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Access to mental healthcare in low- and middle-income countries (LMICs) is one of the greatest challenges in public health today. One suggestion for improving accessibility is through collaboration between biomedical practitioners and traditional healers. This paper reviews studies of traditional healers' and biomedical practitioners' perceptions of collaboration. We conducted a systematic review of online databases, selected journals, and reference lists for relevant studies. Eligible papers were assessed using a tool designed for this review for quality and study characteristics, and qualitative data demonstrating participants' views were extracted. A total of 14 papers from seven countries were included. The published literature on this topic is relatively homogenous and studies are of variable quality. The findings suggest that, despite differing conceptualisations of mental illness causation, both traditional healers and biomedical practitioners recognise that patients can benefit from a combination of both practices and demonstrate a clear willingness to work together. There are concerns about patients' safety and human rights regarding traditional methods and some healers are sceptical about the effectiveness of Western psychiatric medication. Despite keeping the inclusion criteria open to all LMICs, 13 of the studies were conducted in Africa, seven of which were in South Africa. This limits the applicability of the findings of this review to the wider LMIC context. The paper concludes with recommendations for research and practice. [ABSTRACT FROM AUTHOR]

An important challenge to enhancing community access to mental health interventions in marginalised, transcultural settings is the development of culturally relevant screening measures. Cross-cultural adaptation (CCA) and translation methods offer guidelines for the adaption of existing screening measures for use across cultures with the aim of preserving semantic and construct equivalence as well as validity. Yet, the application of CCA methods has been inconsistent and validation strategies have focused predominantly on expert review and quantitative validity testing. Additionally, potentially important context-specific interpretations of measure items have been lost in translation-heavy approaches. The missing link in the CCA of existing measures may be the addition of culturally sensitive, community-based evaluative methods. This paper presents a report of the application of a seven-step CCA method developed by the first author to address the issue of cultural relevance in the translation and cross-cultural adaptation of the Spence Child Anxiety Scale (SCAS) an anxiety measure for use in a specific South African community context. The findings emphasise the surprising context-specific interpretations of items in measures applied transculturally, which support the case for qualitative, community-based validation of translated, CCA screening measures used to explore the effectiveness of mental health interventions across cultural contexts. [ABSTRACT FROM AUTHOR]

The Movement for Global Mental Health’s (MGMH) efforts to scale up the availability of mental health services have been moderately successful. Investigations in resource-poor countries like South Africa have pointed to the value of an integrated primary mental health care model and multidisciplinary collaboration to support mental health needs in underserved and underresourced communities. However, there remains a need to explore how these policies play out within the daily realities of communities marked by varied environmental and relational complexities. Arguably, the lived realities of mental health policy and service delivery processes are best viewed through ethnographic approaches, which remain underutilised in the field of global mental health. This paper reports on findings from a case study of mental health services for HIV-affected women in a rural South African setting, which employed a motivated ethnography in order to explore the realities of the primary mental health care model and related policies in South Africa. Findings highlighted the influence of three key symbolic (intangible) factors that impact on the efficacy of the primary mental health care model: power dynamics, which shaped relationships within multidisciplinary teams; stigma, which limited the efficacy of task-shifting strategies; and the silencing of women’s narratives of distress within services. The resultant gap between policy ideals and the reality of practice is discussed. The paper concludes with recommendations for building on existing successes in the delivery of primary mental health care in South Africa. [ABSTRACT FROM AUTHOR]

Social work students deal with complex social problems such as poverty, unemployment and the devastating effects of HIV and AIDS in their practice, education and training and it is important to acknowledge that these developmental challenges have global dimensions. The four foundational pillars in the Global Agenda on Social Work and Social Development provide a framework for social work policy education. A project using this framework was implemented in South Africa and the United States. This article discusses the findings of an exploratory qualitative research project based on 58 student final papers from South Africa. [ABSTRACT FROM PUBLISHER]

