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Culture, Medicine, and Psychiatry

, Volume 43, Issue 3, pp 496–518 | Cite as

“How Can We Help You”: Mental Health Practitioners’ Experiences of Service Provision in Northern Namibia

  • Theodore T. BartholomewEmail author
  • Shelene G. Gentz
Original Paper

Abstract

Although 12–13% of Namibians are reported to struggle with psychological distress, very few practitioners are available to provide mental health services in Namibia. Those practitioners who are available are often trained from Western counseling and psychiatric perspectives that may not readily align to beliefs about illness held constructed in Namibian cultures. Institutional effort is invested in the education and use of mental health practitioners, including counselors, social workers, nurses, psychologists, and psychiatrists. However, little is known about the experiences of these providers. Therefore, this study, a grounded theory ethnography, was undertaken as part of broader ethnographic work to understand how mental health practitioners (N = 7) in Northern Namibia view their work with Aawambo Namibians given that Namibian mental health practitioners are few but embedded in the country’s health care system. Four categories were identified in analyses: Provision of Mental Health Services in the North, Practitioners’ Conceptualizations of Psychological Distress: Western and Aawambo Influences, Beliefs about Mental Health Services in the North, and Integration of Traditional Treatment and Counseling. Results are discussed with respect to cultural competence in Namibian mental health practice and potential for integrating traditional practices and mental health services.

Keywords

Namibia Mental Health Care in Namibia Integration of Traditional Healing Grounded Theory Ethnography Mental Illness Explanations 

