|Year : 2015 | Volume
| Issue : 1 | Page : 87-91
Views of practitioners of alternative medicine toward psychiatric illness and psychiatric care: A study from Solapur, India
Prabhakar C Holikatti1, Nilamadhab Kar2
1 Department of Psychiatry, Al-Ameen Medical College and Hospital, Bijapur, Karnataka, India
2 Department of Psychiatry, Black Country Partnership NHS Foundation Trust, Steps to Health, Showell Circus, Low Hill, Wolverhampton, WV10 9TH, United Kingdom
|Date of Web Publication||31-Jul-2015|
Prabhakar C Holikatti
B - 37, Ekta Nagar, Solapur - 413 006, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: It is common knowledge that patients seek treatment for psychiatric illnesses from various sources including the alternative medicine. Views and attitudes of clinicians often influence the provision of appropriate mental health care for these patients. In this context, it was intended to study the views of the practitioners of alternative medicine toward psychiatric disorders, patients and interventions. Methods: The study was conducted as a questionnaire-based survey among a sample of practitioners of alternative medicine specifically Ayurveda and Homeopathy, who were practicing in Solapur and adjoining areas of Maharashtra and Karnataka states in India. A semi-structured Attitudinal Inventory for Psychiatry questionnaire was used. Demographic and professional data were collected. Results: Out of 62 practitioners approached, 50 responded (80.6%). There were no significant differences in the views of practitioners toward psychiatry and psychiatrists based on respondents' gender, place of residence, location of practice, type of alternative medicine, exposure to psychiatric patients, or if they knew someone with psychiatric illness. Attitudes were generally positive, but variable. Among negative observations were that approximately 60% of respondents felt that a patient can be disadvantaged by being given a psychiatric label and 58% believed that emotions are difficult to handle. A considerable proportion (40%) of the respondents felt doctors other than psychiatrists were unable to identify psychiatric disorders. Discussion: This study's findings suggest that practitioners of alternative medicine have mixed views about mental illness, patients and treatment. Some of their negative views and perceived inability to identify psychiatric disorders may be addressed through further training, information sharing and collaborative work.
Keywords: Alternative medicine, attitude, Ayurveda, homeopathy, psychiatry, psychiatric disorder, psychiatric patient
|How to cite this article:|
Holikatti PC, Kar N. Views of practitioners of alternative medicine toward psychiatric illness and psychiatric care: A study from Solapur, India. Educ Health 2015;28:87-91
| Introduction|| |
Psychiatric disorders are common; available data from Indian studies suggests that about 20% of the adult population is affected with a psychiatric disorder.  It has been observed in India, as is likely the case in many countries, that most psychiatrically ill individuals do not recognize or acknowledge their need for treatment.  Further, a considerable proportion of these individuals do not receive psychiatric treatment, including nearly one-third of urban schizophrenics in India.  On the other hand, many psychiatric patients and their relatives seek treatment from various non-mainstream medical sources, including alternative medicine practitioners and faith-based healers. 
There is need to understand and, if found necessary, to intervene in the mental health concerns of the patients who seek help from practitioners of alternative medicine for their health related issues. However, clinicians' (of all types) views on mental illness and mentally ill patients contribute to the care paths they pursue for their patients and outcomes. Views about mental illness and psychiatric interventions have been shown to vary across the health professions and clinicians' stage of career, including medical students, ,, medical and surgical specialists,  and nurses.  It has been observed that the views of psychiatrists and medical physicians in other specialties also differ even in hospitals where psychiatrists assess and treat any mental illness of patients admitted in medical and surgical wards. 
In India many mentally ill patients receive Ayurveda and homeopathy treatment, which are forms of alternative medicine ,,,,, commonly practiced within India. Numerous reports explore the use and efficacy of interventions from these disciplines in psychiatric disorders, which highlight a need for studying the interdisciplinary collaboration in the care of psychiatric patients. ,, In this context, we explore the perceptions of the of Ayurvedic and homeopathic physicians about mental illness, mentally ill patients and psychiatric interventions. This information may help the disciplines better understand one another and improve mental health care.
| Methods|| |
The survey was of the practitioners of Ayurveda and homeopathy with degrees like Bachelor of Ayurveda Medicine and Surgery (BAMS) and Bachelor of Homeopathic Medicine and Surgery (BHMS) who were practising in Solapur and adjoining areas. Solapur is a multilingual, multicultural city at the border of Maharashtra and Karnataka states in India, with a population just under a million. The practitioners were attending a Continuing Medical Education program on psychiatry delivered by the first author and organized by National Integrated Medical Association (NIMA), which is an association of general practitioners educated in integrated system of medicine which includes study of Modern Medicine and knowledge of Ayurveda, unani or siddha with scientific approach.
A semi-structured, self-rated Attitudinal Inventory for Psychiatry (AIP) was used, which has 14 statements with 5-point Likert type of responses (1: Strongly disagree; 2: Disagree; 3: Neither agree nor disagree; 4: Agree; 5: Strongly agree) for the survey [Appendix 1 [Additional file 1]]. This questionnaire was used in a previous study,  however the validation data was not available. This was updated and one more statement was added. The inventory was face-validated through discussion with peers. Comparatively higher scores in the AIP generally indicate negative attitudes.
Demographic details such as age, gender; professional information like degree in alternative medicine, years of practice, exposure to psychiatric patients and having any known person with psychiatric illness were collected. As a considerable majority of Indian population live in rural areas where lifestyles and facilities are quite different from those living in cities, the information about where the practitioner lived (rural/urban) and practised (rural/urban) was also collected.