Globalized labour mobility has led to questions regarding the degree to which social work education in one country can be applicable to practice in another. This paper examines social work education programmes and practice contexts in South Africa, England and Canada as examples through which to examine this question. [ABSTRACT FROM PUBLISHER]

Ubuntu was recently adopted as the first theme for the 2020–2030 global agenda for social work, and yet little research is available to explore how it is transmitted and implemented in communities. The authors present findings of a qualitative study conducted in an academic setting in South Africa, where the transmission of Ubuntu was discussed among 30 young adult 'born frees'. Students seemed to embrace principles of Ubuntu as a whole; however, economic, social and cultural strains are documented as obstacles to its pragmatic application. Implications of community engagement through service learning as a means of strengthening Ubuntu are discussed. [ABSTRACT FROM AUTHOR]

While intellectual disability is experienced worldwide, with much greater rates in contexts of poverty, relatively few studies on intellectual disability have been conducted in low- and middle-income countries. High levels of intellectual disability in South Africa exist alongside high levels of poverty, malnutrition and poor or inaccessible healthcare services. The lack of access to services partly explains why many turn to traditional healers. Within this context there is very limited research on the role that traditional healers play in relation to intellectual disability in South Africa. The current study investigated traditional healers' understanding and beliefs about intellectual disabilities and the treatment modalities that they use. An exploratory qualitative research design was used to examine the views and perspectives of traditional healers on intellectual disability. Fifteen traditional healers participated in the study. Key findings show that the naming of and the terminology used to describe and identify intellectual disability are very much similar to what has been observed in African cultures in general where intellectual disability is identified as an abnormality. Some traditional healers located the presentation of intellectual disability within the biomedical sphere while others gave supernatural explanations for how intellectual disability presents in children and for its causes. All traditional healers expressed a willingness to work with the Western formal healthcare system. Findings on traditional healers' views on future collaborations with the formal health system provide opportunities for these two forms of healthcare services to be synergised for the strengthening and improvement of services provided to children with intellectual disability and their families. [ABSTRACT FROM AUTHOR]

This qualitative ethnographic study complements an epidemiological study on first episode psychosis in Vulindlela, a rural area in KwaZulu-Natal, South Africa. It focuses on two themes that emerged from our data: (1) the calling of the ancestors to become a traditional health practitioner and (2) ukuthwasa, the training to become a traditional health practitioner. The purpose of this study is to describe the ancestral calling, and to explore whether ukuthwasa may help with the management of mental disturbances, including unusual perceptual experiences. We also provide a discussion of the changing sociopolitical context of healing in KwaZulu-Natal, as a background to our study. In-depth interviews were conducted with 20 (apprentice) traditional health practitioners, formal health practitioners, patients and relatives recruited through local traditional health practitioners and a health care clinic. Our results show that the ancestral calling might announce itself with symptoms of mental illness including unusual perceptual experiences, for which some participants consider ukuthwasa as the only effective cure. We found indications that in some individuals successful completion of ukuthwasa might promote recovery from their illness and lead to a profession in which the unusual perceptual experiences become a legitimate and positively valued aspect. We suggest that – in this particular community today, which has been subject to several sociopolitical changes – ukuthwasa may be a culturally sanctioned healing process which moderates experiences that a Western psychiatric system might characterize as psychotic symptoms, providing some individuals with a lucrative and respected role in society. [ABSTRACT FROM AUTHOR]

Social policy and welfare provision have converged with socio-economic conditions, cultural beliefs about kin support and intra-household dynamics to position older women as important financial providers in their families. This article draws on the findings of a qualitative study about intergenerational relationships of care in a large township near Cape Town. Semi-structured interviews were conducted with fourteen female Old Age Grant recipients and some of their co-resident adult children. The article focuses on the grant recipients' experiences of giving and receiving financial support ('financial care') in their intergenerational relationships. It also unpacks the intra-household dynamics involved in this caregiving. Although the grant better enabled the women in the study to meet the needs of their households, beliefs about the mutual and shared responsibility for financial caregiving in families informed their expectations of financial assistance from younger kin. When their co-resident younger relatives did earn an income, negotiations around the provision of financial care ensued; generating conflict and reflecting unequal power relations between relatives. These dynamics contributed to the women's experiences of vulnerability and their high burden of care. In this context, the article examines the state's role in the care process and how it has contributed to the gendered and generational distribution of care work in families. [ABSTRACT FROM AUTHOR]