Notes

References

  1. American Psychiatric Association 2013. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.CrossRefGoogle Scholar
  2. Ashipala, Daniel O., Wilma Wilkinson, and Agnes van Dyk, 2016. Mental health policy implementation as an integral part of primary health care services in Oshana region, Namibia. Journal of Nursing Education and Practice, 6, 53-60.  https://doi.org/10.5430/jnep.v6n11p53baudenstein,CrossRefGoogle Scholar
  3. Babchuk, Wayne A., and Robert K. Hitchcock 2013. Grounded Theory Ethnography: Merging Methodologies for Advancing Naturalistic Inquiry. In E. P. Isaac-Savage (Ed.), Proceedings of the 54th Annual Adult Education Research Conference (pp. 27–34). St. Charles, MO: Lindenwood University.Google Scholar
  4. Bartholomew, Theodore T., 2012. A Human Being is Free: The Phenomenological Experience of Liberation in Namibia. International Perspectives in Psychology: Research, Practice, Consultation, 1, 94–109.Google Scholar
  5. Bartholomew, Theodore T., 2016. Mental Health in Namibia: Connecting Discourses on Psychological Distress, Western Treatments and Traditional Healing. Psychology and Developing Societies, 28, 101–125.CrossRefGoogle Scholar
  6. Bartholomew, Theodore T., 2017. Madness (Eemwengu) and its Sources: Conceptualizing Mental Illness in Namibian Ovambo Culture. Journal of Cross-Cultural Psychology, 48, 421–437.CrossRefGoogle Scholar
  7. Bartholomew, Theodore T., 2018. Beliefs About the Treatment of Mental Illness Among the Namibian Aawambo: An Exploratory Study. International Perspectives in Psychology: Research, Practice, Consultation, 7, 258–275.Google Scholar
  8. Benish, Steven G., Stephen Quintana, and Bruce E. Wampold 2011. Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis. Journal of Counseling Psychology, 58, 279-289.  https://doi.org/10.1037/a0023626 CrossRefGoogle Scholar
  9. Berg, Astrid 2003. Ancestor reverence and mental health in South Africa. Transcultural Psychology, 40, 194-207.  https://doi.org/10.1177/1363461503402004 CrossRefGoogle Scholar
  10. Bhana, Arvin, Inge Petersen, Kim L. Baillie, Alan J. Flisher, and MHaPP Research Programme Consortium. 2010. Implementing the World Health report 2001 recommendations for integrating mental health into primary health care: A situation analysis of three African countries: Ghana, South Africa and Uganda. International Review of Psychiatry, 22, 599-610.  https://doi.org/10.3109/09540261.2010.536152 CrossRefGoogle Scholar
  11. Bird, Philippa, Maye Omar, Victor Doku, Crick Lund, James R. Nsereko, Jason Mwanza, and MHaPP Research Programme Consortium 2010. Increasing the priority of mental health in Africa: Findings from qualitative research in Ghana, South Africa, Uganda, and Zambia. Health Policy and Planning, 26, 357-365.  https://doi.org/10.1093/heapol/czq078 CrossRefGoogle Scholar
  12. Bojuwoye, Olaniyi 2013. Integrating principles underlying ancestral spirits belief in counseling and psychotherapy. IFE PsychologIA, 21, 74-89.Google Scholar
  13. Bojuwoye, Olaniyi and Tholene Sodi 2010. Challenges and opportunities to integrating traditional healing into counselling and psychotherapy. Counselling Psychology Quarterly, 23, 283-296.  https://doi.org/10.1080/09515070.2010.505750 CrossRefGoogle Scholar
  14. Charmaz, Kathy 2014. Constructing grounded theory (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
  15. Coomer, R. A. 2013. The experiences of parents of children with mental disability regarding access to mental health care. African Journal of Psychiatry, 16, 271-276.  https://doi.org/10.4314/ajpsy.v16i4.36 Google Scholar
  16. Cooper, Saths and Nicholas, Lionel. 2013. Counseling and psychotherapy in South Africa: Responding to post-apartheid counseling needs. In R. Moodley, U. P. Gielen, and R. Wu (Eds.), Handbook of counseling and psychotherapy in an international context (pp. 61-71). New York, NY: Routledge.Google Scholar
  17. Feinstein, Anthony 2002. Psychiatry in post-apartheid Namibia. Psychiatric Bulletin, 26, 310-312.  https://doi.org/10.1192/pb.26.8.310-a CrossRefGoogle Scholar
  18. Gentz, Shelene G., and Kevin Durheim 2009. Psychological Expertise and Governmentality in Democratic South Africa: A Tracer Study of Masters Graduates from UKZN. Psychology in Society, 37, 18–38.Google Scholar
  19. Haidula, Lea, Elizabeth Shino, Ilse Plattner, and Anthony Feinstein 2003. A Namibian version of the 28 items general health questionnaire. South African Psychiatry Review, 6, 23-25.Google Scholar
  20. Kahn, Marc S.,and Kevin J. Kelly 2001. Cultural tensions in psychiatric nursing: Managing the interface between Western mental health care and Xhosa traditional healing in South Africa. Transcultural Psychiatry, 38, 35-50.  https://doi.org/10.1177/136346150103800104 CrossRefGoogle Scholar
  21. Kakuma, R., S. Kleintjes, C. Lund, N. Drew, A. Green, A. J. Flisher, and MHaPP Research Programme Consortium 2010. Mental health stigma: What is being done to raise awareness and reduce stigma in South Africa? African Journal of Psychiatry, 13, 116-124.CrossRefGoogle Scholar
  22. Kirmayer, Laurence J., Cecile Rousseau, Jaswant Guzder, and G. Eric Jarvis 2008. Training clinicians in cultural psychiatry: A Canadian perspective. Academic Psychiatry, 32, 313-319.  https://doi.org/10.1176/appi.ap.32.4.313.CrossRefGoogle Scholar
