In South Africa, a large percentage of the population would choose to consult with a Traditional Healer rather than a Mental Health Practitioner, such as a Psychiatrist or a Psychologist, when they are experiencing mental health problems. The reason for this is that in most African cultures it is believed that mental illnesses are caused by evil spirits, witchcraft or curses, and that only Traditional Healers can cure them of being possessed by these forces. There are a few Traditional Healers that acknowledge environmental causes of mental illness such as accidents, stress and alcohol and these ones are often willing to work in collaboration with western trained Mental Health Practitioners.
For the most part, Traditional Healers make their diagnosis of mental illness through observing their patient. Signs that they typically look for include bizarre speech, running away, fear, removing their clothes, unkempt appearance, and red or unsteady eyes. They are relatively unconcerned with history-taking, and they do not refer to the DSM-5.
Treatment mostly takes the form of administering herbal remedies collected from rural areas. The administration is done through skin incisions, orally or nasally, and sometimes bathing and washing in herbal water is also prescribed.
Currently, medical aid schemes in South Africa do not have benefits for consultations with or treatments administered by Traditional Healers.
The available research on traditional healing methodologies and treatment outcomes for mental illness is limited, therefore, it is not really known how effective the role of these Practitioners is. Many employers in South Africa are uncertain about how to handle the situation when an employee is clearly mentally ill and chooses to consult only with a Traditional Healer. Questions that arise include the following:
- Can Traditional Healers provide medical certificates to book employees off work due to mental illness?
- Can a diagnosis by a Traditional Healer be accepted?
- How long should the employer allow an employee to be off work due to incapacity if they are undergoing treatment only with a Traditional Healer for a mental illness?
- Can an employer insist that an employee consult with a Mental Health Practitioner?
My opinions are as follows:
- If the Traditional Healer is registered with the THPCSA (Traditional Health Practitioners Council of South Africa), then yes, I think that a medical certificate can be accepted. However, it must be on a letterhead with their name and registration number, and it should include a diagnosis and preferably also treatment details. Having said that, according to section 23(2) of the BCEA (Basic Conditions of Employment Act), Traditional Healers are not medical practitioners and are not registered with a recognised professional council, therefore, these certificates are not accepted as valid for paid sick leave. It is important to note that this does not apply to every sectoral determination or bargaining council as certain collective agreements make provisions for traditional healer certificates.
- Traditional Healers have their own diagnoses, which do not always make sense to people that are unfamiliar with their practice. I would suggest that over and above their indigenous diagnosis, they provide an indication of the western equivalent.
- This is a tricky one. It is well known that getting the treatment right for a patient with mental illness can be a complicated and long drawn out process even for a Psychiatrist. However, due to the relatively unknown practices of Traditional Healers, it seems reasonable to me that a time limit be applied before an employer ought to be allowed to intervene. This time limit is at the discretion of the employer, and it would be prudent to include it in employment contracts prior to commencement of employment of every employee.
- I would suggest that if after an agreed upon time limit of consultation with and treatment by a Traditional Healer, the employer sees no improvement in their employees condition and functioning, they ought to be allowed to suggest that the employee consult with a Psychiatrist. However, this cannot be enforced and if resisted by the employee, the employer would need to resort to further action as per the employment contract noted in number 3 above.
In concluding, as South Africans we live in a multi-cultural society and therefore we have a multi-cultural workforce. The beliefs and values of all cultural groups when it comes to mental illness need to be respected, as do the employers’ business operation requirements. This requires fine tuning and balancing from pre-employment stage in order to avoid complexities and conflict during the course of employment. As the frequency and severity of employee mental illness continues to increase at an alarming rate, it would be a mistake for employers to “wait until something happens” before deciding how they are going to manage it.
Take care everyone.
Your Partner in Mental Health Matters @ Work