Pathway of Care among Psychiatric Patients Attending a Mental Health Institution in Central India

By Lahariya, Chandrakant; Singhal, Shyam et al. | Indian Journal of Psychiatry, October-December 2010 | Go to article overview

Pathway of Care among Psychiatric Patients Attending a Mental Health Institution in Central India


Lahariya, Chandrakant, Singhal, Shyam, Gupta, Sumeet, Mishra, Ashok, Indian Journal of Psychiatry


Byline: Chandrakant. Lahariya, Shyam. Singhal, Sumeet. Gupta, Ashok. Mishra

Introduction : Only a limited proportion of patients with psychiatric disorders attend the healthcare facilities, and that too when the condition becomes severe. Treatment from unqualified medical practitioners and faith healers is a common practice, and is attributable to the delay in proper treatment. Materials and Methods: A cross-sectional study was conducted to understand the pathway of care adopted by psychiatric patients and its relationship with the socio-demographic determinants in the study population. The subjects were selected from urban specialty psychiatric hospitals and interviewed using a pre-tested, semi-structured interview schedule. The data was analyzed using SPSS v10.0 software. The Chi square test, T test, and Kruskall Wallis Test were used, as needed. Results: A total of 295 patients (203 males) were included in this study. The majority of the patients (45%) were suffering from Bipolar affective disorders (45%), followed by schizophrenia (36%). The majority, 203 (68%), were from the rural area, with 94 patients being illiterate. The mean distance traveled for treatment was 249 km. The majority of these (69%) had first contacted faith healers and a qualified psychiatrist was the first contacted person for only 9.2% of the patients. Conclusion: A large proportion of psychiatric patients do not attend any health facility due to a lack of awareness about treatment services, the distance, and due to the fear of the stigma associated with treatment. The psychiatric patients first seek the help of various sources prior to attending a psychiatric health facility. The pathway adopted by these patients need to be kept in mind at the time of preparation of the mental health program.

Introduction

Mental illnesses are commonly linked with a higher disability and burden of disease, than many physical illnesses. The World Health Organization noted that one in every four people are affected by a mental disorder at some stage of life. [sup][1] Six neuropsychiatry conditions, unipolar depressive disorders, alcohol use disorders, schizophrenia, bipolar affective disorder, Alzheimer's, and other dementias, as also migraine, have figured in the top 20 causes of disability in the world. [sup][2] It is estimated that at any point in time, in India, 2-5% of the population is suffering from serious mental illnesses, while another 10% of the population is suffering with minor mental illnesses. [sup][3] In India, there are a very small number of qualified psychiatrists, mostly concentrated in the metropolitan and the urban areas, to deal with this huge problem, further compounding the issue. [sup][4] Furthermore, it is a general observation in India that a majority of patients with mental disorder never seek professional help; and most of them utilize the help of unqualified medical practitioners, faith healers, and so on. The non-availability of mental health services, penury, stigma, and superstitions associated with mental disorders, coupled with the unwillingness or inability of families to care for their mentally ill relatives, appear to be the main contributory factors. [sup][5] The widely prevalent magico-religious beliefs associated with mental illness and lower literacy, especially in rural areas, poses significant social obstacles in seeking appropriate health care for psychiatric patients.

The pathway a patient adopts to reach the appropriate treatment center is termed as the pathway of care. Studying the pathway of care helps us in analyzing health services use, identification of the sources of delay in attending the right care, and to find out the possible remedies. These care pathways are not random; they are structured by the convergence of psychosocial and cultural factors and have sufficient integrity to be studied directly as unfolding processes. [sup][5]

In recent times, the pathway of care by psychiatric patients has been studied across the world. …

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