The hardcopy surveys were distributed to the practitioners and collected back before the program. Out of 62 practitioners approached, complete responses were received from 50 (80.6%).
The project was approved by the ethics committee of Quality of Life Research and Development Foundation, an organization of multidisciplinary researchers based in Bhubaneswar, India. Participation in the survey was voluntary. Informed consent from the practitioners was collected. The responses were collected without any identifiable information about the respondent and the anonymity was maintained throughout the process.
'Agree' and 'strongly agree' responses were combined for analyses, as were comparable disagreeing responses. Neutral responses were included for calculating total value, mean and standard deviation (SD) of the responses. Most results were provided in percentages, categorical variables were compared by Chi-square tests and means by t-tests. Internal consistency of the AIP for the study sample was assessed by the Cronbach's alpha. Significance level was set at standard 0.05 levels.
| Results|| |
Sample characteristics are given in [Table 1]. There were 34% female and 66% male practitioners. Mean age of female practitioners was 32 and for males was 36 years. Their average years of practice were 7 and 10, respectively. There were 42 BAMS and 8 BHMS practitioners; they were comparable in their years of professional practice (10 vs 7 years).
Considering this study, the internal consistency of AIP (full scale, 14 items) measured by Cronbach's Alpha was 0.63 suggestive of acceptable internal consistency. Mean AIP score of the entire sample (n = 50) was 38.0 ± 6.4. There were no significant differences in AIP scores based on degree, gender, exposure to psychiatric patients, place of residence (rural/urban) or location of practice [Table 2]. There were 24 practitioners who knew someone with mental illness and 26 who did not. Those who knew were significantly older in age (38 ± 8 vs 32 ± 7 years; P < 0.01) and had higher number of years in practice (12 ± 7 vs 7 ± 6; P < 0.01); however, their total score on AIP was higher (39.8 ± 5.5 vs 36.4 ± 6.7), which approached significance (P = 0.06).
|Table 2: Comparison of Attitudinal Inventory for Psychiatry score among various groups|
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It is evident from the percentage of agree responses [Figure 1] that there is a wide variation in the views about different aspects of psychiatric illness and practice among these Ayurvedic and homeopathic physicians. Most practitioners (60%) felt being 'labeled' as a psychiatric case is disadvantageous for the patient and nearly as many found patients' emotions difficult to handle. On the other hand, only a small minority (4%) had pessimistic opinion about the course and prognosis of psychiatric illnesses.
|Figure 1: Percentages of respondents who agreed with each item of the Attitudinal Inventory for psychiatry|
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| Discussion|| |
This study reports the views of a sample of practitioners of Ayurveda and homeopathy from Solapur, India regarding mental illness and psychiatric interventions. It was observed that the views of these practitioners of alternative medicine were generally more positive than negative in the areas explored. Positive views toward psychiatric interventions and the treatability of psychiatric disorders were exemplified by the observation that most respondent practitioners disagreed with the statements like 'psychiatric disorders are untreatable'; and 'psychiatric services are unsatisfactory'. Most practitioners did not subscribe to the myth that psychiatric disorders are permanent and without any hope of recovery. In contrast, there were perceptions held by varying proportions of these practitioners that seemed contrary and need further attention.
Most of the samples (60%) felt that patients are disadvantaged by being labeled as a psychiatric case. This highlights the continuing stigma toward the psychiatric patients in the Indian society. In another study, even 68.2% of psychiatrists similarly felt the same way.  A considerable proportion (58%) of these Ayurvedic and homeopathic practitioners felt that patients' emotions are difficult to handle during care. This may suggest the need for better training in assessing managing psychiatric disorders by the practitioners of alternative medicine.
It has been reported that patients seen in medical or surgical departments sometimes do not wish to be referred to psychiatry  for various reasons including stigma. Indeed, 44% of this study's respondents believed this. This may mean that many patients seen by these alternative medicine practitioners have an unmet need for psychiatric care.
Forty percent of respondents believed that doctors other than psychiatrists may not be able to identify psychiatric disorders and arrange for appropriate treatment, and that these other doctors do not have the time in the office to address psychological issues. This again points out the need for psychiatric education, which may be addressed through curricula in alternative medicine training programs and through continuing medical education programs on mental health issues.
It is a concern that 40% of the practitioners reported that there is poor working relationship between psychiatrists and other doctors. Greater collaboration between psychiatrists and other health professionals is essential to improve care to patients with mental illness.
There are limitations of this study. The sample size was small and it was confined to a relatively small geographical area, so the generalizability of findings may be limited. Future studies should include larger and geographically broader sample, and include other disciplines of alternative medicine. Also, this study did not survey psychiatrists and other medical/surgical specialists from the same locality to offer complementary opinions. Although AIP, the scale used in this study, had face validation and there was acceptable internal consistency, it has not gone through a more thorough validation process.
| Conclusion|| |
Views of the alternative medicine practitioners of psychiatric disorders and psychiatric interventions were generally positive; however, a considerable proportion held views that are not conducive of providing optimal care to patients with mental illness. These should be addressed through curricular changes in the training of these disciplines and their continuing education, and by promoting opportunities for collaborative multidisciplinary work.
| Acknowledgment|| |
The study was supported by the Quality of Life Research and Development Foundation, India.
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[Table 1], [Table 2]