Pathways to mental health services across local health systems in sub-Saharan Africa: Findings from a systematic review.

Globally, over 280 million individuals suffer from mental disorders, and almost 85% in low-resource settings do not receive any therapy. In sub-Saharan Africa (SSA), many patients are forced to either live with untreated mental illness or seek care from traditional or religious leaders due to the high treatment cost. This literature review identifies pathways to access mental health services and proposed a collaborative model for care across SSA. We systematically searched five electronic databases (Embase and MEDLINE via OVID, CINAHL, PsycINFO, and Global Index Medicus) using the following search terms, 'pathways to care', 'mental disorders,' and 'sub-Saharan Africa' for primary studies reporting on pathways to care for mental disorders in SSA. There were no restrictions on the study's date. Overall, the electronic database search produced 3399 search results, of which we retrieved 194 articles for full-text screening and 29 studies included in the analysis. This study finds that traditional and faith-based healers play an integral role in the pathway to care; more than 70% used traditional and religious healers as the first point of care for mental health care. The median duration for the delay in seeking treatment in a health facility was six months. Patients who sought care from traditional and faith healers were found to have experienced the most prolonged delay without treatment. Age, gender, level of education, marital status, and geographical location were some of the factors associated with the pathway choice. Patients who sought care from traditional and faith healers as the first point of care were found to have experienced the most extended delay without treatment when they arrived at the hospital. The study proposes and recommends a new model for collaboration between biomedical, traditional and faith-based healers that focuses on education through training and adopting a new referral framework.