Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 148
Guide XI-148

Herbal household medicine

A 29 · L 64 · M 717 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: there is no single manual or founding body. Household herbal medicine is a lay practice. For the therapist's own assessment this guide follows the DSM-5-TR (APA 2022) Cultural Formulation Interview (CFI) and its supplementary modules. For product safety and regulation it follows the US National Center for Complementary and Integrative Health (NCCIH) fact sheets (St John's wort, last updated December 2017; kava, last updated April 2025), the US FDA's dietary-supplement Q&A under DSHEA 1994, and the UK MHRA Traditional Herbal Registration (THR) pages.

What it is. Herbal household medicine means the plant remedies (teas, tonics, poultices, bought herbal products) that families use at home. They use them to manage illness, distress and everyday health, usually before or alongside professional care. It is a practice, not a therapy. In an ethnobotanical survey of 153 households in a peri-urban Amazonian community, women managed household illness. Most had learned plant knowledge from family members (79%), and 80% used plants at least occasionally. Plants were often the "first line of defense," and families kept using them alongside pharmaceuticals, prayer healers and hospitals. [source: https://ethnobiomed.biomedcentral.com/track/pdf/10.1186/1746-4269-10-25] Among patients at one Toronto clinic, 99% used natural health products, 46% used them alongside prescription medicines, and 42% did not tell their family doctor. [source: https://news.mcmaster.ca/patients-still-not-telling-mds-about-use-of-natural-health-products/] These figures come from single settings and should not be read as general prevalence. [uncertain]

The psychotherapist's role. The therapist does not recommend, prepare or adjust remedies. The therapist's job has three parts:

  • Understand what remedy use means to the client: identity, family care, coping, explanatory model.
  • Ask about it openly and record it.
  • With the client's consent, pass anything that may affect safety or medicines to the prescriber or pharmacist.

How change happens (therapist's frame). Clients often hide remedies because they expect disapproval. [source: https://news.mcmaster.ca/patients-still-not-telling-mds-about-use-of-natural-health-products/] Respectful curiosity makes disclosure possible. Once remedy use is disclosed, it can be woven into the formulation and kept safe through medical liaison. [synthesis]

Who holds authority.

  • Within families: knowledge is usually held and passed on in the household, often by mothers, grandmothers and elders. [source: https://ethnobiomed.biomedcentral.com/track/pdf/10.1186/1746-4269-10-25]
  • Over products: national regulators. In the UK, the MHRA grants a THR to herbal medicines for minor conditions that do not need medical supervision. A THR rests on evidence of safety, quality and at least 30 years of traditional use, not clinical efficacy trials. [source: https://www.gov.uk/apply-for-a-traditional-herbal-registration-thr] Registered products carry a THR number and a certification mark. [source: https://www.gov.uk/drug-safety-update/introduction-of-the-traditional-herbal-registration-certification-mark] The EU legal basis, usually cited as Directive 2004/24/EC, is [uncertain: not verified].
  • In the US: under DSHEA 1994, the FDA "does not have the authority to approve dietary supplements before they are marketed." Manufacturers are responsible for safety and labelling. [source: https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements]
  • Interactions with medicines: the prescriber and pharmacist hold clinical authority.
  • Internationally: WHO frames traditional, complementary and integrative medicine within health systems. Its Global Traditional Medicine Strategy 2025-2034 was adopted by the Seventy-eighth World Health Assembly. [source: https://www.who.int/teams/who-global-traditional-medicine-centre/traditional-medicine-strategy-2025-2034]
  • Plants with ceremonial standing: some plants used at home, such as kava, also hold ceremonial standing in their home communities. Pacific Islanders have used kava "for thousands of years for ceremonial and medicinal purposes." [source: https://www.nccih.nih.gov/health/kava] Authority over those ceremonial uses rests with those communities, and this guide does not describe them.

No household remedy is presented here as a treatment for any physical or mental disorder.

