Scoping review: efficacy of combining traditional healing and modern psychiatry in global mental healthcare

Jilka S, Winsper C, Johnson SA, Ilozumba O, Wagner RG, Subhedar S, Morroni D, Lilford R, Singh SP and On behalf of the TRANSFORM consortium (2025). A scoping review to evaluate the efficacy of combining traditional healing and modern psychiatry in global mental healthcare. Cambridge Prisms: Global Mental Health, 12, e35, 1–12. https://doi.org/10.1017/gmh.2025.20

Rationale

Twelve percent of the global disease burden is attributed to mental and behavioral disorders, with over 70% of this burden experienced in low- and middle-income countries (LMICs).

The mental health treatment gap in some LMICs is between 80% and 93%, indicating that less than 1 in 10 people are able to access appropriate care.

In many LMICs, public mental health systems are underfunded, and mental health receives little attention in overall annual health budgets.

Help-seeking for serious mental illnesses (SMIs) in LMICs is often pluralistic, with traditional and faith-based healers (TFHs) frequently being the initial point of contact.

While traditional healing can alleviate mild symptoms and provide social support, there is limited evidence that it improves care or outcomes for SMIs, and it can sometimes lead to harmful practices.

The limited availability of biomedical mental healthcare in LMICs, coupled with concerns about harmful treatment practices by traditional healers, highlights the need for collaborative models between faith healers and the modern healthcare system.

A recent systematic review by Green and Colucci (2020) found that TFHs and biomedical practitioners are willing to work together to provide holistic care, despite having different conceptualizations of mental illness.

The current review builds on this work by exploring intervention studies on collaborative care models between TFHs and biomedical practitioners for mental illness.  

Method

This review was a systematic scoping review.  

The review adhered to a predefined scoping review protocol developed in collaboration with local stakeholders from Nigeria and Bangladesh.  

The databases searched were:

• MEDLINE ALL (OVID, 1946-)
• Embase (OVID, 1947-)
• PsychInfo (OVID, 1806-)
• CINAHL (EBSCO, 1981-)
• Web of Science (Clarivate, 1900-)

The searches were conducted up to March 2, 2023, and updated to December 4, 2024.  

The search terms used included:

• (“traditional healer” OR “spiritual healer” OR “religious healer” OR diviner OR shaman OR “traditional practitioner”)
• AND
• (“healthcare professional” OR “healthcare worker” OR doctor OR psychiatrist OR nurse OR psychotherapist”)
• AND
• (“mental health” OR “mental disorder” OR “mental illness” OR “mental health services” OR “mental healthcare” OR “serious mental disorder” OR “serious mental illness” OR “severe mental illness” OR “severe mental disorder”).  

Inclusion criteria:

• Studies focusing on participants from formal and informal settings (e.g., psychiatrists, community health workers, traditional healers).
• Studies including care provided by TFHs, traditional or faith-based interventions by TFHs, evidence-based treatment on which traditional healers were trained, or care provided by both traditional and biomedical professionals in collaboration.
• Interventions where collaboration between sectors aimed to improve TFHs’ knowledge, attitudes, and practices towards mental health.
• Studies providing quantitative data on a treatment-seeking population for mental disorder or quantitative data on TFH outcomes based on collaboration with the biomedical sector.
• Studies with a comparator for sample, outcomes, or change over time.
• Studies providing quantitative data pertaining to the outcomes of a collaborative intervention for mental illness.
• Pilot studies, pre-post studies, and randomized controlled trials.
• Peer-reviewed published studies.  

Exclusion criteria:

• Qualitative viewpoint or outcomes from the perspective of persons with lived experience and their caregivers.
• Effects of personal religiosity and spirituality, distant healing, and Western psychotherapies that incorporate religious elements.
• Studies where traditional healers provided any oral, topical, nasal, or inhaled herbal/chemical/substances for managing common mental illness.
• Unpublished studies, including dissertations and conference abstracts.
• Review articles and qualitative studies without complementary quantitative data.
• Studies not written in English.
• Studies reporting duplicate data.  

In the final review, eight articles comprising six independent studies were included.  

Data were extracted using a predefined data-charting form.   

