In urban slums in New Delhi and Ibadan, traditional healers and faith leaders will be trained to screen residents for psychotic disorders and severe mood disorders and refer them to biomedical care. This matters because people living in slums in low- and middle-income countries have high rates of serious mental disorders but very poor access to effective medical treatment. Many rely on traditional or faith-based healing, which alone is insufficient for conditions like schizophrenia or bipolar disorder that require ongoing biomedical care. The project addresses a gap: no tested model exists for integrating traditional healers into formal mental health referral pathways in these settings. If the intervention succeeds, more people with serious mental disorders will be identified and receive appropriate treatment—antipsychotics, mood stabilisers, and follow-up—than in the year before the project began. The research will also produce a cost-effectiveness analysis, so funders and governments in other slum communities can decide whether to adopt the model. Beyond clinics, the team will use street theatre and cinema to reduce stigma and spread information about where to seek help.
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We wish to address the problem of inadequate biomedical care for those with serious mental disorders (SMDs– psychotic disorders and severe mood disorders, often with co-occurring substance-abuse) living in urban slums in low- and-middle-income countries (LMICs). Slums have high rates of SMDs, poor access to biomedical care and conditions of chronic hardship and adversity. Faith-based and traditional healing can play an important part in delivering care in LMICs, especially for common mental disorders like anxiety and depression, but those with SMDs require additional biomedical treatment and follow-up. The TRANSFORM project aims to improve outcomes of persons with SMDs through better access to effective biomedical care by developing an innovative collaborative care model between traditional/faith healers, mental health professionals, primary care practitioners and community health workers (CHWs). We will develop and test community-delivered identification and referral pathways that recognise existing beliefs and pluralistic help-seeking of slum-dwellers in New Delhi, India and Ibadan, Nigeria (both ODA eligible countries). We will conduct rapid community-based ethnographic assessment using qualitative and participatory methods to explore community understandings of mental disorders and help-seeking. Using non-participatory observations, we will explore the role of traditional and faith healing for mental disorders, from the perspectives of the population, healers, CHWs and health professionals. Our findings will be used to co-design, with CHWs and traditional practitioners, training packages for screening, early detection and referral to biomedical care for individuals (18+) suffering from SMDs. We will evaluate the effectiveness of the training programmes in increasing referrals to and the provision of community mental health care of cases of SMDs and conduct a cost-effectiveness analysis of the intervention and its outcomes. We predict that as a result of our intervention, more individuals with SMDs will be identified and referred to appropriate biomedical care by both CHWs and traditional/faith healers. More SMD cases will therefore receive appropriate biomedical care following our intervention, as compared to those accessing help in the year preceding our intervention. The proposal was developed in detailed discussion with research teams in Delhi and Ibadan, slum community leaders, CHWs and local traditional/faith healers, and community organisations working with SMDs in LMICs. The project team involves academic/clinical partners from UK, India, Nigeria and Canada, all with expertise in global mental health, community organisations, and creative arts from partner sites. It builds on existing work by project partners in both improving psychosis outcomes and slum health in India and Nigeria. Besides disseminating findings through the usual channels of scientific publications and policy papers, we will develop street theatre and cinema based on our findings in order to increase the impact of the research and further engage the slum communities across LMICs, raise awareness, reduce stigma and provide information on plural health care for SMDs
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