Traditional healers are common in most low-income countries and, despite the presence of practitioners of modern medicine, people routinely consult traditional healers in the first instance. Indeed this situation is aggravated in countries where the public know that even if they do consult primary care or specialist clinics, there is unlikely to be an available supply of medicine. In Western countries there has also been a resurgence of alternative healers such as homeopathy, aromatherapy, acupuncture, and shiatsu. More research needs to be done on the prevalence of psychiatric disorders in people who consult traditional healers, but it is likely that the prevalence is at least as high as it is in people who consult primary care doctors. Collaboration and exchange of ideas is likely to be helpful. There has already been considerable cross-fertilization and many if not most traditional healers are familiar with concepts of psychosis, depression, epilepsy, and alcohol abuse, and have some recognition of the value of hospital tests and often encourage their clients to use orthodox care as well.
There is no doubt that traditional healers tend to give patients respect, dignity, and time. Traditional healers characteristically spend time eliciting the social and family context to the illness. It is likely that patients with moderate depression, anxiety, somatization, and hysterical epilepsy will do well with the traditional healer. Other patients with more severe illnesses, psychosis, and epilepsy are likely to continue to be symptomatic unless assessed, investigated, and actively treated by more orthodox medicines and therapies although this does not preclude continuing support from traditional healers as well.
Policy will need to set the framework to encourage regular opportunities for discussion, through workshops between mental health personnel, primary health-care teams, and traditional healers working towards gradual agreement of collaborative ways of working which may eventually include criteria for referral, diagnostic algorithms, shared care, and consideration of appropriate research including evaluation of traditional herbal remedies. In a number of countries including Zanzibar there is already good liaison between the obstetric service and traditional birth attendants. In Rawalpindi, Pakistan, diagnostic algorithms have been developed between the psychiatric service and traditional healers to encourage the referral of people with psychosis, and with petit mal and grand mal fits.
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