Patients who seek traditional magico-religious treatments: Are they different from patients who seek medical treatments? A case-control study

Abstract

Introduction: A patient’s decision to seek help for mental health symptoms (and from who) depends on a number of socio-demographic and illness related factors, as well as accessibility and affordability of care. Traditionally magico-religious healers have constituted an important source of health-care for a significant proportion of mentally ill patients in India. The concern however, is that these consultations may also delay patients en route their pathway to medical or psychiatric care- thus potentially adding to the duration of untreated illness and associated poor outcomes. Aims: The present study aimed to examine whether patients who seek traditional magico-religious treatments were different from those who seek medical or mental health care for their symptoms. Methodology: Ninety-one patients were recruited from the Outpatient and emergency departments of the Institute of Medical Psychology, Asha hospital in Hyderabad, Telangana. After gaining informed consent, carers (key informants) for these patients were interviewed to enquire about the patient’s first and subsequent care contacts, as well as for a number of background socio-demographic and illness details. Subjects whose first contact was with a traditional magico-religious healer were compared with subjects who sought help from a medical or mental health professional (psychiatrist/ physician/ registered or unregistered medical practitioner/ medical specialist/ community nurse) for their symptoms. Results: Thirty three (36.3%) of the subjects had sought care from magico-religious healers in the first instance. The rest (63.7%) consulted various other healthcare providers like medical practitioners, psychiatrists, medical specialists like neurologists, community nurses/ social workers, etc. Subjects who sought care from magico-religious healers were similar to those did not, with respect to their age, sex-distribution, residence, social status and incomes, but the latter group was more educated than the former (p<0.05). The groups did not differ with respect to their diagnostic distribution or the duration of untreated illness. However, the magico-religious treatment subjects sought care (from the magico-religious healer) substantially sooner than those who sought care from elsewhere. They also had more health-care contacts than the non-magico-religious treatment group (p<0.05), despite the duration of untreated illness being comparable between the two groups. Discussion and Implications: Magico-religious healers constitute an important health-care contact point for patients who develop mental health symptoms. This study did not identify any specific socio-demographic profile of patients who consult magico-religious healers in the first instance. They were however, less educated than patients who seek health-care from alternative sources. We also could not identify any specific diagnostic characteristics of patients who consult magico-religious healers. Although these patients do have more health-care contacts before they seek psychiatric care and treatment, this did not delay their eventual psychiatric treatment (as compared to patients who did not seek magico-religious treatments). This study has implications for the development of mental health services. Training and awareness creation amongst patients as well as locally identified magico-religious healers may help to shorten the duration of untreated illness. Maintenance of a registry of locally practicing magico-religious healers, regular training/ exchange of information, and active liaison with local psychiatric services may help in improving mental health care. This is probably especially relevant in the current context of scarce governmental resources.