2. Framework

The sources set no phases for this work. The structure below is [synthesis], built around the CFI's own sequence. The CFI moves from (1) the cultural definition of the problem, through (2) perceived causes, context and support, and (3) self-coping and past help seeking, to (4) current help seeking. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]

  • Phase A: Opening inquiry (session 1, within intake).
    • Goal: normalise the topic, then ask about all remedies, teas, supplements and products alongside prescribed medicines.
    • Move on when the client has named what they use, or said they use nothing, without visible discomfort, and the record lists it. [synthesis]
  • Phase B: Cultural formulation (sessions 1-3).
    • Goal: the core CFI, the Explanatory Model and Coping and Help-Seeking modules as needed, and the Informant Version with a family knowledge holder if the client wishes.
    • The CFI can be given at the first evaluation, later in care, or repeatedly. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
    • The time the CFI takes is [uncertain]. A field trial found that later interviews "required less time." [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]
    • Move on when you can state, in the client's terms, what the remedy is for, who advised it and how it fits their explanatory model. [synthesis]
  • Phase C: Safety liaison (as soon as concerns arise; may run alongside Phase A).
    • Goal: with consent, pass remedy details to the prescriber or pharmacist, and screen urgently for red flags.
    • Move on when the prescriber has been informed, or the client has declined and you have documented this and the risks discussed. [synthesis]
  • Phase D: Integration and review (throughout therapy).
    • Goal: hold remedy use as part of coping and identity within the treatment plan.
    • Review at medication changes, pregnancy, new symptoms or crises, and at the end of therapy. [synthesis]

Format: individual sessions, with family sessions optional. The CFI Informant Version is used with a family member or friend. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf] The work adds no separate sessions. It sits inside the existing therapy. [synthesis]

3. Guiding principles

  • Stay in your lane on medicines. Never advise starting, stopping, combining or changing any remedy or medicine, and give no doses or preparations. In practice, every safety question goes to the prescriber or pharmacist. [synthesis]
  • Ask everyone, routinely. Use is common and often undisclosed. [source: https://news.mcmaster.ca/patients-still-not-telling-mds-about-use-of-natural-health-products/] In practice, put remedy questions in every intake, not only for clients you assume are "traditional."
  • Non-judgement enables disclosure. The top reasons for non-disclosure were expected disapproval and expected lack of understanding. [source: https://news.mcmaster.ca/patients-still-not-telling-mds-about-use-of-natural-health-products/] In practice, show interest before concern.
  • "Natural" does not mean harmless. Clinicians are urged to ask because interactions with prescriptions are possible. [source: https://news.mcmaster.ca/patients-still-not-telling-mds-about-use-of-natural-health-products/] In a review, 13 commonly used herbs had clinically relevant interactions with neuropsychiatric drugs, through effects on drug-metabolising enzymes and transporters, or through added effects on the nervous system. [source: https://nutrition-evidence.com/article/445812/herb-drug-interactions-in-neuropsychiatric-pharmacotherapy-a-review-of-clinically-relevant-findings] In practice, take remedies as seriously as you take medicines.
  • Regulation varies. A UK THR shows quality, safety and traditional use, not proven efficacy. [source: https://www.gov.uk/apply-for-a-traditional-herbal-registration-thr] US supplements are not approved before sale. [source: https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements] In practice, do not treat a label or a shop as proof of safety. Leave product judgements to the pharmacist.
  • Remedy use is cultural and relational. Knowledge passes within families, often from women. [source: https://ethnobiomed.biomedcentral.com/track/pdf/10.1186/1746-4269-10-25] In practice, a remedy may stand for a mother's care or for cultural continuity, and questioning it can feel like questioning the family.
  • Explanatory models matter. Use Kleinman's questions on what the client calls the problem, its cause, course and fitting treatment. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] In practice, remedy choice often shows how the client understands the problem.
  • Attribute, neither endorse nor dismiss. Report beliefs about plant properties as the client's or the family's. In practice, say "in your family, this is used for…", not "this works" or "this is nonsense." [synthesis]
  • Watch for substitution. NCCIH advises against using St John's wort to replace conventional depression care or to delay seeing a provider, because depression can become severe and raise suicide risk. [source: https://nccih.nih.gov/health/stjohnswort/sjw-and-depression.htm] In practice, ask whether a remedy is being used instead of agreed treatment.
  • Consent governs liaison. Share remedy details with the prescriber with consent, except where risk overrides confidentiality under your professional code. [synthesis]
  • Respect ceremonial boundaries. Where a plant has ceremonial standing (e.g. kava in Pacific communities), its cultural use belongs to those communities. [source: https://www.nccih.nih.gov/health/kava] In practice, do not discuss or interpret ceremonial use beyond what the client offers.
  • Cultural humility. The CFI is "designed to be used by any clinician providing services to any individual in any care setting." [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf] In practice, examine your own assumptions about folk and "alternative" remedies before you ask.

