Explanatory model of mental illness and treatment-seeking behavior among caregivers of patients with mental illness: Evidence from Eastern India

Vijay Kumar Lilhare; Abhijit Pathak; KJ Mathew; Chittranjan Subudhi

doi:10.4103/ijsp.ijsp_24_20

ORIGINAL ARTICLE

Year : 2020 | Volume : 36 | Issue : 4 | Page : 327-332

Explanatory model of mental illness and treatment-seeking behavior among caregivers of patients with mental illness: Evidence from Eastern India

Vijay Kumar Lilhare¹, Abhijit Pathak², KJ Mathew³, Chittranjan Subudhi⁴
¹ State Health Resource Centre, Raipur, Chhattisgarh, India
² Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, Odisha, India
³ Médecins Sans Frontières, Jordan
⁴ Department of Social Work, Central University of Tamil Nadu, Tiruvarur, Tamil Nadu, India

Date of Submission	07-Feb-2020
Date of Decision	14-Apr-2020
Date of Acceptance	10-Jun-2020
Date of Web Publication	31-Dec-2020

Correspondence Address:
Mr. Abhijit Pathak
Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, Odisha
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijsp.ijsp_24_20

Abstract

Background: Mental illness does not have a homogeneous definition since its explanation varies across the culture. Caregivers are playing a vital role in the decision-making process of patient treatment. Thus, the objective of this study is to investigate the explanatory models (EMs) about mental illnesses and treatment-seeking behavior (TSB) prevalent among the patients' caregivers in Jharkhand, India. Methods: The present study was conducted among the patients' caregivers from the Hazaribagh district of Jharkhand, India. Two-hundred and forty respondents were selected through a convenient sampling method. A sociodemographic detail sheet used for recording the sociodemographic profile of the respondents and semi-structure interview schedule sheet was used to record the EMs and TSB of the respondents. Results: Most caregivers understand mental illness as a brain dysfunction (50.4%) but unaware of the causation of it (48.3%). Whereas 82.1% of patients' caregivers prefer medical facilities for the treatment; at the same time, 57.5% prefer faith healers or religios practice to cure. Conclusion: It can be inferred from the results that half of the respondents still have other kinds of EMs on the causation of mental illness. Although the high frequency of seeking medical facilities has come in the result, different modes of treatment seeking which are done parallelly by caregivers such as faith and traditional healing cannot be ignored. Therefore, there is a need to raise the mental health literacy in this region in addition to the medical and psychiatric care facilities.

Keywords: Caregiver, explanatory model, India, mental illness, traditional healing

How to cite this article:
Lilhare VK, Pathak A, Mathew K J, Subudhi C. Explanatory model of mental illness and treatment-seeking behavior among caregivers of patients with mental illness: Evidence from Eastern India. Indian J Soc Psychiatry 2020;36:327-32

How to cite this URL:
Lilhare VK, Pathak A, Mathew K J, Subudhi C. Explanatory model of mental illness and treatment-seeking behavior among caregivers of patients with mental illness: Evidence from Eastern India. Indian J Soc Psychiatry [serial online] 2020 [cited 2021 Jan 28];36:327-32. Available from: https://www.indjsp.org/text.asp?2020/36/4/327/305943

Introduction

Mental illness is a global concern since it leads to psychological dysfunction. It carries and accounts for 30% of the nonfatal global burden of disease and an aggregate of 10% share of the worldwide burden, i.e., fatal and nonfatal.^[1] Mental illness can affect a person at any age, race, religion, or income.^[2] It is not the outcome of personal weakness, lack of character, or poor upbringing; however, it obstructs an individual from performing his/her daily socio, occupational functioning. With the advancement of science and technology, the detection of symptoms and its treatment and management has become possible. The psychiatric community though attributes to hereditary, socioenvironmental stress for mental illness, people across cultures have their own explanations which can be scientifically termed as “explanatory model.”

An explanatory model (EM) of mental illness explains prior knowledge on the causation, perception, experiences, and traditional belief held by the patients, their caregiver, and the population in general.^[3] These EMs are rooted in the culture and the religions followed by many around us. About 90% of people on earth believe in religion and religious practices to define the cause and treatment of the mental illnesses.^[4] Thus, the notion of the majority justifies the causes of the mental illnesses which are due to possession of evil spirits, black magic, controlled by a ghost, and the influence of lousy air and witchcraft.^{[5],[6],[7],[8]}

Few studies reflected that the causation of mental illness is due to sexual dysfunction, loss of semen due to excessive masturbation, and vaginal secretion.^[9],[10] Others attributed it to family and work burden.^{[11],[12],[13]} The EMs remain consistent in other studies too,^{[14],[15],[16],[17]} but few studies reported different EMs in terms of gender; male, despite having a higher percentage of literacy, attributed spirituality, black magic, and supernatural powers for the causation of mental illness, whereas female explanation includes biomedical model and poor marital relationship and sexual dysfunction.^[10],[18]

