning that included small-group work and role plays.
One hundred traditional and faith healers (THPs) were trained using an adapted mhGAP-IG.
Over a period of three months, 4,081 patients were screened for depression and 22.9% scored positive for depression.
Because the total number screened exceeded the number expected (3,000), the training was shown to increase access to mental health services in the community.
The change in depression scores was measured using the Becks Depression Inventory scale (BDI) and showed a highly significant 34% improvement of depression symptoms three months after the intervention.
In a test group of 100 subjects, a strong relationship was shown between the traditional and faith healers’ patients’ diagnosis and that of a mental health professional using clinical judgement, as per DSM-IV guidelines (the reference standard).
The ability of THPs to correctly identify patients with depression (sensitivity) was 46%, while the likelihood that the patient will actually have depression (positive predictive value) was 79%.
The ability to correctly exclude depression from patients (specificity) was 86% and the likelihood that the patient will have no depression (negative predictive value) was 57.8%.
To alleviate mistrust and enhance respect, a dialogue was facilitated between traditional faith healers and healthcare workers through independent discussions with each group.
The majority of practitioners showed an interest in collaborating and stated that they had joined the dialogue to interact with people committed to improving the lives of patients.
Results from this project have been presented at conferences, published in the Journal of Ethnobiology and Ethnomedicine, and other manuscripts have been accepted and developed for publication in a mental health journal.