4. Intervention inventory

Everything below is the psychotherapist's own culturally responsive work. None of it involves preparing, recommending or dosing remedies.

4.1 Cultural self-examination before asking

  • Purpose: to notice your own reactions to folk, family and "alternative" remedies (dismissal, romanticising, alarm) before they leak into the interview. Do this before the first intake and again when a remedy surprises you. [synthesis]
  • Steps:
    1. List the remedies used in your own family of origin and how they were talked about.
    2. Note any reflex judgement, such as "unscientific," "dangerous" or "wise."
    3. Decide on a neutral way to describe remedies, attributed to the client: "in your family…".
    4. Bring strong reactions to supervision.
  • Example language (illustrative, self-talk): "My job here is to understand and to keep the client safe through the prescriber, not to rule on the remedy."
  • Watch for: sarcasm, a hurried tone, or jumping to warnings when a client names a remedy. It is working when you can hear about a remedy and ask a follow-up question before you voice any concern.

4.2 Routine, non-judgemental remedy inquiry

  • Purpose: to get full disclosure of every herb, tea, tonic, supplement and bought natural product, at intake and at every medication change. Non-disclosure is common, and the main reasons are expected disapproval or lack of understanding. [source: https://news.mcmaster.ca/patients-still-not-telling-mds-about-use-of-natural-health-products/]
  • Steps:
    1. Normalise the question first: many people use home remedies.
    2. Ask open questions: what they take or drink for health, sleep, nerves or mood, including teas and remedies from family or shops.
    3. Ask who recommended each one and what it is for.
    4. Ask whether the prescriber knows about it.
    5. Record the client's own names for each remedy, plus the product name or label if they can bring it. Do not guess botanical identities. [synthesis]
    6. Thank them for telling you.
  • Example language (illustrative): "Lots of people use teas, herbs or remedies from home or from the health shop alongside anything a doctor prescribes. What do you or your family use when you're stressed, can't sleep or feel low?" Then: "Who suggested that one? What is it meant to help with?"
  • Watch for:
    • Hesitation or a glance at a family member, which may signal fear of judgement.
    • "Just tea" answers that may hide stronger products.
    • Remedies bought online with unclear contents.
    • It is working when the client volunteers new items in later sessions without being asked. [synthesis]

4.3 Core Cultural Formulation Interview, focused on remedies

  • Purpose: to place remedy use within the client's definition of the problem, causes, supports, coping and help seeking. The CFI has 16 questions in four domains. Questions 11-13 cover self-coping, past help seeking and barriers. Questions 14-16 cover current preferences and the clinician-patient relationship. The CFI supports clinical understanding and is not the only basis for a diagnosis. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
  • Steps:
    1. Use the official APA form. Clinicians may reproduce it for use with their own patients, but modifying or translating it needs APA permission. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
    2. Work through the four domains in order.
    3. In the self-coping and past-help-seeking domain, explore household remedies, family advisers and any herbal practitioners consulted.
    4. In the current-help-seeking domain, ask what the client wants from you in relation to those remedies.
    5. Summarise back in the client's words.
  • Example language (illustrative): "Sometimes people try things at home or with family before coming to someone like me. What have you tried, and what helped or didn't?" and "Is there anything about how you look after this at home that you'd like me to understand or respect?"
  • Watch for: the client presenting only the remedies they think you will approve of. It is working when the CFI summary includes remedies, the people who advise on them, and the client's preferences about combining them with therapy and medicines.

