title: Pathways to mental healthcare in south-eastern Nigeria.
abstract: In sub-Saharan Africa, traditional and faith healers provide competing services alongside biomedical professionals. This may be associated with delays in reaching specialised mental health services, and hence with longer duration of untreated illness. As first line care constitutes a crucial stage in accessing of psychiatric care, investigating pathways to mental healthcare can highlight help-seeking choices. This study explored the pathways to care for mental illness preferred by a non-clinical sample of the population in south-eastern Nigeria. Multistage sampling was used to select participants (N = 706) who completed questionnaires on help-seeking. Results showed a significant preference for biomedical (90.8%) compared to spiritual (57.8%) and traditional (33.2%) pathways. Higher education predicted preference for the biomedical model, while low education was associated with traditional and spiritual pathways. Protestants preferred the spiritual pathway more than did Catholics. The use of biomedical care is potentially undermined by poor mental health infrastructure, a lack of fit between the culture of biomedical care and the deep-seated cultural/religious worldviews of the people, stigma surrounding mental illness, and the likelihood of a social desirability bias in responses. A complementary model of care is proposed.
authors.affiliation: University of Wolverhampton U.I.Ikwuka@wlv.ac.uk.
authors.forename: Ugo
authors.initials: U
authors.lastname: Ikwuka
authors.affiliation: University of Wolverhampton.
authors.forename: Niall
authors.initials: N
authors.lastname: Galbraith
authors.affiliation: University of Wolverhampton.
authors.forename: Ken
authors.initials: K
authors.lastname: Manktelow
authors.affiliation: University of Wolverhampton.
authors.forename: Josephine
authors.initials: J
authors.lastname: Chen-Wilson
authors.affiliation: University of Birmingham.
authors.forename: Femi
authors.initials: F
authors.lastname: Oyebode
authors.affiliation: University of Nigeria Teaching Hospital.
authors.forename: Rosemary Chizobam
authors.initials: RC
authors.lastname: Muomah
authors.affiliation: Northwick Park Hospital.
authors.forename: Anulika
authors.initials: A
authors.lastname: Igboaka
mesh_terms: D000293:Adolescent; D000328:Adult; D003156:Community Mental Health Services; D003906:Developing Countries; D004522:Educational Status; D029221:Faith Healing; D005260:Female; D006801:Humans; D008297:Male; D016488:Medicine, African Traditional; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D009549:Nigeria; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D057240:Patient Preference; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Indigenous healing; biomedical model; mental health services; pathways to health care; spiritual; traditional