These EMs tend an individual to seek traditional treatment from and faith healing, which does not have a guarantee of recovery from the illness but has mass acceptance. The prominent explanation for such a tendency lies in the lack of awareness and understanding of mental illness and their scientific treatment.^{[7],[12],[19],[20]} The caregiver's literacy also determines the nature of seeking treatment if their belief systems are colored by supernatural so does their treatment option too, i.e., faith healing and traditional treatment.^{[12],[21],[22],[23]}

The present study aims at exploring the EMs and treatment-seeking behavior (TSB) from the caregiver perspective, especially in the context of Jharkhand – a state with an initial stage of development and meager facilities of health and mental health. The study has the following research questions: (i) what are the EMs used by the patients' caregivers to understand the causes of mental illness? and (ii) what are the treatment practices sought by the patients' caregivers?

Methods

Study area

The current study is a community-based descriptive study conducted in the Hazaribagh district of Jharkhand, state of India, in the month of December and January 2015–2016 with the help of Nav Bharat Jagriti Kendra – a nongovernment organization catering to the mental health needs of the local population apart from other developmental programs. The list of 1400 individuals with mental illness shared by the organization helped the researchers to reach the caregivers.

Sample

A total of 240 caregivers were selected based on the estimate of 1.2 million population of a district with a prevalence rate of 20% of mental illness (power = 0.95; alpha = 0.05)^{[24],[25],[26]} with the inclusion and exclusion criteria as follows:

Inclusion criteria

A person is living with a patient with mental illness for at least 2 years, having either blood relations or marriage
Caregivers of the patient with psychosis, mood disorder, or any neurotic disorder as per the International Classification of Diseases-10 Classification of Mental and Behavioral Disorders.

Exclusion criteria

A caregiver who has a developmental disability, mental disorder, and unable to give reasonable responses
The persons below the age of 18 years and above the age of 60 years were excluded, since persons below the age of 18 years are considered adolescents who take care of the patient with the help of neighbors and above 60 years in India are considered senior citizens who too need care
Refused to give the consent.

The researcher used a convenient sample technique by selecting only those blocks of the Hazaribagh district where the concentration of patients was more as compared to other blocks of the districts.

Assessment

The researcher went to the respondent's house, explained the objectives, and, after obtaining their consent, collected their responses. A sociodemographic data sheet was used to record the sociodemographic details of the patients. A semi-structured interview schedule was drawn as per the guidelines of Kleinman et al.^[24] to record the EMs and TSB of the respondents. The schedule was presented to the respondents in their local tongue, i.e., Hindi. For the illiterate, students of Dr. Guislain Svastha Educational Trust in collaboration with Tata Institute of Social Sciences were trained using semi-structured interview schedule. Students along with the researcher visited each patient's house and explained the schedule to the caregivers and helped in comprehending and filling up the schedule.

Results

Researchers, as per the verbatim obtained, analyzed and categorized the responses into the different themes and assigned codes to it accordingly. The numerically coded theme was further processed using Statistical Package for the Social Sciences (SPSS) Windows Version 16.0: SPSS Inc., Chicago (IL), US. Frequency and percentile were used to display the sociodemographic variables and to count the responses on the EMs and TSB of the caregivers of patients with mental illness.

[Table 1] shows the sociodemographic detail of the patients' caregivers (respondent). The range of age of the respondents was between18 and 60 years. Males were 44.2% and females were 55.8%. Among the informants, 26.7% were mothers, 12.5% were fathers, 17.9% were siblings, 18.3% were spouse, and 24.6% were other relatives. The large number of population (69%) belonged to the other backward class category. Majority of the respondents belonged to the Hindu religion (84.2%). Respondents residing in rural area were 80.4%. Regarding the family type of the respondents, 52.9% represented the nuclear family and 44.6% represented the joint family system. About 79.6% of the total respondents were married. Respondents' literacy rate below 10^th class was 26.7%, 12.5% were 10th class passed and 24.6% were illiterate. Significant portions (40%) of the respondents were unemployed and 20% were daily wagers.

Table 1: Sociodemographic profile of respondents

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[Table 2] shows the explanation of the relatives about what is meant by mental illness as per their understanding. About 50.4% believed in brain dysfunction, 11.7% believed in psychological disturbance, and 10% believed in behavioral disturbance. The rest of the respondents (27.9%) had different opinions like occupational dysfunctional, low intelligence, social dysfunction, having no information, and others.

Table 2: Distibution of the respondents based on the responses on the understanding of mental illness

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[Table 3] shows the 'explanation of the causation of mental illness by caregivers'. About 48.35% were unable to answer. Nearly 10% attributed to untreated illness, 9.2% associated with the psychological factor, and 6.2% shared that problems with delivery or pregnancy are the key issues of mental illness.

