Research in context
Evidence before this study
We searched PubMed and PsychINFO from Sept 25, 2012, to Oct 1, 2014, for studies exploring the feasibility, effectiveness, and cost-effectiveness of collaboration between complementary alternative health care providers, specifically traditional and faith healers, and conventional health-care providers in the care of people with psychosis. We imposed no language restrictions. Our search terms included “severe mental disorders”, “psychosis”, “traditional healers”, “faith healers”, “mental health providers”, “collaboration”, “integration”, and “low and middle-income countries”. We also hand searched reference lists of papers and books identified by this search. Several journal articles provided information about the profile of patients in the care of traditional and faith healers, with evidence that people with psychosis were commonly among these patient groups. There was also information about diagnostic and treatment approaches as well as observation that, even though the care provided often led to improvement in the clinical condition of the patients, some of the treatment practices were potentially harmful and not always in conformity with the human rights of patients. A need to develop approaches to facilitate collaboration between the healers and conventional health care providers was frequently emphasised even though there was also scepticism about whether collaboration could work given discordant views about the nature of psychopathology between healers and conventional providers. Other than collaborative efforts involving the engagement of traditional healers in the provision of care, specifically counselling, to people with HIV, no systematic study had been done to test whether healers and conventional providers can collaborate in the care of people with psychosis and no previous randomised controlled trial of the effectiveness and cost-effectiveness of collaboration between healers and providers has been done.
Added value of this study
To our knowledge, this is the first randomised controlled trial of the effectiveness and cost-effectiveness of a collaborative shared care for psychosis delivered by traditional and faith healers and conventional primary care providers. Prespecified primary and secondary outcomes, assessed at 6 months following trial entry, included psychotic symptoms, disability, self-stigma, course of illness, duration of admission, quality of work performance, living condition, and having harmful or inhumane treatments. Findings show that most outcomes were better with a model of care in which primary care providers worked collaboratively with traditional and faith healers to deliver care to people with psychotic disorders compared to care as usual. Collaborative shared care was successfully implemented between healers and conventional providers and was cost-effective.
Implications of all the available evidence
Our findings suggest that collaboration between healers and conventional providers can be designed and implemented, and that collaboration has the potential for delivering effective and cost-effective care to the large population of people in need of care for psychosis in low-income and middle-income countries. However, more research is needed to examine the factors that might be relevant for scaling up such collaborative shared care model into routine service for people with psychosis.