Barriers to mental health service utilisation in Sudan - perspectives of carers and psychiatrists

Abstract

BackgroundIn order to scale up mental health care nationally, barriers to health services utilisation need to be identified and addressed.Aim: The aim of this study was to identify barriers to mental health services utilization in Sudan from the perspectives of carer’s of mentally ill patients and psychiatrists and to make recommendations to address the identified barriers.MethodsMixed research methods were used in this cross sectional survey. The quantitative part was conducted with carers of mentally ill patients who were staying in Tijani Elmahi psychiatric hospital in Sudan, and the qualitative part was conducted with the psychiatric consultants in the country.Results103 carers and six psychiatric consultants participated in the study. According to carers, the main barriers to utilisation of mental health services includes: the beliefs around mental illness, resorting to alternative treatments such as religious and traditional healers, centralization of mental health services, inadequate number of mental health staff, and mental health not being a priority by policy makers. In addition to these barriers, the psychiatric consultants identified stigma, cost of medications, and worries about medication’s side effects as barriers to the utilisation of mental health services. The carers and psychiatrists proposed several solutions to address the barriers to health services utilisation.ConclusionCarers and psychiatrists are aware of the barriers to mental health services utilisation in Sudan. Addressing these barriers require a health policy and political response.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1280-2) contains supplementary material, which is available to authorized users.

Global barriers to provision and utilization of mental health services: a systematic scope study

“…(22) Furthermore, patients tendency towards alternative types of treatment may make them to become pessimistic about the specialized services. (19,48) According to these reasons, it seems that improving the quality of mental health services and increasing public knowledge about these services can be effective in removing or modifying the barrier.…”

“…It has been reported that in some parts of the world especially in low-and middle-income countries, cost of MH services is not affordable. (11,48) The highest expenditures are related to medications and treatment services. (52) Cost of MH services is also related to the economic losses due to the reduced productive capacity of patients and their family (53).…”

“…Concern about social stigma 16 (18-25, 48, 54-56, 58, 63, 65, 66) Concerns about effectiveness of services 9 (19-22, 24, 25, 54, 65, 67) Personal stigma/ Shame 7 (18-21, 54, 58, 68) Patients' Self-Reliance 7 (19-22, 54, 66, 68) Preference for getting alternative forms of care 6 (19,20,23,48,55,59) Cultural beliefs against treatment 5 (23,59,63,67,68) Patients' concerns about attitudes, beliefs, and behaviors of care providers 5 (17-19, 23, 65) Lack of confidence in professionals 2 (21,66) Concern about confidentiality 1 (54) Structural barriers…”

“…Resource and administrative barriers Insufficient resources 14 (10-15, 23, 31, 35, 48, 55, Centralized and non-integrated services 7 (10, 12-14, 16, 18, 64) Inappropriate service types 5 (10,13,15,35,36) Geographical imbalance in resource allocation 5 (10)(11)(12)(13)48) Insufficient preventive services 4 (14,16,36,64) Lack of administrative coordination 4 (10,11,18,55) Weakness of quality assurance schemes 3 (11,23,36) Information and knowledge barriers lack of evidence-based service development 6 (10,11,13,16,36,62) Imperfect mental health information system 4 (11,13,18,38) Inappropriate training of providers 3 (23,31,62) Lack of cross-cultural understanding between patients and care givers 1 (23) Policy and legislation barriers Parental education/employment status 1 (73) Family income status 1 (73) Parental concern about treatment side effects 1 (47)…”

Client Satisfaction and Quality of Life at Primary Healthcare Clinics and Psychiatric Hospitals in the Eastern Province of Saudi Arabia

“…Another study in KSA showed that mental health problems are often thought to have religious or somatic causes, making them difficult for mental health practitioners to diagnose and treat [12]. Literature from adjacent African countries supports these findings [13] [14] [15]. Regretfully, it was clear that most of these mental health cases were treated either by PHC medical professionals or by religious/traditional healers [16] [17] [18] and that perhaps less than one-third of patients ever met with a psychologist or other mental health providers [19].…”