Table 3: Explanation of causation of mental illness by caregivers

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[Table 4] shows 'caregiver's community treatment seeking options'. Almost 82.1% of people used treatment through hospital/medical professional, 57.5% used faith healer/prayer/religious, and 39.6% used traditional healer. The state of mental illness is a kind of long-term illness without having physical symptoms. This is the main reason among most of the patients to consult multiple healers to cure the illness. Nearly more than half of the respondents believed in faith healing to cure the illness.

Table 4: Caregiver's community treatment seeking option

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[Table 5] shows 'caregiver's self-treatment seeking behavior for their relative. Almost 90.4% were agreeing to medical facilities and 7.1% were agreeing to faith healing and traditional healing. Every society has its own way of treatment and belief practice to any type of illness which cannot be segregated from the individual's belief. Although the modern and scientific method has its own importance, it fails to remove the belief and healing practices.

Table 5: Caregiver's self-treatment seeking behavior

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Discussion

Understanding of mental illness

The current study was undertaken to know the EMs of mental illness and TSB. As per the results, the caregivers' description of mental illness comprises brain dysfunction, behavioral changes, and psychological disturbances which are contrary to the previous studies where caregiver and general population denied to call it an illness and attributed it to the supernatural phenomenon.^{[9],[22],[25],[26]} A current finding which has stressed on the biomedical model is due to the psychoeducation provided by the treatment team from mobile medical services and nongovernmental organizations.^[27]

Causal explanation of mental illness

Caregivers' causal explanations on mental illness have popped up with multiple explanations including physical illness and supernatural phenomenon along with a large number of people who were unable to give specific reasons. Thus, findings were corroborated with the previous studies.^{[5],[6],[7],[8]} The presence of supernatural and superstitious beliefs by the side of medical explanation denotes the proximity of the individual to its culture, which has its support system to the causation.^[28] Simultaneous presence of both medical and scientific explanations with indigenous cultural beliefs of supernatural system constitutes an EM which synchronizes and contradicts at the same time due to respondent's characteristics and influence of indigenous culture, hence difficult to judge the concept through etic or emic perspectives.^[29],[30]

Treatment methods

The conglomeration of scientific, traditional, religious, and cultural practices has been seen in the findings in the TSB of the caregivers. However, there was a contradictory response from the respondents in the case of community help-seeking and self-seeking treatment methods. From the psychosocial perspective, people often try to conceal their real opinion to parade with the majority's opinion.^[3],[31] This happens because medical practitioners have a Western model of treatment and causal explanation, which acts dichotomous with native's belief and causal explanation. Their opinions are hardly taken and treated inferior to them, thus concealing their explanation and nature of such explanation and giving their verbatim desirable to Western practitioners.^[32],[33] Such an explanation seems futile in the Indian context as there is a dearth of studies in this direction. The other perspective called the “Eclectic Healing Model proposed by Biswal et al.^[28] describes the nature of the Indian population in seeking multiple treatment methods to attain maximum benefits to mental illness. “Eclectic Healing Model” amalgamates the Western model of treatment, traditional Indian medicine, faith, and religious healing practices. The choices for choosing any line of treatment first depend on the patients and their caregivers colored by their cultural beliefs. The following model caters to the mass of the remote and rural areas where there is a want of comprehensive public and mental health care. The treatment options, if utilized in a particular proportion, will benefit and will become the base of the Indian treatment system.^[28]

Limitation of the study

The study also pointed out its limitations. The research has been done with a convenient sample technique. Due to the difficulty in mobilizing financial and human resources, only one district of Jharkhand was selected. Therefore, generalization seems difficult. Other limitations include nonassociation of the EMs with sociodemographic variables and respondent's characteristics which could have revealed the reasons for holding such explanations; such explanations will give scope for further research to trace the origin, nature, and persistence for such EMs in that area. The application of the “Eclectic Healing Model” and their findings can also become the motive for future study.

Conclusion

The caregivers' EM clearly displays that there is a lack of knowledge among the majority of the respondents in identifying the cause of mental illness which shows the lack of mental health literacy among the population; though half of the respondents believes that mental illness is a brain dysfunction. This is also affecting their choice of treatment which compels them to resort to traditional healers including modern medical professionals or resorting to multiple healing points to cure the illness which needs to be further explored in future research. Despite having some limitations, the study has come up with some significant findings which are necessary to be taken care of sensitively.Thus, it is necessary to sensitize the community towards the psychosocial model of mental health care. Along with this, mental health literacy should be raised in addition to the increase the adequate psychiatric services in this region.

Acknowledgment

We would like to acknowledge all the respondents of the study for their contribution, especially Nav Bharat Jagriti Kendra, for their cooperation for the completion of the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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