Help-Seeking Behavior of Patients with Mental Health Problems Visiting a Tertiary Care Center in North India

Article excerpt

Byline: Nitin. Mishra, Sajanjiv. Nagpal, Rakesh. Chadda, Mamta. Sood

Background: Patients with mental health problems in the nonwestern world seek help from a variety of sources, such as the family physicians, psychiatrists, psychologists, traditional faith-healers, or alternative medicine practitioners. Understanding the help-seeking behavior is important from the public health perspective. Materials and Methods: Two hundred new patients visiting a psychiatric outpatient service at a tertiary care hospital were interviewed on a semi-structured questionnaire for various services contacted by them for their mental health problems.

Results: Psychiatrists were the first choice in 45% of the cases followed by nonpsychiatric physicians and religious faith healers. Important reasons to seek help from different sources included easy accessibility, belief in the system, or particular healer and good reputation. Mean duration of treatment varied from 2.35 months with the alternative system practitioners to 16.63 months with the psychiatrists. The mean expenditure per visit to a service was highest for the nonpsychiatric physician and lowest for alternative system practitioners. Conclusion: Patients with mental health problems seek help from psychiatrists, nonpsychiatric physicians, faith healers, alternative system practitioners, and traditional faith healers for multiple reasons. It is important to sensitize various nonpsychiatric physicians with early identification and optimum management of mental disorders.

Introduction

An understanding of the way people seek care for mental disorders is important to know for planning mental health services, provision of appropriate training to the health care providers, and mental health reforms. [sup][1] Reasons for choosing a particular service help in understanding how the population perceive mental illnesses and respond to them. This knowledge can be helpful in developing community awareness programs so as to remove myths and misconceptions about mental illnesses and sensitize the people with the availability of various sources of help available in the community.

Epidemiological studies across different nations show that only about one third of people with a mental disorder consult the mental health services, others seeking help from different sectors, such as the family physicians, general practitioners, or other physicians, depending on the type of health system of the country. [sup][2] Even in the high-income countries, such as USA, Canada, Italy, and Netherlands, a substantial number of patients with mental health problems don't seek treatment from the mental health sector, and rather seek help in the general medical sector, which includes general physicians or general practitioners, and are referred to the psychiatrists later, if required. [sup][3],[4],[5],[6]

In India, the mental health resources are very low compared with high-income countries. According to a recent estimate, the country has just 0.25 psychiatric beds per 10,000 population, 0.2 psychiatrists, 0.03 clinical psychologists, 0.05 psychiatric nurses, and 0.03 social workers per 100,000 of the population. [sup][7] The facilities for psychiatric treatment are generally available in general hospital psychiatric units, mental hospitals, and office-based practice. Besides these, the patients, depending on the availability and accessibility, may consult a nonpsychiatric physician, general practitioner, lay counselor, local religious leaders, or traditional faith healer. [sup][8],[9],[10],[11],[12]

The present study was conducted to investigate various health care facilities used by a group of patients with mental health problems and reasons for using the services.

Materials and Methods

Study setting

The study was conducted in psychiatric outpatient setting at the All India Institute of Medical Sciences, New Delhi. The institute is a tertiary care premier medical institution of the country. …