Beyond belief: understanding contexts for help-seeking for severe mental illness in urban slum communities in Dhaka, Bangladesh and Ibadan, Nigeria

Research on help-seeking for serious mental illness (SMI) has often focused on the influence of cultural beliefs and explanatory models however a number of factors also influence decisions around treatment including availability, cost and quality of care. This study utilises an ecological framework to explore influences on help-seeking for serious mental illness in deprived urban slum communities in Ibadan, Nigeria and Dhaka, Bangladesh. Interviews and observation were conducted with family caregivers and people with lived experience of SMI. Although in both settings some participants speculated on the role of spiritual agents they also expressed uncertainty around the causes of SMI. Families commonly sought help from both biomedical practitioners and traditional and faith healers Help-seeking was embedded within complex ecologies of care, informed by considerations of quality, efficacy and cost, as much as beliefs. The complexity of influences on help-seeking and dissatisfaction with health services as well as healers suggests that a contextually informed, multi-component approach is needed which addresses health system weaknesses and affordability as well as accessibility. • Studies of help-seeking commonly focus on cultural beliefs and explanatory models. • We report on qualitative research in urban slum communities in Nigeria and Bangladesh. • We found that help-seeking is embedded within relational ‘ecologies of care’. • A multi-component approach should address accessibility, affordability and quality of care.