  23. Kritzinger, Janis, Leslie Swartz, Sumaya Mall, and Laila Asmal 2011. Family therapy for schizophrenia in the South African context: Challenges and pathways to implementation. South African Journal of Psychology, 41, 140-146.  https://doi.org/10.1177/008124631104100203 CrossRefGoogle Scholar
  24. Leach, Mark M., Jacqueline Akhusrt, and Clive Basson 2003. Counseling psychology in South Africa: Current political and professional challenges and future promise. The Counseling Psychologist, 31, 619-640.  https://doi.org/10.1177/0011000003256787 CrossRefGoogle Scholar
  25. Mkhize, Nhlanhla 2004. Chapter 4: Psychology: An African perspective, in K. Ratele, N. Duncan, D. Hook, P. Kiguwa, N. Mkhize, & A. Collins (Eds). Self, community and psychology. Cape Town, South Africa: University of Cape Town Press.Google Scholar
  26. Ministry of Health and Social Services 2005. National policy for mental health. Windhoek, Namibia: Author.Google Scholar
  27. Moodley, Roy, Uwe P. Gielen, and Rosa Wu 2013. Handbook of counseling and psychotherapy in an international context. New York, NY: Routledge.CrossRefGoogle Scholar
  28. Moodley, Roy and Patsy Sutherland 2010. Psychic retreats in other places: Clients who seek healing with traditional healers and psychotherapists. Counselling Psychology Quarterly, 23, 267-282.  https://doi.org/10.1080/09515070.2010.505748 CrossRefGoogle Scholar
  29. Mpofu, Elias 2002 Psychology in sub-Saharan Africa: Challenges, prospects and promises. International Journal of Psychology, 37, 179-186.  https://doi.org/10.1080/00207590244000061 CrossRefGoogle Scholar
  30. Mpofu, Elias, Karl Peltzer, and Olaniyi Bojuwoye 2011. Indigenous healing practices in sub-Saharan Africa. In E. Mpofu (Ed.), Counseling people of African ancestry (pp. 3-21). New York, NY: Cambridge University Press.CrossRefGoogle Scholar
  31. Mwiti, Gladys. K. and Naomi N. James (2013). Counseling and psychotherapy in sub-Saharan Africa: Brewed in an African pot with Western seasoning. In R. Moodley, U. P. Gielen, and R. Wu (Eds.), Handbook of counseling and psychotherapy in an international context (pp. 72-82). New York, NY: Routledge.Google Scholar
  32. Owen, Jesse 2013. Early career perspectives on psychotherapy research and practice: Psychotherapist effects, multicultural orientation, and couple interventions. Psychotherapy, 50, 496-502.  https://doi.org/10.1037/a0034617 CrossRefGoogle Scholar
  33. Patel, Vikram 2007. Mental health in low- and middle-income countries. British Medical Bulletin, 81-82, 81-96.CrossRefGoogle Scholar
  34. Pillay, Anthony L., Rashid Ahmed, and Umesh Bawa 2013. Clinical psychology training in South Africa: A call to action. South African Journal of Psychology, 43, 46-58.  https://doi.org/10.1177/0081246312474411 CrossRefGoogle Scholar
  35. Ruiz-Casares, Monica, Brett D. Thombs, B. D., and Cecile Rousseau 2009. The association of single and double orphanhood with symptoms of depression among children and adolescents in Namibia. European Child and Adolescent Psychiatry, 18, 369-376.  https://doi.org/10.1007/s00787-009-0739-7 CrossRefGoogle Scholar
  36. Sidandi, Paul, Charles, Mambwe, Zoran Zoric, Suresh Vanvaria, Nirmala Vanvaria, and Emmanuel Laryea 1999. Psychiatric rehabilitation: The perspective from Botswana. International Journal of Mental Health, 28, 31-37.CrossRefGoogle Scholar
  37. Sima, Rebecca G. and William West, W. 2005. Sharing healing secrets: Counselors and traditional healers in conversation. In R. Moodley and W. West (Eds.), Integrating traditional healing practices into counseling and psychotherapy (pp. 316-325). Thousand Oaks, CA: SAGE.CrossRefGoogle Scholar
  38. Stockton, Rex, Amy Nitza, and Dan-Bush Bhusumane 2010. The development of professional counseling in Botswana. Journal of Counseling and Development, 88, 9-12.  https://doi.org/10.1002/j.1556-6678.2010.tb00142.x CrossRefGoogle Scholar
  39. Tavory, Iddo, and Stefan Timmermans 2009. Two cases of ethnography: Grounded theory and the extended case method. Ethnography, 10, 243-263.  https://doi.org/10.1177/1466138109339042 CrossRefGoogle Scholar
  40. Tönjes, Hermann 1996. Ovamboland (2nd ed.). Cape Town, South Africa: Scientific Society.Google Scholar
  41. Trimble, Joseph E. 2010. Bear spends time in our dreams now: Magical thinking and cultural empathy in multicultural counselling theory and practice. Counselling Psychology Quarterly, 23, 241-253.  https://doi.org/10.1080/09515070.2010.505735 CrossRefGoogle Scholar
  42. Vranckx, Constant H. 1999. Notes from Namibia: Assessing mental illness in a multicultural developing country. International Journal of Mental Health, 28, 38-43.CrossRefGoogle Scholar
  43. Watson, Mark B., Paul Fouche 2007 Transforming a Past into a Future: Counseling Psychology in South Africa. Applied Psychology, 56, 152–164.CrossRefGoogle Scholar
  44. World Health Organization 2014 Mental Health Atlas 2014: Namibia. Retrieved from http://www.who.int/mental_health/evidence/atlas/profiles-2014/nam.pdf?ua=1
  45. Yen, Jeffrey and Lindy Wilbraham 2003. Discourses of culture and illness in South African mental health care and indigenous health, part I: Western Psychiatric Power. Transcultural Psychiatry, 40, 542-561.  https://doi.org/10.1177/1363461503404006 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Educational StudiesPurdue UniversityWest LafayetteUSA
  2. 2.University of NamibiaWindhoekNamibia

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