Perceived causes of severe mental disturbance and preferred interventions by the Borana semi-nomadic population in southern Ethiopia: a qualitative study

Abstract

BackgroundCulture affects the way people conceptualize causes of severe mental disturbance which may lead to a variation in the preferred intervention methods. There is a seemingly dichotomous belief regarding what causes severe mental disturbance: people living in western countries tend to focus mainly on biological and psychosocial risk factors; whereas, in non-western countries the focus is mainly on supernatural and religious factors. These belief systems about causation potentially dictate the type of intervention preferred. Studying such belief systems in any society is expected to help in planning and implementation of appropriate mental health services.MethodsA qualitative study was conducted among the Borana semi-nomadic population in southern Ethiopia to explore perceived causes of severe mental disturbance and preferred interventions. We selected, using purposive sampling, key informants from three villages and conducted a total of six focus group discussions: three for males and three for females.ResultsThe views expressed regarding the causes of mental disturbance were heterogeneous encompassing supernatural causes such as possession by evil spirits, curse, bewitchment, ‘exposure to wind’ and subsequent attack by evil spirit in postnatal women and biopsychosocial causes such as infections (malaria), loss, ‘thinking too much’, and alcohol and khat abuse. The preferred interventions for severe mental disturbance included mainly indigenous approaches, such as consulting Borana wise men or indigenous healers, prayer, holy water treatment and seeking modern mental health care as a last resort.ConclusionsThese findings will be of value for health care planners who wish to expand modern mental health care to this population, indicating the need to increase awareness about the causes of severe mental disturbance and their interventions and collaborate with influential people and indigenous healers to increase acceptability of modern mental health care. It also provides information for further research in the area of mental health in this semi-nomadic population.

Help-seeking intention and associated factors towards mental illness among residents of Mertule Mariam town, East Gojam Zone, Amhara Region, Ethiopia: a mixed-method study

“…This justification for this might be that participants who think of mental illness as a severe form might take seek help from modern treatment than the traditional one. Besides, in our community, people think that the modern form of treatment for mental illness is the last preserved option for severe mental illness [11]. Besides, participants whose age group was from 25-34 years were 1.46 times at higher odds of having an intention to seek help from traditional forms of help than participants whose ages ranged from 18-24 years.…”

“…Also, in some areas, people left clients who have mental illness alone if he/she did not respond to informal help source and modern treatments. Based on the patient's condition, he/she chose to live with the family getting his/her basic needs or wander around the street naked [11].…”

“…The Borena societies have intentions seeking help according to the following. They may seek help initially from Borana wise men consultation followed by indigenous healers, then modern health facility which is the last option [11].…”

Community Perception towards Mental Illness among Residents of Gimbi Town, Western Ethiopia

“…The conceptualization and perceived cause of mental illness vary from community to community. Accordingly, people with mental health problem get different names in different societies [4–6]. …”

Assessment of Common Mental Disorders among Visitors to Traditional Healers: a Mixed Study in North Ethiopia

“…Community based studies conducted in Ethiopia revealed that common mental disorders are highly prevalent in the society ranging from 11.7-22.7% [15][16][17]. And traditional measures have been the most preferred treatment option [18,19]; because of the belief that mental illness is a related to a consequence of a sinful act [20][21][22].…”