4.4 Supplementary modules: Explanatory Model and Coping and Help-Seeking

  • Purpose: to go deeper when remedies are central to how the client copes. These modules can be used as add-ons to the core CFI or as standalone tools, at first evaluation or later. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
  • Steps:
    1. Choose a module from the core CFI's cross-references.
    2. Add the Spirituality, Religion, and Moral Traditions module if remedies sit within a religious frame.
    3. Add Immigrants and Refugees if remedies are linked to a home country or to the difficulty of getting them in exile.
    4. Add Older Adults or School-Age Children and Adolescents where they apply.
    5. Add the Caregivers module, completed by the caregiver, if a family member manages the client's remedies.
    6. Paraphrase the module questions in your own words only where APA permission allows. Otherwise use the official form.
  • Example language (illustrative): "You mentioned your grandmother's remedy. When you take it, what do you understand it to be doing for you?"
  • Watch for: module fatigue. Pick one module at a time. It is working when the remedy's meaning (comfort, protection, family loyalty, distrust of services) is clear enough to use in the formulation. [synthesis]

4.5 Kleinman explanatory-model questions applied to remedies

  • Purpose: to learn how the client understands the problem and why this remedy fits it. Kleinman, Eisenberg and Good's (1978) questions cover:
    • what the client calls the problem;
    • what caused it;
    • why it started when it did;
    • what it does and how it works;
    • how severe it is and whether it will be short or long;
    • what treatment the client should receive;
    • the chief problems it has caused;
    • what the client fears most about it.
    [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader]
  • Steps:
    1. Ask the questions conversationally over one or two sessions.
    2. Link the client's answer on treatment to the remedies they use.
    3. Note where the client's model and the clinical model agree and where they differ.
    4. Agree a shared, workable description of the problem.
  • Example language (illustrative): "What do you call what's been happening? … And what do you think the tea does for it?" and "What worries you most about this problem?"
  • Watch for: answers that suggest the client sees therapy or prescribed medicine as conflicting with the remedy. These are moments to plan liaison, not to argue. It is working when the client can hold both frames without feeling they must choose. [synthesis]

4.6 Recognising cultural concepts of distress linked to remedies

  • Purpose: to notice when a remedy is used for a named idiom or syndrome, and to use the DSM-5-TR concept as the manual intends: to understand the client, not as a diagnosis in itself. The DSM-5-TR says cultural concepts "include idioms, explanations or perceived causes, and syndromes," and its examples were revised to avoid stigmatising language. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf] One secondary source lists the DSM-5-TR examples as:
    • ataque de nervios
    • dhat syndrome
    • hikikomori
    • khyâl cap
    • kufungisisa
    • maladi dyab
    • nervios
    • shenjing shuairuo
    • susto
    • taijin kyofusho
    [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf] The exact DSM-5-TR list, compared with the DSM-5 list, is [uncertain]. [source: https://revistapsiquiatria.pt/index.php/sppsm/article/download/139/69]
  • Steps:
    1. When the client uses an idiom (e.g. "nervios"), ask what it means to them and their family, and how it is usually cared for at home.
    2. Assess for any co-occurring disorder separately, using standard assessment.
    3. Record both the idiom and any diagnosis.
  • Example language (illustrative): "When you say nervios, what is that like for you? How does your family usually look after someone with nervios?"
  • Watch for:
    • Assuming that every member of a group uses a given idiom.
    • Missing a depressive, anxiety or psychotic disorder that sits behind the idiom.
    • Which remedies, if any, a family uses for a given idiom is not documented in the sources used here. Ask; do not assume. [uncertain: not verified]
    • It is working when the idiom shapes your language with the client and the diagnostic picture is still assessed.

4.7 Mapping the household healing system (with an informant if wished)

  • Purpose: to learn who in the family holds remedy knowledge and decides on care. Households often combine home remedies, pharmaceuticals, prayer healers and hospitals, and women usually manage household illness. [source: https://ethnobiomed.biomedcentral.com/track/pdf/10.1186/1746-4269-10-25]
  • Steps:
    1. Draw a simple map or genogram with the client, marking who advises on health, who prepares or buys remedies, and who the client trusts.
    2. If the client wishes, invite that person to a session and use the CFI Informant Version (17 questions, starting with the informant's relationship to the client). [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
    3. Keep the client's confidentiality boundaries explicit before the joint session.
  • Example language (illustrative): "Who in your family do people go to when someone isn't well? Would it help if they came to a session so I can understand how your family looks after each other?"
  • Watch for: a family adviser who speaks over the client, or a client who feels unable to disagree with them. It is working when the client's own view and the family's view are both recorded. [synthesis]

4.8 Red-flag screening and urgent medical routing

  • Purpose: to recognise, without diagnosing, presentations that need same-day medical attention or prompt prescriber review. [synthesis, built on the cited clinical sources]
  • Steps:
    1. Know the warning signs that the clinical sources name:
      • St John's wort with certain antidepressants: can cause a "potentially life-threatening increase" in serotonin. Symptoms can start within minutes to hours and include agitation, diarrhoea, fast heartbeat, high blood pressure, hallucinations and raised body temperature. [source: https://nccih.nih.gov/health/stjohnswort/sjw-and-depression.htm]
      • St John's wort and psychotic symptoms: case reports describe worsened psychotic symptoms in people with bipolar disorder or schizophrenia. [source: https://nccih.nih.gov/health/stjohnswort/sjw-and-depression.htm]
      • Kava: linked to rare but sometimes serious or fatal liver injury. NCCIH says it should not be combined with sedating substances such as benzodiazepines or alcohol. [source: https://www.nccih.nih.gov/health/kava]
    2. If acute signs are present, stop the session's agenda and direct the client to emergency or urgent medical care, following your service's emergency procedure.
    3. If signs are non-urgent (new agitation, sleep change, sedation, confusion, rise in mood), ask permission to contact the prescriber the same week. [synthesis]
    4. Never tell the client to stop or keep taking anything.
  • Example language (illustrative): "What you're describing could be a reaction that needs a doctor to look at today. I can't tell you what's causing it or what to take, but I'd like you to get checked now. Shall we call together?"
  • Watch for:
    • Clients minimising symptoms to protect a family remedy.
    • Combinations of several sedating products with alcohol.
    • New or worsening mania or psychotic symptoms.
    • It is working when the client accepts timely medical review and you have documented the routing.

4.9 Consent-based liaison with the prescriber or pharmacist

  • Purpose: to pass remedy information to the professional who can judge interactions. Thirteen commonly used herbs have clinically relevant interactions with neuropsychiatric drugs, among them St John's wort, kava, valerian, ginkgo, ginseng, rhodiola and kratom. [source: https://nutrition-evidence.com/article/445812/herb-drug-interactions-in-neuropsychiatric-pharmacotherapy-a-review-of-clinically-relevant-findings] St John's wort can weaken several medicines, including antidepressants, birth control pills and warfarin. [source: https://nccih.nih.gov/health/stjohnswort/sjw-and-depression.htm] A UK clinical summary reports NICE advice that practitioners should not prescribe or advise St John's wort, because of variable preparations and potentially serious interactions. [source: https://gpnotebook.com/en-GB/pages/neurology/st-johns-wort] The specific NICE guideline was [uncertain: not verified].
  • Steps:
    1. Explain why you want to share: safety, not disapproval.
    2. Get and record consent for what you will share and with whom.
    3. Send the remedy list in the client's words, with product names or labels, reason for use and adviser. Ask the prescriber to review interactions.
    4. Encourage the client to bring the products or labels to the prescriber or a pharmacist.
    5. Close the loop: note the prescriber's response, and ask the client how the conversation went.
  • Example language (illustrative): "Some herbs and teas can change how prescribed medicines work. That's a question for your doctor or pharmacist, not me. Would it be OK if I let Dr [prescriber] know what you're using, so they can check it fits with your medication?"
  • Watch for: clients fearing that the prescriber will scold them or stop their medicine. Prepare them, and coach them to say what the remedy means to them. It is working when the prescriber is informed and the client stays engaged with both.

4.10 Sharing regulatory facts without advising

  • Purpose: to support informed discussion when clients assume "sold in a shop" or "natural" means tested.
  • Steps:
    1. Share only neutral, sourced facts, then hand product questions to the pharmacist:
      • In the US, the FDA does not approve supplements before they are sold. [source: https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements]
      • A UK THR number and mark show quality, safety and traditional use for minor conditions, not proof that the product works. [source: https://www.gov.uk/apply-for-a-traditional-herbal-registration-thr] [source: https://www.gov.uk/drug-safety-update/introduction-of-the-traditional-herbal-registration-certification-mark]
    2. Never compare or recommend products.
  • Example language (illustrative): "In the UK, some herbal products carry a THR mark. It tells you about quality and traditional use, not whether it works for a condition. Your pharmacist can tell you more about this one."
  • Watch for: any slide into recommending. It is working when the client takes the question to the pharmacist. [synthesis]

4.11 Watching for substitution and suicide risk

  • Purpose: to notice when a remedy replaces agreed care. NCCIH advises against using St John's wort to replace conventional depression care or delay seeing a provider, because depression can become severe and raise suicide risk. [source: https://nccih.nih.gov/health/stjohnswort/sjw-and-depression.htm]
  • Steps:
    1. Ask whether prescribed treatment has changed since the remedy started.
    2. If the client has stopped prescribed medicine, do not advise. Inform the prescriber with consent, or without it where risk requires and your code allows.
    3. Run a standard suicide risk assessment and safety plan where depression is worsening. Lethal-means counselling covers safe storage and removal only.
  • Example language (illustrative): "Since you started the remedy, has anything changed with the medicine Dr [prescriber] gave you? I'm asking so we can make sure you're getting all the care you need."
  • Watch for: sudden stopping of prescribed medicine, worsening mood, and hopelessness. It is working when the prescriber knows and the risk plan is current.

4.12 Ongoing monitoring of mental-state changes

  • Purpose: to track changes in mood, anxiety, sleep, sedation or psychosis over time that may relate to remedies. NCCIH notes that St John's wort may worsen anxiety in some people. [source: https://nccih.nih.gov/health/stjohnswort/sjw-and-depression.htm]
  • Steps:
    1. Add a brief standing check to session reviews: any new remedy, any change, any new symptom.
    2. Use your usual outcome measures.
    3. Pass notable changes to the prescriber.
    4. Re-ask at medication changes, pregnancy and crises.
  • Example language (illustrative): "Quick check: any new teas, supplements or remedies since we last met, or any changes to what you take?"
  • Watch for: attributing every symptom change to a remedy, or none. That judgement belongs to the medical team. [synthesis]

4.13 Collaboration with community herbal practitioners or healers, when the client wishes

  • Purpose: to coordinate care when the client also sees a herbalist or a traditional or faith healer. WHO's 2014-2023 strategy aimed to promote safe and effective use of traditional and complementary medicine through regulation, research and integration into health systems, including integration of practitioners. [source: https://www.who.int/activities/implementation-of-the-WHO-traditional-medicine-strategy-2014-2023] Trial evidence on collaboration comes from settings with traditional and faith healers, not from household remedy use:
    • COSIMPO (Gureje et al., The Lancet 2020), Nigeria and Ghana, people with psychosis: collaborative shared care between healers and primary health care workers gave a greater fall in symptoms than usual care, and fewer harmful practices. [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839]
    • Ofori-Atta et al., prayer camp in Ghana (Br J Psychiatry 212(1)): adding psychiatric medication to prayer-camp care lowered symptoms, but days in chains were not significantly reduced. [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial]
    How far these findings apply to household or commercial herbal use is [uncertain].
  • Steps:
    1. Ask whether the client wants you to be in contact with the practitioner. Respect a "no."
    2. With written consent, agree what will be shared.
    3. Ask the practitioner which remedies they have given and what they observe. Share only the information needed for safety.
    4. Ask the practitioner to coordinate with the prescriber on products.
    5. Do not refer clients to unregulated sellers or online sources.
    6. Where the practitioner belongs to a regulated or registered profession in your jurisdiction, check their registration. Registration rules for herbalists differ by country and are [uncertain: not verified].
  • Example language (illustrative): "You've said the herbalist is important to you. Would you like me and them to be in touch, so your care fits together? You decide what I share."
  • Watch for: practitioners advising the client to stop prescribed treatment, or practices that restrain or harm (see 4.16). It is working when the client experiences their helpers as working together. [synthesis]

