Pathways to mental health care in Nepal: a 14-center nationwide study

International Journal of Mental Health Systems

Norman Sartorius¹  Suraj Nepal²  Bikram Kafle³  Robin Jha⁴  Prabhakar Pokhrel⁵  Shuva Shrestha⁶  Anoop Krishna Gupta⁶  Suresh Thapaliya⁷  Reet Poudel⁸  Sulochana Joshi⁹  Sanjib Pandit^1,10  Manisha Chapagai^1,11  Ranjan Thapa^1,12  Prabhat Sapkota^1,13  Abhash Niraula^1,14  Umberto Volpe^1,15  Bina Sing Gurung^1,16  Sreya Paudyal^1,17 

[1] Association for the Improvement of Mental Health Programmes (AMH), 20 chemin Colladon, 1209, Geneva, Switzerland;Department of Psychiatry, B. P. Koirala Institute of Health Sciences, Dharan, Nepal;Department of Psychiatry, Devdaha Medical College, Devdaha, Nepal;Department of Psychiatry, Janakpur Provincial Hospital, Janakpur, Nepal;Department of Psychiatry, KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal;Department of Psychiatry, National Medical College, Birgunj, Nepal;Department of Psychiatry, National Medical College, Birgunj, Nepal;Kent and Medway NHS and Social Care Partnership Trust, Kent, UK;Department of Psychiatry, Nepalgunj Medical College, Kohalpur, Nepal;Department of Psychiatry, Patan Academy of Health Sciences, Lalitpur, Nepal;Department of Psychiatry, Rapti Academy of Health Sciences, Ghorahi, Nepal;Department of Psychiatry, Karnali Academy of Health Sciences, Jumla, Nepal;Department of Psychiatry, Tribhuvan University Teaching Hospital, Kathmandu, Nepal;Neuro Cardio and Multi-Specialty Hospital, Biratnagar, Nepal;Nisarga Hospital and Research Centre, Dhangadi, Nepal;P.T. Birta City Hospital and Research Centre, Birtamode, Nepal;Unit of Clinical Psychiatry, Head, Department of Clinical Neurosciences/DIMSC, School of Medicine, Università Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, Italy;United Mission Hospital, Tansen, Nepal;Universal College of Medical Sciences, Siddharthanagar, Nepal;

关键词: Pathways to care;    Mental health service;    Nepalese psychiatry;    Multicentre study;    Faith healer;    Proper psychiatric care;    Treatment delay;   

DOI  :  10.1186/s13033-021-00509-4

来源: Springer

【 摘 要 】

BackgroundPathways 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.MethodsThis 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.ResultsMost 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.ConclusionsFaith 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.

【 授权许可】

CC BY