Attitude towards Psychiatric Medication among the Providers and Recipients of Mental Health Services

Abstract

People often do not seek or adhere to psychiatric treatment for mental health problem. Among many factors including accessibility, stigma and side effects, attitudinal barriers toward psychiatric medication is one of the major reasons behind this. The attitudinal aspect of both the service providers and recipients can contribute to this. However, study findings on attitude towards psychiatric medication are limited in the worldwide context and almost nonexistent in the Bangladesh context. This study was therefore designed to explore the attitude towards psychiatric medication among the providers and recipients of mental health services. Qualitative exploration using grounded theory approach was used in this study. 18 individuals from different categories of providers and recipients participated in this study. The recipients were selected purposively from mental health service centers (National Institute of Mental Health, Bangabandhu Sheikh Mujib Medical University, Nasirullah Psychotherapy Unit) and from community to ensure maximum variation. Ethical approval was taken before starting data collection. Data collection involved in-depth interview done face to face using a predesigned topic guide to cover the research objectives. The topic guide was developed through mind-map exercise and was pilot tested before starting the interview. Written consent was obtained from the participants before the interview except for one illiterate participant. All the interviews were audio recorded with participants‟ permission. Recorded interviews were transcribed in the form of text document. Data was analyzed using computer based qualitative analysis program NVivo-10. Data collection, coding and analysis were carried out simultaneously. The data from the interview revealed several distinct themes which were classified into six broad categories namely, pre-conceived ideas, experience, attitude, behavior, facilitators of behavior and burden. Although the primary concern was the attitude towards medication, the other categories seem to contribute in widening the context in which attitude towards psychiatric medication develops and interact. Data revealed presence of several pre-conceived ideas among the participants, which include equating psychiatric medicine with psychiatric illness, reliance on medical model, low priority of mental health problem and misconceptions. They also reported personal and vicarious experiences of using psychiatric medication that have exposed them to direct and indirect impacts of psychiatric medication. The pre-conceived ideas and experiences seemed to contribute to the formation of attitude towards psychiatric medication. Attitude was conceptualized with a bi-factorial cognitive-affective model, which leads towards medication related behavior. The findings also indicated six distinct themes namely knowledge, psycho-education, communication, faith on expertise, multidisciplinary teamwork, and family influence that seemed to facilitate behavior related to psychiatric medication. Several types of burdens also revealed, which thought to be associated with behavior related to psychiatric medication. The findings have enhanced understanding of the connections between attitude and practice around the use of psychiatric medication. This may be useful in increasing early uptake of psychiatric intervention and in reducing non-compliance to medical treatment. Overall, findings of this study may contribute in policymaking and devising strategies to reduce mental health service gap in Bangladesh.