4.14 Interpreters and cultural brokers

  • Purpose: to get remedy names and meanings right across languages. Plant names often do not translate, and family terms may carry meaning. [synthesis]
  • Steps:
    1. Use a trained interpreter, not a family member, for the remedy inquiry where possible.
    2. Ask the client to spell or write the remedy's name, or to bring the packet.
    3. With consent, a cultural broker from the client's community can explain the remedy's place in family life. Confidentiality must be agreed first.
    4. Never guess a botanical identity. Pass the client's term and any label to the pharmacist.
  • Example language (illustrative): "Could you tell me the name you use for it, and maybe bring the packet next time? I want to make sure we get it right."
  • Watch for: interpreters adding their own judgement about remedies, or small communities where the interpreter knows the family. It is working when names and purposes are recorded accurately.

4.15 Integrating remedy use into formulation and the treatment plan

  • Purpose: to treat household remedies as part of the client's coping, identity and relationships, not as a side note. [synthesis]
  • Steps:
    1. In the formulation, name what the remedy does for the client relationally and emotionally: comfort, connection to a parent, cultural continuity, autonomy from services.
    2. Build on those functions in therapy, for example through rituals of care, family connection and self-soothing routines that do not depend on taking a product.
    3. Keep all decisions about the product itself with the prescriber.
    4. Revisit at the end of therapy.
  • Example language (illustrative): "It sounds like making your mother's tea is also a way of feeling close to her. That closeness is something we can build on, whatever your doctor advises about the tea itself."
  • Watch for: the client hearing this as a step toward taking the remedy away. It is working when the client describes the plan as respecting their way of caring for themselves.

4.16 Safeguarding

  • Purpose: to protect people who are at higher risk or cannot consent. NCCIH notes that safety information on St John's wort is limited for pregnant or nursing women and for children. [source: https://nccih.nih.gov/health/stjohnswort/sjw-and-depression.htm] It also notes that kava may carry special risks in pregnancy and breastfeeding. [source: https://www.nccih.nih.gov/health/kava]
  • Steps:
    1. Ask specifically about remedies given to children, pregnant or breastfeeding family members, and older or dependent relatives.
    2. Route any safety question to the relevant medical professional (GP, paediatrician, midwife, pharmacist).
    3. Follow your local safeguarding procedure where a remedy or practice is causing harm or delaying urgent medical care. Name the harm, not the culture. [synthesis]
    4. Do not record the names of minors in shared documents beyond what your service requires.
  • Example language (illustrative): "Do the children or anyone pregnant in the family take any of these? That's something the midwife or children's doctor would want to know about."
  • Watch for: reading normal family remedy use as neglect, and missing real harm presented as tradition. When in doubt, consult your safeguarding lead. [synthesis]

4.17 Documentation

  • Purpose: to keep a clear, respectful record that supports safe care. [synthesis]
  • Steps:
    1. Record each remedy in the client's terms, plus product name or label, reason for use and adviser.
    2. Record whether the prescriber knows and what consent was given.
    3. Record red flags and the routing action taken.
    4. Record the CFI or explanatory-model summary.
    5. Write neutrally and attribute beliefs: "Client and family use X for nerves."
  • Example language (illustrative, record wording): "Client reports drinking a family herbal tea for sleep, advised by her grandmother; consented to share with GP for interaction review."
  • Watch for: pejorative wording, or vague entries such as "takes herbs." It is working when a colleague reading the note would know what to check and with whom.

