Skip to main content

Joining psychiatric care and faith healing in a prayer camp in Ghana: randomised trial

  • A. Ofori-Atta (a1), J. Attafuah (a2), H. Jack (a3), F. Baning (a4), R. Rosenheck (a5) and the Joining Forces Research Consortium...

Care of people with serious mental illness in prayer camps in low-income countries generates human rights concerns and ethical challenges for outcome researchers.


To ethically evaluate joining traditional faith healing with psychiatric care including medications (Clinical identifier NCT02593734).


Residents of a Ghana prayer camp were randomly assigned to receive either indicated medication for schizophrenia or mood disorders along with usual prayer camp activities (prayers, chain restraints and fasting) (n = 71); or the prayer camp activities alone (n = 68). Masked psychologists assessed Brief Psychiatric Rating Scale (BPRS) outcomes at 2, 4 and 6 weeks. Researchers discouraged use of chaining, but chaining decisions remained under the control of prayer camp staff.


Total BPRS symptoms were significantly lower in the experimental group (P = 0.003, effect size –0.48). There was no significant difference in days in chains.


Joining psychiatric and prayer camp care brought symptom benefits but, in the short-run, did not significantly reduce days spent in chains.

Declaration of interest


Corresponding author
Correspondence: Robert Rosenheck, Department of Psychiatry, Yale Medical School, New Haven, Connecticut, USA. Email:
Hide All

See editorials, pp. 6–8 and 9–10, this issue.

Hide All
1 World Health Organization. Ghana Country Summary. World Health Organization, Department of Mental Health and Substance Abuse, 2007.
2 Ofori-Atta, A, Read, UM, Lund, C, Consortium, MHRP. A situation analysis of mental health services and legislation in Ghana: challenges for transformation. Afr J Psychiatry (Johannesbg) 2010; 13: 99108.
3 Ae-Ngibise, K, Cooper, S, Adiibokah, E, Akpalu, B, Lund, C, Doku, V, et al. ‘Whether you like it or not people with mental problems are going to go to them': a qualitative exploration into the widespread use of traditional and faith healers in the provision of mental health care in Ghana. Int Rev Psychiatry 2010; 22: 558–67.
4 Appiah-Poku, J, Laugharne, R, Mensah, E, Osei, Y, Burns, T. Previous help sought by patients presenting to mental health services in Kumasi, Ghana. Soc Psychiatry Psychiatr Epidemiol 2004; 39: 208–11.
5 Quinn, N. Beliefs and community responses to mental illness in Ghana: the experiences of family carers. Int J Soc Psychiatry 2007; 53: 175–88.
6 Edwards, J. Ghana's mental health patients confined to prayer camps. Lancet 2014; 383: 15–6.
7 Carey, B. The Chains of Mental Illness in West Africa. New York Times; 2015: 11 Oct.
8 Fosu, GB. Women's orientation toward help-seeking for mental disorders. Soc Sci Med 1995; 40: 1029–40.
9 Lamensdorf Ofori-Atta, AM, Linden, W. The effect of social change on causal beliefs of mental disorders and treatment preferences in Ghana. Soc Sci Med 1995; 40: 1231–42.
10 Ofori-Atta, A, Cooper, S, Akpalu, B, Osei, A, Doku, V, Lund, C, et al. Common understandings of women's mental illness in Ghana: results from a qualitative study. Int Rev Psychiatry 2010; 22: 589–98.
11 Stefanovics, EA, Rosenheck, RA, He, H, Ofori-Atta, A, Cavalcanti, M, Chiles, C. Medical student beliefs and attitudes toward mental illness across five nations. J Nerv Ment Dis 2016; 204: 909–15.
12 Stefanovics, EA, He, H, Cavalcanti, M, Neto, H, Ofori-Atta, A, Leddy, M, et al. Witchcraft and biopsychosocial causes of mental illness: attitudes and beliefs about mental illness among health professionals in five countries. J Nerv Ment Dis 2016; 204: 169–74.
13 Overall, J, Gorham, D. Brief Psychiatric Rating Scale. Psychol Rep 1962; 10: 799812.
14 Mount Horeb Prayer Center. Mount Horeb Prayer Center, 2012 (
15 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
16 Derogatis, LR. Brief Symptom Inventory (BSI)-18. Administration, Scoring and Procedures Manual. NCS Pearson Inc, 2001.
17 Lowe, B, Kroenke, K, Herzog, W, Grafe, K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord 2004; 81: 61–6.
18 Lehman, A. A quality of life interview for the chronically mentally ill. Eval Program Plann 1988; 11: 5162.
19 Jones, SH, Thornicroft, G, Coffey, M, Dunn, G. A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). Br J Psychiatry 1995; 166: 654–9.
20 Guy, W. ECDEU Assessment Manual for Psychopharmacology-Revised. Department of Health, Education, and Welfare. Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs, 1976.
21 Lingjaerde, O, Ahlfors, UG, Bech, P, Dencker, SJ, Elgen, K. The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatr Scand Suppl 1987; 334: 1100.
22 Lindstrom, E, Lewander, T, Malm, U, Malt, UF, Lublin, H, Ahlfors, UG. Patient-rated versus clinician-rated side effects of drug treatment in schizophrenia. Clinical validation of a self-rating version of the UKU Side Effect Rating Scale (UKU-SERS-Pat). Nord J Psychiatry 2001; 55 (suppl 44): 569.
23 Cohen, J. Statistical Power Analysis for the Behavioral Sciences (2nd edn). Lawrence Erlbaum Associates, 1988.
24 Leucht, S, Arbter, D, Engel, RR, Kissling, W, Davis, JM. How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials. Mol Psychiatry 2009; 14: 429–47.
25 Huhn, M, Tardy, M, Spineli, LM, Kissling, W, Förstl, H, Pitschel-Walz, G, et al. Efficacy of pharmacotherapy and psychotherapy for adult psychiatric disorders: a systematic overview of meta-analyses. JAMA Psychiatry 2014; 71: 706–15.
26 Mendez, JE. Report of the Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. OHCHR, 2016.
27 Gureje, O, Nortje, G, Makanjuola, V, Oladeji, BD, Seedat, S, Jenkins, R. The role of global traditional and complementary systems of medicine in the treatment of mental health disorders. Lancet Psychiatry 2015; 2: 168–77.
28 Arias, D, Taylor, L, Ofori-Atta, A, Bradley, EH. Prayer camps and biomedical care in Ghana: is collaboration in mental health care possible? PLoS One 2016; 11: e0162305.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
Type Description Title
Supplementary materials

Ofori-Atta et al supplementary material
Ofori-Atta et al supplementary material 1

 Word (79 KB)
79 KB


Altmetric attention score

Full text views

Total number of HTML views: 417
Total number of PDF views: 509 *
Loading metrics...

Abstract views

Total abstract views: 2442 *
Loading metrics...

* Views captured on Cambridge Core between 4th January 2018 - 23rd June 2018. This data will be updated every 24 hours.

Joining psychiatric care and faith healing in a prayer camp in Ghana: randomised trial

  • A. Ofori-Atta (a1), J. Attafuah (a2), H. Jack (a3), F. Baning (a4), R. Rosenheck (a5) and the Joining Forces Research Consortium...
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *