Five-year outcomes of western mental health training for Traditional Chinese Medicine practitioners

Since the last decade, the World Health Organization (WHO) has promoted the integration of mental health into primary care in response to the high prevalence of common mental disorders such as anxiety and depression [1, 2]. Although there are rising expectations of primary care practitioners dealing with patients’ mental health problems, many of them lack confidence in diagnosing and managing these cases [3, 4]. To improve their competence, some postgraduate training courses have been organized for western medicine primary care doctors and significant impacts were found in different countries [5‐8]. The trained doctors recognized more mental health patients compared with those without training [9‐11].

In Hong Kong, besides western medicine doctors, 15 % of the general public consult Traditional Chinese Medicine (TCM) practitioners regularly for their primary health care needs [12, 13]. TCM has been widely recognized as part of the health system in Hong Kong, with strong support from the post-colonial Government since 1997 such as the launch of licensing examination and full time undergraduate programmes in universities [14]. Notwithstanding the rise of stature, TCM practitioners inclined to gain better understanding of western medicine including treatment options and evidence-based practice [14, 15]. Similar observations were shown among western studies, in which complementary and alternative medicine (CAM) practitioners addressed the need to acquire the skills of western conventional approach and guidelines [16, 17]. Studies have demonstrated the benefits of overcoming the gap between TCM and western medicine towards treating organic disease [18]. By gaining better understanding in the diagnostic and management style from western medicine doctors, the TCM practitioners showed improved interrater reliability of diagnoses. Also, better communication and agreement might facilitate future referral and collaboration.

TCM does not differentiate between psychological and physiological functions, which are seen as interconnected [19]. TCM recognizes psychosomatic problems, similar to any other organic diseases, are resulted from the disequilibrium of yin-yang and the disorder of qi and their viscera. The terms yin and yang represent two opposite yet interdependent properties of the body, whereas qi is the vital energy that circulates along the meridian channels to supply to all major organs. Irregular emotional activity is believed to occur as a consequence of obtruded homeostasis between the polarities, or interfered flow of energy, in the organs [20]. There is no specific classification of mental disorders in TCM. [21, 22]. Instead, they are described as symptoms in a few general terms for example depressive mood, manic mood and madness. Our published paper reported the impact of an innovative 10-session western mental health training course for TCM practitioners [23]. To our knowledge, there had been no similar study in the literature. Adopting an inter-disciplinary and problem-oriented approach, psychiatrists, clinical psychologists and family physicians were recruited to teach the training programme, in which 10 interactive seminars on topics related to common psychological problems and psychotherapy were offered (see Additional file 1). The Course aimed to increase TCM practitioners’ capacity in recognition, diagnosis, basic management and referrals of mental health patients in primary care settings. Questionnaire survey on the first batch of TCM practitioners taking the Course in 2010 reported significant improvements in their confidence in recognizing patients with psychological problems (60.6 % being confident before the Course vs. 81.8 % after), diagnosis (33 % vs. 76 %) and management (24 % vs. 55 %) of common mental health problems (e.g. anxiety, depression, sleeping disorder). Focus group interviews found that the training on western classification of mental illness was recognized as the most important reason for their improvement. We continued the pre- and post- course assessment survey subsequently for 5 years. This paper analyzed the data collected from the additional cohorts (2011–2015) which had five times the size of the previous sample (2010). Apart from a stronger quantification of their improvement in mental health care, we are also able to explore the association between their learning outcomes and background characteristics. Further, the enablers and barriers they encountered can be summarized and analyzed. The findings should be useful to other countries where TCM practitioners and other CAM practitioners make significant contributions towards their health care services.