Most recently, the role of grandmothers has been highlighted as significant in the lives of their grandchildren in South Africa. Studies have previously highlighted the contribution the Old Age Grant makes in contexts of poverty, orphanhood and the migrant labour system. Similarly, studies on the Child Support Grant (CSG) have illustrated its contribution to the well-being of children and families in general. However, missing in these examinations has been an understanding of how the CSG is contested in contexts of parental absence due to internal labour migration. Through a thematic content analysis of qualitative interviews with members of migrants' families, this article illustrates that in the context of internal labour migration, family responsibilities shift in ways that make unemployed grandmothers who do not receive the Old Age Grant vulnerable. This vulnerability is manifested through a tension in familial relationships. This tension stem from the contestation of the CSG by young labour-migrant mothers, the guardian (grandmother), and the beneficiaries of the CSG. The article concludes that these tensions result from continuing socio-economic struggles experienced by poor households. [ABSTRACT FROM AUTHOR]

Millions of refugees are on the move globally, mostly settling in low- and middle-income (LMIC) “host” countries, where they often receive insufficient assistance and encounter a multitude of barriers. Despite a risk for developing mental illness, limited research exists on their struggles and coping strategies in these settings, especially outside of camps. Against this backdrop, our qualitative study aimed to gain a deeper understanding of refugee experiences in Durban, South Africa. We conducted semistructured individual interviews with 18 adult refugees from Zimbabwe and the Democratic Republic of Congo at a community-based support center in Durban. Participants described their problems, effects on mental health, and coping abilities. Interviews were recorded and analyzed for themes. Major problems were reported with work, xenophobia/racism, mental health, physical safety, housing, healthcare, and quality of life. Participants discussed feelings of worry, fear, emotional pain, anger, powerlessness, hopelessness, worthlessness, and passive suicidal ideation. Coping mechanisms consisted of friendships, church, praying, work, physical activities, family, learning the local language, and avoidance of thoughts. Many interviewees expressed a strong desire to either return to their homeland or move elsewhere. Refugees in South Africa face considerable hardships including xenophobia, physical abuse, and work/legal obstructions. More research is needed in LMICs to identify the challenges, psychological effects, and coping in such populations so that appropriate and accessible mental health services can be created for those who require them. [ABSTRACT FROM AUTHOR]

This article is based on a qualitative study on sexuality, identity and relationships among female and male youth living on the streets. Data were obtained from approximately 50 focus groups and individual interviews with 37 youth, of which 17 were female. There were several themes with regard to masculinity and femininity and constructions of motherhood and fatherhood that emerged from the study. In this article we focus on the following broad theme: men as providers, violence, sex, and sexuality. Recommendations are made regarding consciousness raising, therapeutic intervention, transforming gendered relationships and working towards socio-economic equality. [ABSTRACT FROM PUBLISHER]

Children’s participation in decisions affecting them is a fundamental human right. This article proposes an ethical framework for meaningful, authentic children’s participation consistent with children’s rights, one developed within the context of international and continental human rights treaties, global commitments and declarations on children’s rights and legal provisions within South African legislation. [ABSTRACT FROM PUBLISHER]

The article discusses the benefits and challenges of community engagement in the development of community mental health services for common mental disorders (CMDs), presenting the lessons from a case study in a rural South African subdistrict site. Through interviews with service providers and users, it was found that community participation can contribute to culturally competent services, personal empowerment of the care recipients and promotion of the mobilization of resources and actions.