211 Pathways and barriers to access mental health care in patients presenting to department of psychaitry in a tertiary care hospital in Kathmandu: a cross-sectional study

Abstract OP 8: Health Services 6, B304 (FCSH), September 3, 2025, 15:45 - 16:45 Aim This study aimed to explore the pathways and barriers to accessing mental health care among patients presenting to the Department of Psychiatry, Tribhuvan University Teaching Hospital. Specifically, it sought to: (1) examine the patterns of mental health service access; (2) identify instrumental, attitudinal, and stigma-related barriers; (3) analyze the association between pathways of care and relevant demographic and clinical variables; and (4) examine the association between barriers to care and these variables. Methods A cross-sectional study was conducted with a purposive sample of 326 new patients attending the outpatient and inpatient services of the Department of Psychiatry, TUTH, after approval from the Institutional Review Committee. Data were collected using a semi-structured questionnaire, the Nepali-translated WHO Encounter Form, and the Barriers to Access Care Evaluation (BACE v3) tool. Socio-demographic and clinical factors were assessed, and statistical analyses were performed to identify patterns and associations. Results Most participants (83.7%) were aged 18–60 years, with a slight female predominance (52.5%). The most common first point of contact was medical practitioners (42.6%), followed by psychiatric services (35%). However, delays in accessing care were significant, with a mean duration of 93 weeks and a median of 13 weeks to the first contact. The barriers identified included instrumental challenges such as financial constraints and service unavailability, attitudinal barriers like low perceived need, and stigma-related barriers. Notably, stigma was a pervasive issue influencing help-seeking behavior. Statistical analysis revealed significant associations between barriers and socio-demographic factors, such as education and employment status. Conclusion The findings highlight the complex interplay of pathways and barriers influencing access to mental health care in Nepal. Instrumental and stigma-related barriers remain significant obstacles, underscoring the need for targeted interventions, including public awareness campaigns, enhanced resource allocation, and culturally appropriate task-shifting models to improve care access.