This study was done to find out the difference of attitudes with respect to the socio-demographic profile of the study participants. The key findings of the current mixed-method study among women from rural Odisha who participated in this study are summarized as follows: The women viewed a negative attitude towards the psychiatric hospitals and the factor associated with such kind of attitude was education and gender. And the qualitative findings showed that there were four major barriers among patients to seek care from mental health care facilities: the rejection of mental illness by patients due to fear of societal stigma, faith on magico-religious healers, lack of availability of mental health services, and poor socioeconomic conditions. A study conducted in India also revealed that factors such as lower education and females are having more of negative attitudes towards mental health care facilities [17, 22].
The present study suggested that females are best weakly related to the attitudes; they are slightly more rigid with their views and have more negative attitudes. A comparison study conducted in Canada highlighted that services provided by the psychiatric hospital are utilized more by male patients than the females [9], and the factors associated with such findings were low socio-economic status and being single. Other studies conducted in India [11] and other developing countries [4] supported the above results.
Our study reported that a lower education was accompanied by more negative attitudes towards mental healthcare facilities across all subscales. While examining the issues related to the mental health system, it was always found that level of education is the key factor responsible for the attitudes [1]. Low education levels are responsible for gaps in mental health literacy and inadequate knowledge about seeking correct treatment, which could involve not approaching the appropriate mental health care facilities needed [22].
India, with its diverse cultural and ethical systems mixed in recent years with Western approaches of thinking, makes it tough to identify a uniform and exclusive Indian paradigm of mind and mental health [7]. In addition to this, receiving allopathy form of treatment does not necessarily imply the acceptance of all kinds of bio-medicine that support such therapies [12]. Mental illness can be cured using biomedicine and other traditional concepts such as Ayurveda. Supernatural and spiritual explanations are also standard practices such as evil-eye and spirit possession [9].
The qualitative result of the current study depicts that the study participants believe on faith healers, and most of these patients first contact the faith healers, then came to the allopathic practitioners which are similar in other studies [9]. Most of the cases first contacted the faith healers; if they did not get any relief, then only then, they move to other options like near to allopathic practitioner, traditional healers, etc. Generally, patients and their family members usually seek from different pathways, and these decisions are typically prejudiced by a number of factors, including socioeconomic status such as education [5].
While coming to the policy level, in the year 2015, World Health Organization has proposed two indicators to strengthen mental health in the Sustainable Development Goals; one is reducing the suicidal rate, and another one is service coverage of persons with severe mental illness, which are fully aligned with the Global Mental Health Action plan [21]. Even in India, the Mental Health Act 2017 is introduced to make stronger the mental health by developing good infrastructure and other needed aspects, but in spite of the introduction of several policies and programmatic interventions over the past three decades, there is still only roughly one trained psychiatrist for every 250,000 people in India, and less than one of any sort of mental healthcare facilities for every 100,000 people. Although now people and communities are accepting the mental health care facilities in a positive way, still, negative beliefs and attitudes are present in their mind. Our study is addressing a need for awareness programs or strengthening the existing program to improve population, especially female attitude towards mental health care facilities. In addition, linking religious leaders to raise awareness about mental health care facilities could be important in India, where a lot of patients for mental illness seek care from priests and faith-healers. A possible drawback of our study is its focus on rural India only. Ideally, comparison studies with other countries and societies using a usual method should be carried out in the future.
Stigma can be divided into both public and self-stigma. Public stigma occurs when the general public supports a prejudice about a stigmatized group while self-stigma occurs when a member of a stigmatized group internalizes the negative sights held by the general public [19]. Given its negative impact on treatment-seeking, for instance, perceived social barriers may be particularly important in predicting treatment behaviors, such as taking an antidepressant, to remedy an illness whose victims may experience social stigma [18]. In addition to this, adherence and effectiveness, the stigma associated with mental illness can be considered as a major public health problem [15].
In India, a study revealed that patients attending psychiatric outpatient services at a mental hospital were asked specifically about various treatment facilities utilized by them before coming to the hospital and the reasons for. Various services used by the participants differ from professional care to faith healers. Easy availability, trust, recommendation from other patients and family, and belief in supernatural causation of illness were the significant factors for that. Thus, socio-cultural factors appeared to influence help-seeking behavior [10]. Stigma reduction is equally essential not only for those affected with mental illness and their families, but also for research, advocacy, and health policy globally [10].
The policy is required in this regard to understand the challenges and issues faced by a mentally ill individual and the process of overcoming it. It is very much significant to take account of stigma about mental illnesses and mental health issues. Stigma is disadvantageous not just to people with mental illness, but also to the health of society as a whole. Due to improper actions from the side of the public sector, mental health is facing problems, which also leads to a lack of resources and self-esteem for seeking appropriate care in mental illness. Not only lack of actions is responsible for the wrong health-seeking behavior, but also lack of leadership, legislation, institutions which are now in the stage of crumbling, lack of adequate information, and awareness are equally responsible. As mental health is always taken wrong by the people, creating awareness at the community level is the best weapon in the field of each and every sector of health. At a policy level, cultural and racial disparities can be addressed by considering the social factors like income, the standard of living, and education. In continuum, to this, a mental illness screening program and free mental health services should be initiated by the Govt. of India for early diagnosis and a better approach.
Due to this study’s limitations, it is difficult to generalize the results of this study to the country as a whole. Furthermore, India is a country known to be ethnically and publicly diverse, and this research only looked at India’s rural part. Further studies could broaden this subject of study by including other cities and states while also including larger sample size. Eventually, this analysis only evaluated behaviors toward a few factors against mental health care facilities. Instead of the exact value, we categorize the variable to decrease the anxiety among participants about sharing their age and education information, this also helps to increase care among them.
