This report presents the findings of a medical anthropological analysis conducted within the MSF mental health (MH) project in Monrovia, Liberia. The analysis focused on gaining a deeper understanding of patient and caregivers healing pathways (within and outside the MSF clinics); how traditional and religious healers fit into this and approach care; and how each understands MH conditions/epilepsy and treatments, in order to adopt a more tailored community-based and patient-centred approach which ultimately improves quality of care. Applied anthropology, in its focus on individual narratives situated in their socio-cultural context can play a major role in enabling such understandings.
The findings indicate that the stigmatisation of MH conditions and epilepsy leads to abuse and impacts patients’ therapeutic pathways. Additionally, patients and religious and traditional healers often believed that MH conditions and epilepsy were the result of witchcraft. This perceived spiritual cause (as well as the belief that biomedicine could not ‘heal’ them) meant that before seeking biomedical treatment, they sought a spiritual cure through traditional and/or religious healers. We also found that while all patients said they had very good experiences at the MSF clinics, most still claimed not to be aware of their diagnosis.
Recommendations include: building on awareness-raising of MH conditions and epilepsy; collaborating with traditional and religious healers; effectively communicating diagnoses in a culturally sensitive manner; and supporting patients in their long-term recovery. The findings and recommendations could be extrapolated where appropriate to areas with similar MH care contexts.