Pathways to mental health care in Nepal: a 14-center nationwide study
Tóm tắt
Pathways to care studies are feasible and tested means of finding the actual routes taken by patients before reaching proper care. In view of the predominance of nonprofessional service providers and the lack of previous large studies on pathways in Nepal, this multicenter study is needed. The aim of the study was to trace the various pathways and carers involved in mental health care; assess clinical variables such as the duration of untreated illness, clinical presentation and treatment; and compare geographically and culturally diverse landscapes. This was a cross-sectional, convenience sampling study performed at 14 centers where new cases were being taken. The World Health Organization Study of the Pathways-to-Care Schedule was applied. The Nepali version of the encounter form was used. The data were collected between 17 September and 16 October 2020 and were analyzed using the Statistical Package for the Social Sciences (SPSS). Additionally, perspectives from local investigators were collected and discussed. Most of the first carers were native/religious faith healers (28.2%), followed by psychiatrists (26%). The median duration for the first psychiatric consultation was 3 weeks. The duration of untreated illness was 30.72 ± 80.34 (median: 4) weeks, and the time taken for this journey was 94.99 ± 274.58 (median: 30) min. The longest delay from the onset of illness to psychiatric care was for epilepsy {90.0 ± 199.0 (median: 25.5)} weeks, followed by neurotic illness {22.89 ± 73.45 (median: 2)} and psychotic illness {10.54 ± 18.28 (median: 2)} weeks. Overall, most patients with severe mental illnesses (SMIs) had their first contact with faithhealers (49%), then met with medical doctors (13%) or psychiatrists (28%). Marked differences in clinical presentation surfaced when hilly centers were compared with the Terai belt. Faith healers, general practitioners and hospital doctors are major carers, and the means of educating them for proper referral can be considered. The investigators see several hindrances and opportunities in the studied pathways. The employment of more mental health professionals and better mental health advocacy, public awareness programs and school education are suggested strategies to improve proper mental health care.
Tài liệu tham khảo
Gater R, Sousa DB, Barrientos G, Caraveo J, Chandrashekar CR, Dhadphale M, et al. The pathways to psychiatric care: a cross-cultural study. Psychol Med. 1991;21:761–74.
Anderson KK, Fuhrer R, Malla AK. The pathways to mental health care of first-episode psychosis patients: a systematic review. Psychol Med. 2010;40:1585–97.
Fujisawa D, Hashimoto N, Masamune-Koizumi Y, Otsuka K, Tateno M, Okugawa G, et al. Pathway to psychiatric care in Japan: a multicenter observational study. Int J Ment Health Syst. 2008;2:1–9.
Gater R, Jordanova V, Maric N, Alikaj V, Bajs M, Cavic T, et al. Pathways to psychiatric care in Eastern Europe. Br J Psychiatry. 2005;186:529–35.
Hashimoto N, Fujisawa D, Giasuddin NA, Kenchaiah BK, Narmandakh A, Dugerragchaa K, et al. Pathways to mental health care in Bangladesh, India, Japan, Mongolia, and Nepal. Asia-Pacific J Public Heal. 2015;27:NP1847-57.
Lahariya C, Singhal S, Gupta S, Mishra A. Pathway of care among psychiatric patients attending a mental health institution in central India. Indian J Psychiatry. 2010;52:333–8.
Steel Z, McDonald R, Silove D, Bauman A, Sandford P, Herron J, et al. Pathways to the first contact with specialist mental health care. Aust N Z J Psychiatry. 2006;40:347–54.
Volpe U, Fiorillo A, Luciano M, Del Vecchio V, Palumbo C, Calò S, et al. Pathways to mental health care in Italy: results from a multicenter study. Int J Soc Psychiatry. 2014;60:508–13.
Volpe U, Monteleone AM, Ricca V, Corsi E, Favaro A, Santonastaso P, et al. Pathways to specialist care for eating disorders: an Italian multicentre study. Eur Eat Disord Rev. 2019;27:274–82.
Jain N, Gautam S, Jain S, Gupta ID, Batra L, Sharma R, et al. Pathway to psychiatric care in a tertiary mental health facility in Jaipur, India. Asian J Psychiatr. 2012;5:303–8. https://doi.org/10.1016/j.ajp.2012.04.003.
Mishra N, Nagpal S, Chadda RK, Sood M. Help-seeking behavior of patients with mental health problems visiting a tertiary care center in North India. Indian J Psychiatry. 2011;53:234–8.
