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

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Change in attitude and help-seeking pattern of caregivers and patients with mental disorders in the community - Recent findings from India

“…[ 1 7 13 14 ] Research from Nepal found that the majority of patients with severe mental problems first met with religious healers (49%), then with medical doctors (13%) or psychiatrists (28%). [ 10 ] This shows a variation in the help-seeking behaviour of the individuals and a variable reliance on traditional healers. This reveals a wide range of individuals’ help-seeking behaviour as well as a varying dependence on traditional healers.…”

“…The main cause of the disparity could be cultural or regional factors influencing the level and kind of use of existing healthcare facilities, as well as knowledge and understanding of mental diseases. [ 10 ] In some parts of India, culturally recognised traditional practices such as temple healing are permitted, while they may not be in other places. [ 9 ]…”

“…This could be related to the stigma associated with mental diseases as well as psychiatric facilities. [ 7 10 ] And need to have regular training programmes for family physicians and community health professionals to facilitate the help-seeking behavior of psychiatric patients and timely referrals in the Indian subcontinent.…”

“…Epilepsy had the greatest time between commencement of illness and psychiatric care, followed by neurotic illness and psychotic illness. [ 10 ]…”

Considering Resources in Mental Health Gap Action Program (mhGAP) Implementation and Training: Insights from Field Trainers in Nepal

“…This particular topic generates significant interest among participants who engage in in-depth discussions. Consequently, the traditional Nepali concept of mind-body division allows traditional healers a unique space to address psychological distress (Gupta et al, 2021;Kohrt & Harper, 2008).…”