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Indian Journal of Community Medicine

Beliefs and attitudes towards mental health among medical professionals in Delhi

Author(s): Jugal Kishore, Mukherjee Radhika, Parashar Mamta, Jiloha RC, Ingle GK

Vol. 32, No. 3 (2007-07 - 2007-09)

SHORT ARTICLE

Year : 2007 | Volume : 32 | Issue : 3 | Page : 198-200

Beliefs and attitudes towards mental health among medical professionals in Delhi

Jugal Kishore1, Mukherjee Radhika2, Parashar Mamta1, Jiloha RC2, Ingle GK1
1 Department of Community Medicine, GB Pant Hospital, Maulana Azad Medical College, New Delhi, India
2 Department of Psychiatry, GB Pant Hospital, Maulana Azad Medical College, New Delhi, India
Date of Submission 26-Apr-2006
Date of Acceptance 10-Aug-2007

Correspondence Address:
Jugal Kishore
Department of Community Medicine, GB Pant Hospital, Maulana Azad Medical College, New Delhi - 110 002
India

Source of Support: None, Conflict of Interest: None
How to cite this article:
Jugal K, Mukherjee R, Parashar M, Jiloha RC, Ingle GK. Beliefs and attitudes towards mental health among medical professionals in Delhi. Indian J Community Med 2007;32:198-200
How to cite this URL:
Jugal K, Mukherjee R, Parashar M, Jiloha RC, Ingle GK. Beliefs and attitudes towards mental health among medical professionals in Delhi. Indian J Community Med [serial online] 2007 [cited 2007 Nov 30];32:198-200. Available from: http://www.ijcm.org.in/text.asp?2007/32/3/198/36827

Introduction

Adverse attitudes to mental illness are found in all societies in the world. The belief that mental illness is incurable or self-inflicted can also be damaging, leading to patients not being referred for appropriate mental health care. For effective health care to be delivered, it is crucial that health professionals are not hampered by prejudiced attitudes. Psychiatrists themselves share the stigma of mental illness with their patients. Surprisingly, medical students judge psychiatrists to be emotionally unstable and 'woolly' thinkers. Similarly, the practice of psychiatry is often viewed as unscientific, imprecise and ineffective. Consequently, primary care physicians who hold these views tend to focus on physical symptoms and omit or minimize their focus on mental disorder and are less likely to refer patients to mental-health services, which indicate their poor training or lack of awareness. Senior medical staff often have more realistic attitudes towards mental illness than do their junior colleagues.[1] This implies that the stigma of mental illness can be reduced by education and experience, and an examination of attitudes towards mental illness should be included in medical training.[2] Stigma associated with mental illness is more frequently reported in the general community than in the medical community. This study was designed to assess the beliefs and attitudes of medical professionals towards mental health.

Materials and Methods

This study was conducted in three out of the five medical teaching institutions of Delhi. For the purpose of this study, a pre-tested, validated, 25-item, self-reported questionnaire assessed attitudes towards mental illness; knowledge about causes of mental illness, contact with mental illness and treatment modalities used. The questionnaire was distributed to interns, residents and medical officers working in these institutions. All the participants had exposure to psychiatry during their undergraduate curriculum. Purpose of the study was explained and responses were kept anonymous to encourage candid opinions. Informed consent from each participant was obtained. Seventy-six medical professionals, as a convenient sample, were contacted to get their responses on the questionnaire. Only those present on any of the working days of one week in the month of November 2005 were included in the study. They were requested to fill the questionnaire and return it on the spot in the presence of the first three authors. The data was analyzed using the Epi-info 6.2 computer software package. Simple proportions were used to present the data.

Results

Only about 60% of the respondents considered mental illness to be a disease. Nearly 80% of the respondents considered psychiatry to be a difficult discipline. Despite this, it was seen that 72% found psychiatry to be a stimulating subject. The most heartening change observed was that now only 4% believed that psychiatrists do nothing and know nothing. However, it was also encouraging to note that 41% wanted to take up psychiatry [Table - 1].

Regarding attitudes towards patients with mental illness, we observed a number of respondents (24%) who believed that people in contact with the mentally ill, could develop odd behavior. Nearly 70% claimed that they would feel comfortable talking to mentally ill patients. As many as 25% of the respondents said they felt sorry when they saw a mentally ill person. According to 63% respondents, mental disorders were caused solely by unfavorable social circumstances. Some believed that mental illness is God's punishment (5.2%); a result of poor diet (18.1%) and loss of semen (1.3%). Regarding attitudes towards treatment, it was disheartening to see that 8% of the respondents considered mental illness to be untreatable; further 8% agreed with the attitude that considered psychiatric treatment as being more disabling than the illnesses [Table - 2].

