Attitudes of psychiatrists and caregivers towards covert medication administration in India: A cross-sectional study

Aim: To assess attitudes of Indian psychiatrists and caregivers toward covert medications (CM) and evaluate the reliability of the Staff and Caregivers Attitude towards Covert Medication Scale (SCACMS) in an Indian context. Materials and Methods: This exploratory cross-sectional study, conducted at Krishna Rajendra Hospital, Mysuru, India, administered the 15-item SCACMS to 90 psychiatrists across India and 90 caregivers from Mysuru. Data were analyzed using descriptive statistics, Chi-square tests, Cronbach’s alpha, and Cohen’s Kappa. Results: Both groups attributed CM use to limited resources and security issues, deeming it appropriate for aggressive patients or those lacking insight. Non-compliance was the primary reason for CM (89%). Patient awareness of CM led to anger in 58% of cases, while 89% improved with CM. The SCACMS showed satisfactory reliability among staff (alpha = 0.75) but less among caregivers (alpha = 0.45). Psychiatrists showed less support for CM compared to caregivers. Conclusion: While psychiatrists and caregivers recognize CM’s utility in specific cases, particularly due to resource scarcity and security concerns, staff show less support for the practice. Findings suggest a need for standardized CM procedures in Indian mental health settings, improved resources, and staff training to potentially reduce CM reliance.