Pathway of psychiatric care

Abstract

Byline: J. Trivedi, Abdul. Jilani In search of the best possible options for appropriate, evidence-based and effective management of psychiatric disorders, constant research activity, nationally and internationally, is being undertaken to underpin both biological and social factors relevant to early treatment, cost effectiveness and the best possible prognosis. Though psychiatric services are limited in many parts of the world, especially in developing countries like India, even at places where they are available and among those who could have easier access to avail benefits early from psychiatric services, significant proportion of patients find psychiatric services as the last resort after having consultations from many different types of non-psychiatric care providers, including faith healers. In this, lot of crucial time is lost, which could have relevance to better prognosis, as early recognition and management are of utmost importance in psychiatry. [sup][1] This has increased the importance of not only the availability of mental health services in the community for easier access but also the various social and cultural factors which determine the help seeking behavior and pathway of psychiatric care, which is defined as the sequence of contacts with individuals and organizations, initiated by the distressed person's efforts and those of his significant others to seek appropriate help. [sup][2] Research related to help seeking behavior and attitude toward mental illnesses and services which primarily determine the pathway of care has been carried out mainly in developed nations. There is, however, deficiency of information from the developing countries. [sup][3] Effectiveness and Determinant of Pathway of Care As the basic purpose of the pathway of care is to provide early engagement with psychiatric services to minimize the effective cost of treatment and maximize better prognosis, this could be of great help in mental health services. Increasing emphasis is being placed on the implementation of care pathways in all types of healthcare settings, including psychiatry, in the developed countries. [sup][4],[5] Though currently the effectiveness of pathway of care and impact of care pathways on the delivery of mental healthcare is still rudimentary, in practice this could be of great help and effective for the developing nations where there is an urgent need to cater for psychiatric patients with limited psychiatric services. This needs explorations of many overt and covert factors acting as hindrance in the pathway of care and appropriate solutions. These factors play an important role at various steps. Factors causing delay in the initiation of appropriate treatment at the first instance vary from region to region depending upon the sociocultural profile, education, attitude of family/society toward mental illness, perceptions, myths, beliefs, stigma attached with psychiatric disorder, availability/accessibility of psychiatric services and referral patterns, and previous experience of receiving psychiatric help. These determinants also differ in their strength of impact deciding the pathway of care in different geographic regions of world. For example, in the developed nations, the major concern is of stigma, while in the developing nations it is the problem of age old cultural myths and supernatural explanations of psychiatric disorders. There is also a significant role of care providers in deciding the pathways to psychiatric care, the first care provider being the most important for giving direction to the pathway of care to seek further help. [sup][6] Need of Pathway of Care in Developing Nations It is estimated that one in four families has at least one member currently suffering from a mental or behavioral disorder. This results in substantial burden on family members, compromised quality of life, and the negative impact of stigma and discrimination. [sup][7] Also, approximately half of the estimated 450 million people affected by mental illness globally live in Asia-Pacific regions; [sup][8] but due to multiple factors playing as barriers in the pathway of care, many are left untreated, many are partially treated and only a small fraction gets access to appropriate place of treatment. …