How can India’s faith healers play a role in mental health care?

On new moon days people from across Bengaluru, India’s largest tech hub, throng the Angala Parameswari Temple at the heart of the city. The entrance is a larger-than-life sculpture of a lion’s mouth, prised open by two plastic pipes supporting the beast’s canines and jaw. Once inside, believers come to seek blessings from the eponymous goddess, a mother guardian who is vigilant against bad energy, phobias, and depressions.

Maheshwari, 20, a house help and baby-sitter, has been going to Angala Parameshwari since she was a child. Now she takes her clients and their children, too. “Whenever they feel low or anxious they come with me,” she told Devex.

This scene is not unique to this temple, and the beliefs are not limited to the young Bengalurean.

In South Asia, places of worship — temples, churches, dargahs, and mosques — attract people of diverse socio-economic backgrounds suffering from a variety of mental health issues and disorders. Studies show allopathy isn’t always the first preference of Indians seeking help for mental health issues. A majority of Indians prefer faith healers, and this is driven by sociocultural preferences as well as poor health infrastructure.

Religious healers over practitioners

“Our research has shown that over 70% of the people first seek help from faith or traditional healers for some weeks or months before turning to mental health practitioners,” said Thara Srinivasan, director of Chennai-based Schizophrenia Research Foundation. She observes that the health seeking behavior has hardly changed over the last few decades.

Kishore Kumar, Director of Banyan, a nongovernmental organization offering mental health services, outlined a key reason for this behavior: what faith healers provide is in line with the beliefs of the patients.

“Religious and faith healers give external causes for a person’s illness or disorder: it’s the fault in the stars, the gods are angry, unfinished business of ancestors, and so on. But in allopathic care, a mental healthcare practitioner will link the causes to the self, and that can be hard to accept,” Kumar said.

People choose religious practitioners who tend to give supernatural explanations of mental illness. Research has shown that many people have a positive association between religious faith, spirituality, and mental health. A person’s health seeking behavior is determined by support systems and coping mechanisms provided by religion and cultural practices, family pressure, and financial constraints.

The debate over how to view the role of faith healing in treating mental health is divided. The main bone of contention is inhumane rituals and methods of treatment. It all goes back to an incident in 2001, when 28 patients died in a fire at a faith-based mental health asylum in Erawadi, in the southern state of Tamil Nadu.

They were chained to poles as part of their treatment, and couldn't escape when fire broke out. Following this, the Supreme Court ordered the preparation of a factual report on faith healing institutions, and monitoring of such establishments.

But such a monitoring mechanism remains on paper, Srinivasan said.

In India, health care is among the lowest public sector spending. From this, mental health receives less than 1% of the health care budget. A meager $5 million was allocated to India’s National Mental Health Programme in 2017-18. But just over $650,000 was spent.

The minutes of a 2017 meeting of the National Human Rights Commission reflects how divided the mental health and policy circles are about the role of faith healers and institutions.

While some members advocated a complete ban on faith healing establishments, others, including Banyan’s Kumar, suggested there could be a convergence of the two. For long, experts have propounded a collaborative model where faith healers work with public health institutions in a referral system. Such an integration of faith healers with the modern health care system can create entry points for mental health practitioners.

Pluralistic approach in practice

Several nongovernmental institutions, hospitals, and states have put this system in practice. District Mental Health programs, such as the one in Karnataka, have created awareness around mental health in recent times and roped in faith healers, too. The National Health Programme runs awareness camps for faith healers “for dissemination of awareness regarding mental illnesses and related stigma.”

Milesh Hamlai of Gujarat-based Altruist runs one such collaborative project called Dava & Dua, which combines medicines — dava in Hindi — and prayers — dua. The project at the dargah, or shrine, of Sufi saint Saiyed Ali Mira Datar in Unava is funded by Gujarat’s Department of Health and Family Welfare and was initially started by the Hospital for Mental Health, Ahmedabad.

“We trained the mujawars [an officiator] to identify serious disorders and refer them to the psychiatrists at the out-patient clinic inside the premises,” Hamlai said. Since 2007, the Project has treated over 85,000 patients from across the country and trained over 800 mujawars.

Srinivasan believes such collaborations seem to be working — contrary to what would have happened a decade ago, today faith healers often refer patients to the hospitals.

Academics Jonathan Campion and Dinesh Bhugra have observed that “it is important that service providers and planners take into account pluralistic approaches to help-seeking.” However, the holistic combination of these two schools is met with practical, on-ground difficulties.

Banyan runs a clinic next to a popular dargah in Chennai. Kumar’s learning has been that this can’t be a standalone system. The referral model works only when there are adequate primary health centers as well as secondary and tertiary hospitals equipped to deal with the patients.

Interestingly, the government’s guidelines come off as confusing. This National Health Portal page on spirituality, operated by the Ministry of Health and Family Welfare, claims: “Recent research has shown that religious practices can be helpful in curing and preventing physical and mental illnesses...When medical care becomes unaffordable, futile, and of no use, spiritual care is absolutely feasible, and logical solution.”

It even denounces biomedical solutions. No references are provided to support these claims. The Ministry was contacted for a comment, but Devex hasn’t gotten a response.

Shortage of mental health professionals

One thing is true, said Kumar, trained mental health practitioners aren’t easily accessible to most people, which is why faith healers are popular as they seem inexpensive and accessible.

India doesn’t maintain a list of mental health care providers. However, news reports reveal an acute shortage of professionals.

“There is a paucity of all categories of mental health professionals in the country. The relative shortage of psychiatric nurses, psychiatric social workers, community mental health workers is significantly larger than the shortage of psychiatrists and psychologists,” Soumitra Pathare, director of the Centre for Mental Health Law & Policy, wrote in response to an email interview.

Addressing the shortage of the former must be a matter of urgent action if India wants to scale up mental health services and make them community-based.

With just 900 psychiatric social workers and 1,500 psychiatric nurses, the shortage currently stands at 35,000 and 30,000 respectively. There are an estimated 9000 psychiatrists and counting, with around 700 psychiatrists graduate added every year. This means there are 0.75 psychiatrists per 100,000 people; the desirable number is anything above three. Most developed countries have six psychiatrists per 100,000 people.

“Do you really think we can meet the mental health care needs of our population by just relying on the modern health care system?” Hamlai asked. Through the Dava & Dua Project mujawars have been trained to become lay counsellors and provide counseling services to the families, he added. Training more people to provide extension services is key.

Moreover, access to allopathic care doesn’t always reduce the dependency on faith healers.

Srinivasan has found that even when mental health care facilities are more easily available, such as urban areas, people simultaneously visit faith healers. “I do believe that this practice will continue for many more years to come,” she said.

“We don't generally dissuade families and patients from going to religious places,” Srinivasan said. “They have as much faith in it as they have in us, and we really don't want to erode that.”

However, interventions are necessary when there is physical harm, starvation, or other inhumane methods of treatment, she noted.

Maheshwari knows this too well as she jostles with other devotees to get a glimpse of the goddess who will alleviate her fears and demons. It’s for the minor stuff, she knows.

“Of course if anyone is seriously having mental health issues, they have to go to a more powerful temple,” she said. “Or a doctor?”

Devex, with support from our partner GHR Foundation, is exploring the intersection between faith and development. Visit the Focus on: Faith and Development page for more. Disclaimer: The views in this article do not necessarily represent the views of GHR Foundation.