Alternative health care providers for severe mental illness: Mapping patterns of use and perspectives for collaboration with formal healthcare

Introduction: Alternative health care providers (AHCPs) are the first point of contact for many people with severe mental illness in Uganda and collaborations between formal and alternative health care providers are recommended by the World Health Organization. However, there is limited evidence on how people with severe mental illness use AHCPs and how collaborative care can be organized in the Ugandan setting. This study assessed patterns of use of AHCPs among patients with severe mental illness and explored barriers and facilitating factors for collaborations between providers. Methods: A cross-sectional survey was conducted among consecutively sampled patients with severe mental illness (bipolar disorder, unipolar depression, schizophrenia and schizoaffective disorders) attending the out-patient department of Butabika National Referral Mental Hospital in Uganda. Results: Out of 304 survey participants, 62% (189) were female, 50% (153) had bipolar disorder and 36% (110) had schizophrenia. 76% (231) had ever consulted an AHCP for their mental illness, for 45% this was the first point of contact at illness debut. 29% had consulted only a faith healer, 18% only a traditional healer, and 28% both. 45% (137) of survey participants were interested in collaborations between providers but only 1% knew of any existing collaboration. 53% (161) thought such collaboration would not be possible, with the main reason given being perceived incompatibility of methods. Among those who wanted collaborations, the preferred types most frequently mentioned in open-ended questions were: formal and alternative providers referring patients to each other (30%), formal and alternative providers advising each other on treatment (17%) and that formal providers should allow spiritual interventions (15%). Conclusion: Most participants had visited an AHCP for their mental illness. While there was a demand for collaborations between formal and alternative providers, perceived barriers between them need to be addressed for collaborations to be successful.