‘I’m managing myself’: how and why people use St John’s wort as a strategy to manage their mental health risk

In this article, we examine the choice to use a complementary and alternative medicine product (St John’s wort) for the management of mental health risk. We draw on data from a study in which we conducted in-depth, semi-structured interviews with 41 adults who self-reported depression, stress or anxiety, in Melbourne, Australia, in 2011. We identified three groups of users – regular St John’s wort users, whose use was continuous; irregular users, whose use was occasional; and non-users, who had stopped or were contemplating use. In each group, St John’s wort use centred around managing risk, taking control and self-management. Participants described a process of weighing up risks and benefits of different treatment options. They viewed St John’s wort as a less risky and/or safer option than antidepressants because they perceived it to be more natural, with fewer side effects. They saw their use of St John’s wort as a means of exercising personal control over mental health risks, for example, to alleviate or self-manage symptoms of depression. Their use of St John’s wort was also linked to perceptions of broader social risks including the stigma and shame of needing to use antidepressants. The findings deepen our understanding of notions of mental health risk by pointing to the importance of localised knowledge of risk in decision-making, and the ways in which perceptions of, and hence responses to, risk differ between groups.