Results

• The review identified two main intervention typologies: (1) Western-based educational interventions for TFHs and (2) shared collaborative models between TFHs and biomedical professionals.  
• Evidence from both typologies indicated that education for TFHs can help reduce harmful practices.  
• Shared collaborative models led to significant improvements in psychiatric symptoms (in comparison to care as usual) and increases in referrals to biomedical care from TFHs.  
• Proposed mechanisms underpinning outcomes included trust-building and empowering TFHs by increasing awareness and knowledge of mental illness and human rights.  
• Barriers to implementation were observed at the individual (e.g., suspicions of TFHs), relationship (e.g., reluctance of biomedical practitioners to equalize their status with TFHs) and service (e.g., lack of formal referral systems) levels.  
• Research on collaborative models for mental healthcare is in its infancy, and preliminary findings are encouraging.  
• To ensure effective collaboration, future programs should incorporate active participation from community stakeholders (e.g., patients, caregivers, faith healers) and target barriers to implementation on multiple levels.  

Insight

The review highlights the potential benefits and challenges of integrating traditional healing practices with modern psychiatry, particularly in LMICs where there are significant mental health treatment gaps.

The findings suggest that collaborative models can be effective in improving mental health outcomes, but their success depends on addressing various factors at individual, relationship, and service levels.

The review underscores the importance of cultural sensitivity and the need to acknowledge the role of traditional healers in communities.

It emphasizes that education and training for traditional healers can lead to a reduction in harmful practices and an increase in appropriate referrals to biomedical services.

The review points to the importance of building trust and fostering collaboration between traditional healers and biomedical professionals.

The findings also indicate that collaborative models can empower traditional healers by increasing their knowledge and awareness of mental illness and human rights.

The research in this area is still emerging, with preliminary findings being encouraging.

Examples for further research:

• Future research should focus on conducting more rigorous evaluations of collaborative models, including randomized controlled trials with long-term follow-up.
• There is a need for studies that examine the cost-effectiveness of collaborative models and their sustainability in different contexts.
• Research should also explore the perspectives of service users and their families on collaborative care and identify their needs and preferences.
• Further investigation is needed to understand the specific mechanisms through which collaborative models improve mental health outcomes and to identify the key components of effective interventions.
• Implementation research is crucial to identify strategies for overcoming barriers to collaboration and ensuring the successful adoption of collaborative models in real-world settings.

Clinical Implications

The findings have significant implications for practitioners and policymakers working in mental health, particularly in LMICs.

They highlight the potential benefits of engaging with traditional healers and incorporating their expertise into mental healthcare systems.

The review suggests that collaborative models can improve access to care, reduce stigma, and enhance treatment outcomes for individuals with mental health conditions.

Recommendations for applying the findings to improve practice or services:

• Policymakers should consider developing policies and guidelines that support the integration of traditional healing practices with modern psychiatry.
• Healthcare providers should seek to establish partnerships with traditional healers in their communities and work together to provide culturally sensitive and holistic care.
• Training programs should be developed to educate both traditional healers and biomedical practitioners about mental health and to promote effective collaboration.
• Mental health services should be designed to be accessible and acceptable to diverse populations, taking into account their cultural beliefs and practices.
• Efforts should be made to raise awareness about mental health in communities and to reduce stigma associated with mental illness.

Potential benefits and challenges of implementing the findings:

• Potential benefits:
  • Improved access to mental healthcare, particularly in underserved communities
  • Enhanced treatment outcomes and recovery rates
  • Reduced stigma and discrimination associated with mental illness
  • Increased cultural sensitivity and appropriateness of mental health services
  • Empowerment of traditional healers and recognition of their role in communities
• Challenges:
  • Resistance from some biomedical practitioners or traditional healers to collaboration
  • Difficulties in establishing trust and effective communication between different healthcare systems
  • Lack of resources and infrastructure to support collaborative models
  • Need for training and education to ensure that all providers have the necessary knowledge and skills
  • Challenges in evaluating the effectiveness of collaborative models and demonstrating their impact

Socratic Questions

• What are the ethical considerations involved in integrating traditional healing practices with modern psychiatry? How can these considerations be addressed to ensure that individuals’ rights and well-being are protected?
• How can collaborative models contribute to reducing stigma associated with mental illness? What role can traditional healers play in this process?
• What is the role of community engagement in the development and implementation of collaborative mental healthcare models? How can communities be effectively involved in this process?
• How can policymakers and healthcare systems support the development and implementation of effective collaborative models? What resources and infrastructure are needed?
• What are the potential unintended consequences of integrating traditional healing practices with modern psychiatry? How can these be mitigated?

Reference

Jilka S, Winsper C, Johnson SA, Ilozumba O, Wagner RG, Subhedar S, Morroni D, Lilford R, Singh SP and On behalf of the TRANSFORM consortium (2025). A scoping review to evaluate the efficacy of combining traditional healing and modern psychiatry in global mental healthcare. Cambridge Prisms: Global Mental Health, 12, e35, 1–12. https://doi.org/10.1017/gmh.2025.20