Culture And Common Mental Disorders In Sub Saharan Africa

The influence of culture on mental illness has been the subject of considerable academic investigation and debate in recent years. This debate has provoked concerns about the validity and reliability of older methodologies which emphasised either universal characteristics of disorders which were heavily biased towards Euro-American systems, or the culturally relativist approach which saw psychological disorders as products largely of their own culture. The "new" cross-cultural psychiatry proposed that the integration of ethnographic and epidemiological techniques be required to enable a culture sensitive psychiatric model to emerge. This monograph describes a series of research studies conducted in primary care in Harare, Zimbabwe, focusing on the most frequent of all psychological disorders, Common Mental Disorders (CMD). The four consecutive studies are unique in several respects, most notably, the involvement of both biomedical and traditional health care providers at all stages, the development of an indigenous measure of CMD for use in epidemiological investigations, the examination of the relationship between local and biomedical models of psychological disorder and the sociodemographic and economic risk factors for CMD. The experiences and findings of these studies provide new directions in our understanding of the contribution of culture to the presentation, assessment, classification and risk factors for CMD in primary care in an urban African setting. The methodology used also sets out a model for epidemiological research in other areas of mental health in different cultural settings.

In many African countries, mental health issues, including the burden of serious mental illness and trauma, have not been adequately addressed. These essays shed light on the treatment of common and chronic mental disorders, including mental illness and treatment in the current climate of economic and political instability, access to health care, access to medicines, and the impact of HIV-AIDS and other chronic illness on mental health. While problems are rampant and carry real and devastating consequences, this volume promotes an understanding of the African mental health landscape in service of reform.

Seventy percent of the global burden of mental disorders is located in low and middle income countries (LMIC),including sub-Saharan Africa (SSA). However, in Africa,only 0.62% of the national health budget is allocated to mental health compared to a global median of 2.8% and 5% in Europe. The government is the source of funding in 62%of patients with severe mental disorder in the World Health Organisation (WHO), Africa Region, the lowest of all the WHO regions, and lower compared to a global median of 79%. This is compounded by poor resources, with mental health outpatient facilities in WHO Africa Region being less that 10% of the global median. To address these problems, the WHO launched its Mental Health Action Gap Programme (mhGAP) in 2008, to scale-up mental health services in low and middle income countries (LMIC). The book is directed to all policy makers in sub-Saharan Africa to aid decision making about the urgent need for sustainable and relevant mental health care strategies, and the important areas that need priority. The book should be helpful to local and international researchers in formulating research questions relevant to the African continent and it will be of interest to medical practitioners and students in the region as adjunct to standard text books.

The influence of culture on mental illness has been the subject of considerable academic investigation and debate in recent years. This debate has provoked concerns about the validity and reliability of older methodologies which emphasised either universal characteristics of disorders which were heavily biased towards Euro-American systems, or the culturally relativist approach which saw psychological disorders as products largely of their own culture. The "new" cross-cultural psychiatry proposed that the integration of ethnographic and epidemiological techniques be required to enable a culture sensitive psychiatric model to emerge. This monograph describes a series of research studies conducted in primary care in Harare, Zimbabwe, focusing on the most frequent of all psychological disorders, Common Mental Disorders (CMD). The four consecutive studies are unique in several respects, most notably, the involvement of both biomedical and traditional health care providers at all stages, the development of an indigenous measure of CMD for use in epidemiological investigations, the examination of the relationship between local and biomedical models of psychological disorder and the sociodemographic and economic risk factors for CMD. The experiences and findings of these studies provide new directions in our understanding of the contribution of culture to the presentation, assessment, classification and risk factors for CMD in primary care in an urban African setting. The methodology used also sets out a model for epidemiological research in other areas of mental health in different cultural settings.

The focus of this handbook is to highlight the key issues in addressing the challenges and opportunities to promote mental health is Sub-Saharan Africa. A unique feature of this work is the privileging of African voices in expressing the strengths, vulnerabilities, and unique approaches which have been found within the Sub-Saharan context. The handbook is broken into three sections. The first introduces the handbook and the general issues and concepts discussed. The second describes diverse community outreach and mental health interventions applied by the contributors in diverse Sub-Saharan Africa countries and contexts and addressing a range of mental health topics. The third focuses on systemic issues that affect mental health service delivery, with recommendations provided. Opportunities for creating new models for sharing practices and disseminating knowledge generated by Sub-Saharan African practitioners for their culture and contexts are discussed.

The "epigenetic puzzle" which is schizophrenia, forms the focus of this monograph. The authors approach the non-affective psychoses on a broad epidemiological base, ascertaining cases of so-called "functional" psychosis over a quarter of a century.