Utilizing a church-based platform for mental health interventions: exploring the role of the clergy and the treatment preference of women with depression.

Theddeus Iheanacho,Farooq Naeem,Donna Spiegelman,Ujunwa Callista Nduanya,Samantha Slinkard,Amaka Grace Ogidi,Dina Patel,Echezona E Ezeanolue,Ijeoma Uchenna Itanyi

doi:10.1017/gmh.2021.4

Abstract

Training lay people to deliver mental health interventions in the community can be an effective strategy to mitigate mental health manpower shortages in low- and middle-income countries. The healthy beginning initiative (HBI) is a congregation-based platform that uses this approach to train church-based lay health advisors to conduct mental health screening in community churches and link people to care. This paper explores the potential for a clergy-delivered therapy for mental disorders on the HBI platform and identifies the treatment preferences of women diagnosed with depression. We conducted focus group discussion and free-listing exercise with 13 catholic clergy in churches that participated in HBI in Enugu, Nigeria. These exercises, guided by the positive, existential, or negative (PEN-3) cultural model, explored their role in HBI, their beliefs about mental disorders, and their willingness to be trained to deliver therapy for mental disorders. We surveyed women diagnosed with depression in the same environment to understand their health-seeking behavior and treatment preferences. The development of the survey was guided by the health belief model. The clergy valued their role in HBI, expressed understanding of the bio-psycho-socio-spiritual model of mental disorders, and were willing to be trained to provide therapy for depression. Majority of the women surveyed preferred to receive therapy from trained clergy (92.9%), followed by a psychiatrist (89.3%), and psychologist (85.7%). These findings support a potential clergy-focused, faith-informed adaptation of therapy for common mental disorders anchored in community churches to increase access to treatment in a resource-limited setting.

Highlights

Training lay people to deliver mental health interventions in the community can be an effective strategy to mitigate mental health manpower shortages in low- and middleincome countries
This paper presents findings from (1) a qualitative study exploring the role of the clergy in healthy beginning initiative (HBI), their beliefs and attitudes about mental illness, and their willingness to be trained to deliver therapy for mental disorders with the supervision of psychiatric specialists on the HBI platform and (2) from a survey that sought to determine the treatment preferences of women diagnosed with depression and whether they would be willing to receive counseling/therapy from trained clergy
In utilizing the PEN-3 cultural model, this study identified clergy’s positive beliefs and practices related to mental illness, existential interactions with those suffering from mental illness, and negative attitudes and stigmatizing behaviors that may serve as barriers to appropriate care for parishioners with mental disorders

Summary

Introduction

Training lay people to deliver mental health interventions in the community can be an effective strategy to mitigate mental health manpower shortages in low- and middleincome countries. We conducted focus group discussion and free-listing exercise with 13 catholic clergy in churches that participated in HBI in Enugu, Nigeria These exercises, guided by the positive, existential, or negative (PEN-3) cultural model, explored their role in HBI, their beliefs about mental disorders, and their willingness to be trained to deliver therapy for mental disorders. These findings support a potential clergy-focused, faith-informed adaptation of therapy for common mental disorders anchored in community churches to increase access to treatment in a resource-limited setting. Mental disorders such as depression and anxiety are as prevalent in low and middle-income countries (LMICs) as they are in high-income, developed countries (Gureje et al, 2006; Bromet et al, 2011; Andrade et al, 2013). With only about 250 psychiatrists for a population of more than 180 million people, Nigeria exemplifies the severe lack of capacity for mental healthcare provision seen in LMICs (Kakuma et al, 2011; Nigeria, 2018)

Methods

Results

Discussion

Conclusion