Discussion

Psychiatry is increasingly being considered a valid medical discipline, reflected from the fact that mental illness is being accepted to be a disease like any other. A study in 1989 found that nearly 90% of the medical community [3] acknowledged the scientific basis of psychiatry. A study by Kumar et al. (2001) found that only 5% of post-graduation medical students disagreed with the opinion that psychiatry is a valid medical discipline.[4]

A heartening fact was the high positive response rate obtained for the question pertaining to etiology of mental disorders. This is in contrast to the finding by Chadda and Shome [5] but similar to the finding by Kumar et al.[4] This finding could be explained by the differences in the sample population and speaks well for the growing awareness of the complex interplay between psychological and biological factors.

The results of a study by Feifel et al.[6] suggest that medical students bring to their medical training a very negative view of psychiatry, compared to other specialties. The consistency of psychiatry's terminal ranking in virtually all areas surveyed by them indicated that this field was perceived as outside the mainstream of medical practice. The findings of our study suggest that 41% of our respondents said they would consider taking up psychiatry as a profession.

In the study by Chadda and Shome (1996),[5] it was found that psychiatric consultation services were not sufficiently utilized by a large number of clinicians. A substantial proportion of doctors underestimated the psychiatric morbidity, especially about unexplained physical symptoms and specific depressive symptoms in their patients. Most of them felt the need to improve upon undergraduate medical education in psychiatry in India, as well as had a desire to have consultation-liaison psychiatric units in India. That mental illness is still a stigma is borne by the finding[5] that a high percentage of residents wanted psychiatry to be practiced in separate setups. That stigmatization of patients with mental disorders was still rampant was reflected in our finding that 63% of respondents said they would not employ a person who has recovered from mental illness, and 45% of respondents said they would be against close relative marrying such a person. However, over the recent years, psychiatry has become more biologically oriented, and tension between psychiatry and medicine has lessened. Our study found that there were 23% of respondents who believed that people in contact with psychiatric patients develop odd behavior. Usually junior doctors tend to lack confidence when dealing with psychiatric patients. Our study, however, found that 69.7% of the study population felt comfortable talking to patients with mental disorders.

Attitudes assessed in this survey reflect primarily a subjective value system and cannot objectively be deemed accurate or inaccurate. However, some of these attitudes appear to reflect inaccurate or incomplete knowledge, and it is these negative attitudes that may be corrected through the course of medical education. There is sufficiently strong scientific evidence available to suggest that the effectiveness of psychiatric treatments, on the whole, is equal to or superior to that of conventional treatments in other specialty fields.[7] On the other hand, patients with diseases that are difficult to treat are found in all medical practices. This points to a need for increased teaching about such issues across specialty boundaries during medical school. Other beliefs about psychiatry seem to be due to erroneous or insufficient knowledge. For example, our respondents only weakly endorsed the belief that psychiatry is a rapidly advancing field and saw it as having a less bright and less interesting future than all the other specialties surveyed. It is hard to identify a specialty that in the last decade has seen an explosion in the understanding and treatment of illness in its purview comparable to that in the field of psychiatry .

In India, where priorities are different, mental health has been a largely ignored field; however, mental health is an integral component of total health. As per the estimates, global burden due to mental illness would be the second leading cause in 2020. This highlights the need of mental health care at the community level. On one side, paucity of mental health professionals in the country exists; and on the other side, presence of myths and misconceptions among medical professionals demands an urgent need of reorientation of undergraduate training of medical students and doctors.

References

1. Mukherjee R, Fialho A, Wijetunge K, Checinski K, Surgenor T. The stigmatization of psychiatric illness: The attitudes of medical students and doctors in a London teaching hospital. Psychiatr Bull 2002;26:178-81.
2. Royal College of Psychiatrists, Royal College of Physicians, British Medical Association. Stigmatization within the medical profession. Council Report CR91. Royal College of Psychiatrists: London; 2001.
3. Jiloha RC. Image of psychiatry among medical community. Indian J Psychiatry 1989;31:285-7.
4. Kumar A, Goyal U, Ganesh KS, Srivastava MK, Gautum BD, Kumar R. Attitude of postgraduate residents towards psychiatry. Indian J Psychiatry 2001;43:2.
5. Chadda RK, Shome S. Psychiatric aspects of clinical practices in general hospitals: A survey of non psychiatric clinicians. Indian J Psychiatry 1996;38:86-93.
6. Feifel D, Moutier CY, Swerdlow NR. Attitudes toward psychiatry as a prospective career among students entering medical school. Am J Psychiatry 1999;156:1397-1402. [PUBMED] [FULLTEXT]
7. National Advisory Mental Health Council: Health care reform for Americans with severe mental illnesses. Am J Psychiatry 1993;150:1447-65.

Tables

For larger view, please click on image

Table 1: Attitudes towards mental health and psychiatrists

Table 1: Attitudes towards mental health and psychiatrists

Table 2: Perception about causes and treatment of mental disorders

Table 2: Perception about causes and treatment of mental disorders

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