Rai N, Pokhrel P, Sharma PP, Basnet M, Dahal B, Bista TB. Pathway to care among psychiatric patients attending a Tertiary care hospital in Kathmandu Valley. J Psychiatr Assoc Nepal. 2018;7:31–5.
Lamichhane N, Thapa D, Timilsina R, Sharma R, Vaidya L, Subedi A. Pathway to care of psychiatric services in Gandaki medical college teaching hospital in western Nepal. J Gandaki Med Coll. 2019;12:80–5.
Dhungana M, Ghimire SR. Pathways to Mental Health Care in Nepal Original Research Paper Pathways to mental health care in Nepal Psychiatry Dr . Shree Ram; 2017.
Upadhaya N, Jordans MJD, Pokhrel R, Gurung D, Adhikari RP, Petersen I, et al. Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study. Int J Ment Heal Syst. 2017;11:37.
Volpe U, Amin H, Ayinde OO, Burns A, Chan WC, David R, et al. Pathways to care for people with dementia: an international multicentre study. Int J Geriatr Psychiatry. 2020;35:163–73.
Kulhara P, Avasthi A, Sharma A. Magico-religious beliefs in schizophrenia: a study from North India. Psychopathology. 2000;33:62–8.
Gupta AK, Grover S, Thapaliya S, Shrestha S, Sawant S, Shoib S. Pathways to care and supernatural beliefs among patients with psychotic disorders in Nepal. Middle East Curr Psychiatry. 2021. https://doi.org/10.1186/s43045-021-00143-3.
Kate N, Grover S, Kulhara P, Nehra R. Supernatural beliefs, aetiological models and help seeking behaviour in patients with schizophrenia. Ind Psychiatry J. 2012;21:49.
Grover S, Nebhinani N, Chakrabarti S, Shah R, Avasthi A. Relationship between first treatment contact and supernatural beliefs in caregivers of patients with schizophrenia. East Asian Arch Psychiatry. 2014;24:58–67.
Luitel NP, Jordans MJD, Adhikari A, Upadhaya N, Hanlon C, Lund C, et al. Mental health care in Nepal : current situation and challenges for development of a district mental health care plan. 2015; 1–11.
Volpe U, Mihai A, Jordanova V, Sartorius N. The pathways to mental healthcare worldwide: a systematic review. Curr Opin Psychiatry. 2015;28:299–306.
Hoge EA, Tamrakar SM, Christian KM, Mahara N, Nepal MK, Pollack MH, et al. Cross-cultural differences in somatic presentation in patients with generalized anxiety disorder. J Nerv Ment Dis. 2006;194:962.
Keynejad RC, Dua T, Barbui C, Thornicroft G. WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: a systematic review of evidence from low and middle-income countries. Evid Based Ment Health. 2018;21:30–4.
Rai Y, Gurung D, Gautam K. Insight and challenges: mental health services in Nepal. BJPsych Int. 2020; 1–3.
Rai S, Gurung D, Kaiser BN, Sikkema KJ, Dhakal M, Bhardwaj A, et al. A service user co-facilitated intervention to reduce mental illness stigma among primary healthcare workers: utilizing perspectives of family members and caregivers. Fam Syst Heal. 2018;36:198–209.
Jordans MJD, Luitel NP, Pokhrel P, Patel V. Development and pilot testing of a mental healthcare plan in Nepal. Br J Psychiatry. 2016;208:s21–8.
Kohrt BA, Mutamba BB, Luitel NP, Gwaikolo W, OnyangoMangen P, Nakku J, et al. How competent are non-specialists trained to integrate mental health services in primary care? Global health perspectives from Uganda, Liberia, and Nepal. Int Rev Psychiatry. 2018;30:182–98. https://doi.org/10.1080/09540261.2019.1566116.
Musyimi CW, Mutiso VN, Nandoya ES, Ndetei DM. Forming a joint dialogue among faith healers, traditional healers and formal health workers in mental health in a Kenyan setting: towards common grounds. J Ethnobiol Ethnomed. 2016;12:4.
Sharma P, Joshi D, Shrestha K. Mental health and COVID-19 in Nepal: a case of a satellite clinic. Asian J Psychiatry. 2020;53:102175.
Shoib S, Bhandari SS. Mental health professionals as ‘ silent frontline healthcare workers ’: perspectives from three South Asian countries. Open J Psychiatry Allied Sci. 2020;2053:1–5.
Gupta AK, Sahoo S, Mehra A, Grover S. Psychological impact of ‘Lockdown’ due to COVID-19 pandemic in Nepal: an online survey. Asian J Psychiatr. 2020;54:102243.