Pathways of Care in the Hospital Visiting Patients Having Mental Health Problems in Central India

Background: There is a high community prevalence of mental health problems in India. Psychiatric patients often consult nonspecialist or unqualified health providers which results in significant treatment delays and poor mental health outcomes. Knowledge of existing treatment-seeking practices may be useful to design specific and effective awareness programs. Objectives: The objectives were to study the types of health-care providers contacted by patients suffering from different mental illnesses as well as assess the treatment delays and associated factors. Methodology: A cross-sectional observational descriptive study was done in a psychiatry clinic of a tertiary health care center and teaching hospital in Central India. The information was collected from consecutive newly visiting patients on two predefined weekdays through face-to-face interviews. A predesigned sociodemographic format and World Health Organization pathways interview schedule were used to assess pathways of care. Results: Data were collected from 157 participants. Majority of participants were males (58%). Mood disorders were the most common diagnostic category (28%), followed by substance-related disorders (23%) and anxiety disorders (21%). Eighty (51%) among the total participants consulted psychiatrist in the first visit. Allopathic practitioners were the second commonly consulted health provider category. The median delay in treatment was maximum in substance-related disorders (7 years). Conclusion: Significant delay in treatment was observed across all diagnostic categories. Training general practitioners in the diagnosis and treatment of mental illnesses and a structured health-care referral system to enhance appropriate psychiatry consultations may be desirable to improve mental health outcomes in India.