5. Handling problems

The sources give little direct guidance for therapists here. Unless a source is cited, the responses below are [synthesis].

  • Client denies any remedy use, but cues suggest otherwise.
    • Do not press. Re-ask later in a normalising way, such as "Some people only mention teas or home remedies once they know me better." Non-disclosure is often driven by expected disapproval. [source: https://news.mcmaster.ca/patients-still-not-telling-mds-about-use-of-natural-health-products/]
    • Offer a paper list the client can complete at home.
  • Client feels judged after a safety question (rupture).
    • Name it and repair: "I think my question about the tea came across as criticism. I'm sorry. I'm interested in how you look after yourself, and my only worry is making sure your doctor can check it fits with your medicine."
    • Return to the meaning of the remedy (4.15) before any further safety talk.
  • Client refuses consent to inform the prescriber.
    • Explore the fear. Often it is of being scolded, or of medicine being stopped.
    • Offer options: the client tells the prescriber themselves, or you rehearse the conversation together, or the client takes the label to a pharmacist.
    • Document the discussion.
    • Breach confidentiality only where risk meets your professional code's threshold. Consult first if you can.
  • Prescriber is dismissive of the remedy, and the client disengages from medical care.
    • Advocate for respectful liaison. Share the client's explanatory model, with consent.
    • Help the client prepare a short statement of what the remedy means to them.
    • Keep the client connected to medical review.
  • Family pressure to use, or to stop, a remedy.
    • Use a family session with the CFI Informant Version, if the client wishes, to bring out each person's view. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
    • Hold the client's autonomy, and route product questions to the prescriber.
    • Do not take sides on the remedy itself.
  • Client asks you directly, "Should I take this?" or "Can I take it with my tablets?"
    • Decline warmly and redirect: "I'm not the right person to answer that, and I don't want to guess. Your pharmacist or doctor can. Shall we work out how you'll ask them?"
    • Never give an opinion on starting, stopping or combining.
  • Client substitutes a remedy for prescribed treatment and is deteriorating.
    • Follow 4.11: risk assessment, safety plan, and prompt prescriber contact.
    • NCCIH warns that depression can become severe and raise suicide risk if professional care is replaced or delayed. [source: https://nccih.nih.gov/health/stjohnswort/sjw-and-depression.htm]
  • Overwhelm during cultural interviewing.
    • Questions about family remedies can bring up grief, for a deceased grandmother or a lost homeland, especially for migrants. Slow down and follow the emotion.
    • Pause the CFI, and use the Immigrants and Refugees module later if it fits. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
  • Products bought online with unclear contents.
    • Ask the client to bring the packaging or a photo of it.
    • Pass the details to the pharmacist.
    • In the US, supplements are not approved before sale, and adverse events can be reported through the FDA Safety Reporting Portal. [source: https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements] Leave reporting decisions to the medical team unless your role includes it.
  • Ceremonial use is raised (e.g. kava in a Pacific community context).
    • Listen and attribute. Do not ask for details of ceremony.
    • Medical safety questions about the substance still go to the prescriber. NCCIH notes that kava should not be combined with sedating substances. [source: https://www.nccih.nih.gov/health/kava]
    • Respect that cultural authority over ceremonial use rests with the community.
  • The therapist's own enthusiasm for herbal medicine.
    • If you use or favour remedies yourself, guard against recommending them.
    • Take it to supervision, and keep the same routing rules.
  • Psychedelic or strongly psychoactive plant use emerges.
    • This lies outside household medicine. Route medical questions to the prescriber.
    • See the psychedelic-assisted therapy guides (Domain VII) for that context.

Sources

Articles and books cited by reference:

  • Kleinman A, Eisenberg L, Good B (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88:251-258.
  • American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).
  • Gureje O, Appiah-Poku J, et al. (2020). Collaborative shared care for people with psychosis in Nigeria and Ghana (COSIMPO), cluster randomised trial. The Lancet.
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