Conceptualisation of mental illness among Christian clergy in Harare, Zimbabwe

Master Thesis


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University of Cape Town

Background: More than 13% of the global burden of disease is estimated to be due to neuropsychiatric disorders, with over 70% of this burden in low- and middle-income countries. Characterised by severe shortages of human and material resources, formal mental health services alone are inadequate to meet the burden of mental disorders in low- and middle-income countries. New community models and innovative ways of increasing community participation and systematic delegation of specific tasks to other community level professionals have been recommended. Available evidence documents historic clergy involvement in health and wellbeing issues, but they have rarely been viewed as a partner in community mental health care. Aim: This study examines the clergy's conception, recognition of and responses to people with mental illnesses. The purpose of the study is to inform the potential roles and contributions of the clergy to community mental health either as the only contact or as a step in to formal mental health care. Method: Twenty eight in-depth interviews were conducted with clergy from ten church denominations in Harare, Zimbabwe. A framework analysis approach was used for thematic analysis. Nvivo 10 qualitative data software was used to organise the data. Results: Mental illness was conceived as a multifactor phenomenon attributed to both natural (biological and psychosocial) and supernatural (malevolent and benevolent spiritual) causes. Spiritual factors were a dominant theme in both the clergy's views on the causes of, and in their management of mental illness. The clergy were regularly consulted on a variety of emotional and psychological problems. Assistance was readily provided for these problems by all denominations, despite professed capacity gaps in the recognition and management of mental illness, and lack of appropriate training in basic mental health issues. Basic mental health training was recommended by the clergy to enhance clergy capacity for mental health awareness raising, recognition of mental disorders, brief problem focused counseling, and for improving collaborative management for initial and continued informal and formal health care and support. Implications of clergy conceptions, current responses and the perceived role of the church in community mental health are discussed.