Pathway of care among psychiatric patients attending a mental health institution in central India

Department of Community Medicine, G.R. Medical College, and the associated J. A. Group of Hospitals, Gwalior, India.
Indian Journal of Psychiatry 10/2010; 52(4):333-8. DOI: 10.4103/0019-5545.74308
Source: PubMed


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.
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.
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.
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.

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    • "The data regarding an understanding of the 94 way people seek care in childhood psychiatric illness like ADHD is 95 limited especially from India. Pathway studies have been used to 96 investigate the roles of previous care providers, the time spent on 97 the pathway and to monitor the effects of service developments 98 over time (Harrison et al., 1997; Lahariya et al., 2010). Thus, 99 understanding of pathways of care is a prerequisite for early 100 detection and effective treatment of illness. "
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    ABSTRACT: Attention deficit hyperactivity disorder (ADHD) is associated with impairment in all aspects of the patient's life. Despite availability of effective treatments for ADHD, a majority of the patient lack access to or have a significant delay in seeking help. This study aimed to assess the pathway of care in ADHD among patients attending the outpatient psychiatric services of a tertiary care centre in India. 57 newly registered cases of the age group 6-16 years with the diagnosis of ADHD as per DSM-IV-TR criteria were included in the study. Pathway of care was assessed on the semi structured proforma. The mean duration of delay in seeking help for ADHD symptoms was 3.96 Years (SD=1.96). Only 50% of the subjects consulted psychiatrists as first contact. Majority of the patients (45.61%) were referred by school teachers. Major reason given by the family members was that the patient was naughty rather than having any disorder for not seeking treatment in (89.47%). Our study showed that there was lack of recognition of ADHD at the level of other qualified practitioners and subsequent delay in referral to CAMHS. Sociocultural beliefs affected the help seeking by the parents. Copyright © 2015 Elsevier B.V. All rights reserved.
    Asian Journal of Psychiatry 08/2015; DOI:10.1016/j.ajp.2015.07.013
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    • "They referred the maximum children to the center. Several pathways of care studies in adults have reported this group to be major referring agency.[12] We found similar pattern of referral in children also. "
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    ABSTRACT: Early intervention in specific learning disability (SpLD) results in better outcome and prevents comorbidity. Understanding the pathways is therefore important. To study and compare the pathways to care for children with SpLD and mental retardation (MR) before reaching a tertiary care center. A cross-sectional study was conducted for pathways to care of two groups: SpLD and MR with 50 children in each group from 8 to 16 years. MINI-KID for comorbidity and Goldberg's pathway to care instrument was used. The groups were divided into early contact (up to three carers) and late contact (more than three carers) and compared. Data were analyzed using Statistical Packages for Social Sciences (SPSS) version 10.0 software. Majority (n = 24 or 48%) of SpLD children visited "others" (teachers, neighbors, relatives, and guardians of fellow classmates) as first carer. Allopathic practitioners were the first choice for MR children (n = 31 or 62%). Six children (12%) in SpLD group and 10 of MR (20%) group have seen either traditional practitioner or healer as first carer. Maximum referral to the tertiary center in both groups was done by others (62% in SpLD and 56% in MR group). Early contacts in SpLD group belonged to younger age group (P = 0.01). While comparing both groups on the basis of early and late contact, mother's education was found to be significant in early contact group (P = 0.036) and having comorbidity was significant among late contacts (P = 0.038). The pathways to care for SpLD children are more or less similar to MR children whose parents recognize MR late. Both the groups visit multiple carers including traditional healers substantiating the strong belief for supernatural causation of developmental disorders in India.
    Indian Journal of Psychological Medicine 03/2014; 36(1):27-32. DOI:10.4103/0253-7176.127243
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    • "Subsequently, many studies on pathways to care have been carried out in different countries of the world using the methodology originally developed by the WHO (Abiodun, 1995; Bekele, Flisher, Alem, & Baheretebeb, 2009; Fujisawa et al., 2008; Gater et al., 1991, 2005; Gater & Goldberg, 1991; Hashimoto et al., 2010; Kiliç, Rezaki, Ustün, & Gater, 1994; Kurihara, Kato, Reverger, & Tirta, 2006; Lahariya, Singhal, Gupta, & Mishra, 2010; Pawłowski & Kiejna, 2004; Steel et al., 2006; Vázquez-Barquero et al., 1993). On the whole, these studies revealed that the actual mental health seeking-care routes are often different from those planned or intended, and may vary significantly among different settings and regions, depending on various factors (including regional demographic characteristics, patients' diagnosis, the role of general practitioners, the structure of the mental health care system, the relationships between mental health professionals and other helping sources, and the accessibility to mental health facilities), which may greatly influence the pathways to care of people with mental disorders. "
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    ABSTRACT: and aims: In Italy, the reform of the mental health system in 1978 should have drastically changed the provision of care and pathways of patients seeking to obtain it. The aim of this article is to examine the current pathways to psychiatric care in Italy. We used a method developed in the World Health Organization international collaborative studies to investigate pathways to care in 15 Italian mental health centers. We recruited 420 patients with a psychiatric illness and explored the care pathways they took to reach to psychiatric services and the delays from the onset of illness to reaching psychiatric care. The majority of patients (33.8%) had direct access to mental health care, whereas the others arrived to a specialist in psychiatry through general hospitals (20.3%), general practitioners (33.0%) or private practitioners (9.8%). The main diagnosis for referral was neurotic disorder (36.6%), followed by affective disorder (35.4%) and psychotic disorder (11.5%). The delay from onset of illness to psychiatric care was greater for patients with psychotic disorders than for those with affective and neurotic disorders. The most frequently prescribed treatments were pharmacotherapy (56%), psychological support (8%), and psychotherapy (7.0%); 15% of the patients received no treatment. Our multicenter study shows that although general practitioners and hospital doctors are still the main referral point for mental health care, a greater proportion of patients are first seen in private settings or directly reach mental health centers, compared to previous surveys conducted in Italy. However, a stronger collaboration of psychiatrists with general practitioners and psychologists is still needed.
    International Journal of Social Psychiatry 09/2013; 60(5). DOI:10.1177/0020764013501648 · 1.15 Impact Factor
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Chandrakant Lahariya