Exploration of indigenous knowledge and practices of the relatives of mental health care users regarding management of mental disorders in Malawi

Exploration of indigenous knowledge and practices of the relatives of mental health care users regarding the management of mental disorders. This study was conducted to explore the management of mental disorders amongst the indigenous people of the Dedza District in Malawi. The government of Malawi declared public mental health services to be free of charge, as a strategy to reduce the burden of disease to the country. Yet despite the free health care services, the indigenous people of Malawi did not take advantage of these free mental health care services, as they regarded them to be culturally incongruent. Instead they used traditional healing systems for mental disorders and consulted the Western health systems only when the traditional systems had failed, the mental health condition had become worse and the mental health care user had become unmanageable. This study was then conducted to explore what the Malawians regarded as culturally sensitive public mental health services. Method: A qualitative phenomenological research approach was adopted to explore the views of the relatives of mental health care users about culturally sensitive public mental health care services. A purposeful sampling method was used to select information rich participants amongst the relatives of mental health care users of indigenous Malawian origin. An unstructured interview guide was used to gather data through face to face interviews. Saturation of data was reached after interviewing fifteen (15) relatives. The verbatim transcribed data from the participants were content analyzed to identify the themes, categories and subcategories. Themes that emerged were: community beliefs; perceived causes, delayed decision making and health system factors. viii Findings: The community beliefs about the management of mental disorders were on traditional and religious health systems. The traditional healers were consulted in cases where mental illness was believed to be caused by witchcraft and spiritual healers were consulted where mental illness was believed to be caused by ancestral wrath. Even such consultations were delayed as the decisions on the type of healer to be used to manage the mental health care user, had to come from the extended family members. These processes took place during the acute phase of the mental illness and thus explain the delays in consulting with the Western mental health care systems. Such delays had a potential to contribute to the chronicity and the related complications of the illness. The Western health care services were only consulted when the indigenous healing systems were unsuccessful. Yet even the western healing systems were not the best option due to the negative and disrespectful attitudes of health care professionals, the impersonal nature of services, the use of foreign language and delays in service delivery. The recommendations were that the results of this study should be used as guidelines to develop strategies for culturally congruent mental health care services to the indigenous Malawians as the development of the strategies was beyond the scope of this study. The focus of the guidelines to ensure the development of evidence-based nursing practices in rendering culturally congruent mental health services to the indigenous Malawians. Firstly, there should be an integration of both the Western and the traditional healing systems to ensure a holistic patient centered approach to the care of the indigenous people of Malawi; secondly to use the nursing process phases, starting with the assessment, the formulation of the nursing diagnosis, the expected outcomes, the development and implementation of the nursing interventions and the discharge ix plans to incorporate the belief systems of the indigenous Malawians as identified in this study