UNDERSTANDING AND MANAGING THE INTERACTION BETWEEN CONVENTIONAL TREATMENT AND TRADITIONAL HEALERS –
Mental Health Care and Well-being Conference
The second annual event of the Mental Health Care and Well-being Conference was held at Movenpick Indaba Hotel during February this year. The topic of day one was “Mental Health in the Workplace”. Speaking on “The Interface between Conventional Treatment and Traditional Healers” was Miss Amanda Shembe of the Witwatersrand Mental Health Society, who is co-ordinator of the Society’s Corporate Services Division. Focusing within the context of the work environment, she outlined two approaches for understanding the interaction between conventional treatment and traditional healers, highlighting their advantages and disadvantages. She then briefly introduced a model for managing and understanding a complementary interaction of these approaches as proposed by Wits Mental Health and adapted from a community-based level.
According to Miss Shembe, two approaches influence the interaction between conventional treatment and traditional healers. The first approach is based on the Diagnostic Statistical Manual of Mental Disorders (DSM IV), and categorises mental disorders or diagnoses based on their symptoms. Although categorising mental illnesses in this way means that appropriate treatment is accessible and available, and that cases which enter a mental health system can be easily identified and counted, Miss Shembe does point out that there are also a number of disadvantages with this approach. Firstly, there are difficulties relating to misdiagnoses of mental illnesses. For instance, according to Miss Shembe, research shows that a majority of cases of depression and anxiety are either undetected or misdiagnosed. Secondly, in some cases their doctors do not explain the side effects of the prescribed medications to patients. There exists a gap between offering of treatment and the informed decision. Lastly, patients experience relapses and no structures exist to manage continuity or care.
The second approach follows the assumption that meanings attached to mental health problems are culturally constructed and defined. It seems logical that one should integrate traditional healing with conventional treatment in this kind of approach. However, as Miss Shembe points out, there is no consensus as to what is appropriate. Perhaps what needs to be proposed at this stage is the co-operative use of both approaches.
The Witwatersrand Mental Health Society has proposed a model developed for a community based approach. In this model, the communication between the employee, traditional healer and Corporate Wellness Programme (CWP) is outlined. The CWP or Employee Assistance Programme of each company assists and supports employees in terms of seeking treatment for mental illnesses. Currently, traditional healing is not incorporated into the CWP as a form of treatment. Thus, the model proposes the need to take into consideration the culture of the employee where support or assistance is required, and based on this, refer him or her to either a conventional or traditional mental health professional.
In this model, the workplace is assumed to be one community together with the CWP. The employee will approach the CWP of the company, which could include psychologists, social workers and industrial psychologist, or in their absence, the supervisors, human resource mangers and the like. The CWP refers the employee to the primary level of intervention – WITS Mental Health or a primary mental health clinic whose function it is to identify mental health problems, and to provide counselling. A referral may be made to the secondary level, which includes formal sectors (recognised as official mental health systems) and informal sectors. The employee will be provided with a referral form, which is submitted at this secondary level. In cases where the employee delays seeking treatment until a mental illness is developed, he or she will be referred to the tertiary level, where a psychiatrist or doctor will provide an assessment, diagnosis, consultation and treatment. From here, the employee can go back to the CWP or Wits Mental Health. In this way, the employee is re-integrated into the workplace by the Supported Employment Programme (SEP), a vocational re-integration programme which helps employees with mental illnesses to maintain employment within the open labour market. The advantage of this model is that it allows communication between the different levels of intervention. This is done through consultation at every level of care.
In terms of helping an employee with mental illness, Miss Shembe suggests that what first needs to be determined is how the employee perceives mental health problems; that is, what does he or she regard as the cause. If mental illness were understood in terms of a medical perspective, the obvious point of entry for help would be general health care facilities, a private clinic or doctor. On the other hand, if mental illness is understood in terms of traditional or spiritual causes, the entry point may be traditional healing.
Amanda Shembe notes that their role as a mental health society is not to define what necessary options exist, but together with employers and society as a whole, to acknowledge the existence of cultural differences. Their role as a mental health society is to act on behalf of the employee in terms of their rights and also to determine the necessary programs to ensure the acknowledgement of different cultures.
Although this model serves a number of advantages, Miss Shembe notes that there are also some obstacles to its implementation. Firstly, there may be a lack of co-operation between mental health professionals. Secondly, there may be a lack of trust on the part of both traditional healers and conventional mental health professionals. Traditional healers may be reluctant to disclose information regarding treatment formulas. This existing gap could foster a conflict of interest between the parties. Thirdly, there still exists the stigma associated with mental health distress – whether the mode of treatment would come from conventional treatment or traditional healing. Lastly, there is the ethical dilemma. Traditional beliefs may interfere with work performance and employee morale in situations where witchcraft enters into the workplace. Perhaps a start to overcoming these barriers is to involve all parties in a discussion with regard to the development of the structure.
On a final note, Amanda Shembe emphasised that it is extremely important to understand that the extent of success of a mental health programme rests with the consumer. Thus, in promoting metal health issues, mental health professionals can only be successful if they approach mental health interventions “through the eyes of the consumer”. This in turn must be “guided by the understanding that the individual’s culture should not be isolated from the cultural group to which he or she belongs”, said Miss Shembe.