Integrating Alternative and Traditional Treatments a Challenge in Global Mental Health

It will be a challenge to develop and implement appropriate models for collaboration between conventional western psychiatry and alternative, traditional approaches to treating psychological crises that are popular in many low and middle-income countries, according to a literature review and commentary in The Lancet Psychiatry.

“Every healing modality assesses and categorises patients’ distress according to its own philosophy of illness, which is embedded in a larger world view,” noted the authors, a team of Nigerian and South African researchers. “Diagnostic systems differ and by necessity show differences in world views. Thus unsurprisingly, practitioners of traditional medicine, and most complementary and alternative medicine use diagnostic systems that are incompatible with conventional medicine.”

Every country and every situation, they wrote, might require a different type of integrative, collaborative or complementary solution. “For example, traditional medicine practitioners could administer psychotropic medication and brief psychotherapies to patients in rural areas, or be trained to deliver other psychiatric support. Although task-shifting might expand the reach of psychiatric services in countries with few resources, this approach makes little use of healers’ unique skills and specific advantages, which should instead be acknowledged and built on.”

“In a collaborative model,” the researchers continued, “traditional or conventional medicine practitioners remain autonomous and independent, but cooperate fully; for example, by referring patients to each other or consulting on complex cases. In a fully integrated model, traditional and conventional medicine health-care services would be blended into a new hybrid system such that patients need not choose one over the other. Treatment approaches would be integrated; for example, a culturally relevant explanation might be given for why someone is depressed, followed by the necessary ritual and a prescription for an antidepressant.”

“Just one model is unlikely to suit every situation,” they concluded, “so a region’s solution will need to be tailored to local circumstances and resources. This tailored approach should be based on a more detailed understanding of the dynamics of traditional medicine than we have at present.”

Gureje, Oye, Gareth Nortje, Victor Makanjuola, Bibilola D Oladeji, Soraya Seedat, and Rachel Jenkins. “The Role of Global Traditional and Complementary Systems of Medicine in the Treatment of Mental Health Disorders.” The Lancet Psychiatry 2, no. 2 (February 2015): 168–77. doi:10.1016/S2215-0366(15)00013-9. (Full text with free registration)