Social Psychiatry and Psychiatric Epidemiology

, Volume 47, Issue 1, pp 129–136 | Cite as

Pathways to psychiatric care in Bangladesh

  • Noor Ahmed GiasuddinEmail author
  • Nafia Farzana Chowdhury
  • Naoki Hashimoto
  • Daisuke Fujisawa
  • Shafquat Waheed
Original Paper



The pattern of care seeking of psychiatric patients is important for service and policy issues. We conducted a study in 2008 in Bangladesh to find out the referral patterns, delays to reach mental health professional (MHP), diagnoses and treatment received before reaching psychiatric care etc.

Materials and methods

We interviewed 50 consecutive new patients at the Psychiatry outpatient department of a tertiary hospital using the translated version of WHO pathway encounter form.


84% of the patients we interviewed consulted other carers before they arrived at a MHP (2.5–3.1 steps were needed to reach MHP) and the range of delay was 8–78 weeks (indirect pathway). 16% of the patients came directly to a MHP with mean delay of 10.5 weeks from onset of mental illness (direct pathway). Among the patients who took the indirect pathway 44% first visited the Individual Private practitioners (PP), 22% first visited native or religious healers (NRH) and 12% rural medical practitioners (RMP). Patients reaching NRH or RMP made the least delay (2–2.5 weeks) and the shortest pathway to MHP (4.5–7 weeks). Most delay occurred from PP to MHP/General Hospital (22–31 weeks). About a third of patients were informed of diagnosis with poor concordance with the diagnosis made by MHP. 70 and 40% of patients with mental illness who attended General Hospital and PP were referred to MHP, respectively.


In the study we found four major pathways to mental health care in Bangladesh. They are direct pathway and referrals from PP, general hospitals and NRH. PP did not play a pivotal role in reaching MHP. Family members had a significant role on the decision to seek help from health service.


Pathway Mental health Bangladesh Psychiatric care Pathway to mental health care 


Declaration of interests

There is no ethical problem or conflict of interest with regard to this manuscript. The study was performed on a volunteer basis and was not supported by any grants. This study was initially proposed and planned by the Japan Young Psychiatrists’ Organization (JYPO) at a Fellowship Program of the WPA regional meeting in Seoul, Korea, in 2007.


  1. 1.
    Mullick M (2007) Teaching and training in psychiatry and the need for a new generation of psychiatrist in Bangladesh: role of the Royal College of Psychiatrists. Int Psychiatry 4/2; 29–31Google Scholar
  2. 2.
    Kilic C, Rezaki M, Ustun TB, Gater RA (1994) Pathways to psychiatric care in Ankara. Soc Psychiatry Psychiatr Epidemiol 29(3):131–136PubMedGoogle Scholar
  3. 3.
    Kurihara T, Kato M, Reverger R, Tirta IG (2006) Pathway to psychiatric care in Bali. Psychiatry Clin Neurosci 60(2):204–210PubMedCrossRefGoogle Scholar
  4. 4.
    Chong SA, Mythily LumA, Chan YH, McGorry P (2005) Determinants of duration of untreated psychosis and the pathway to care in Singapore. Int J Soc Psychiatry 51(1):55–62PubMedCrossRefGoogle Scholar
  5. 5.
    Chadda RK, Agarwal V, Singh MC, Raheja D (2001) Help seeking behaviour of psychiatric patients before seeking care at a mental hospital. Int J Soc Psychiatry 47(4):71–78PubMedCrossRefGoogle Scholar
  6. 6.
    Gater R, e Sousa B, Barrientos G et al (1991) The pathways to psychiatric care: a cross-cultural study. Psychol Med 21(3):761–774PubMedCrossRefGoogle Scholar
  7. 7.
    Goldberg D, Huxley P (1980) Mental Illness in the Community. Tavistock, LondonGoogle Scholar
  8. 8.
    Goldberg D, Huxley P (1992) Common mental disorders: a bio-social model. Routledge, LondonGoogle Scholar
  9. 9.
    Islam MM, Ali M, Ferroni P, Underwood P, Alam MF, Firoz AHM (2001) Care seeking behavior of mentally ill: a qualitative and quantitative approach. Bangladesh J Psychiatry 15(1):13–28Google Scholar
  10. 10.
    Hosain GM, Chatterjee N, Ara N, Islam T (2007) Prevalence, pattern and determinants of mental disorders in rural Bangladesh. Public Health 121(1):18–24PubMedCrossRefGoogle Scholar
  11. 11.
    Islam S (ed.) (2003) Genocide 1971, Refugee, Birangana, Flood. Banglapedia: National Encyclopaedia of Bangladesh, Dhaka, Asiatic Society of Bangladesh. Retrieved from
  12. 12.
    Firoz AHM, Karim E, Alam MF, Rahman AHMM (2006) Zaman MM; Prevalence, Medical Care, Awareness and Attitude towards Mental Illness in Bangladesh. Bangladesh J Psychiatry 20(1):7–36 special issueGoogle Scholar
  13. 13.
    Website information from Accessed on July 18 2010
  14. 14.
    WHO-AIMS (2006) Report on Mental Health System in Bangladesh, WHO and Ministry of Health & Family Welfare, Dhaka, BangladeshGoogle Scholar
  15. 15.
    Gater R, Jordanova V, Maric N et al (2005) Pathways to psychiatric care in Eastern Europe. Br J Psychiatry 186:529–535PubMedCrossRefGoogle Scholar
  16. 16.
    The ICD-10 Classification of Mental and Behavioural Disorders (1992) Clinical descriptions and diagnostic guidelines. Geneva, Switzerland: World Health OrganizationGoogle Scholar
  17. 17.
    Giasuddin NA, Ruksheda S (2009) Beyond the 13th Pacific Rim College of Psychiatrists Scientific Meeting 2008. Asia-Pacific Psychiatry 1:103–105 CrossRefGoogle Scholar
  18. 18.
    Mohit MA, Das MK, Azad MC, Mahmud MH, Alam MF, Karim ME et al (2001) Diagnosis of Patients Attending Out-Patient Department (OPD) of National Institute of Mental Health, Dhaka. Bangladesh J Psychiatry 15(1):5–12Google Scholar
  19. 19.
    Islam H, Noman SZ, Shaheed AYM, Chowdhury NN (2008) Referral Pattern of Patients to a Psychiatric Outpatient Clinic of Dhaka City. Bangladesh J Psychiatry 22(1):22–28Google Scholar
  20. 20.
    Rahman AHMM, Khan MZR, Sarkar M, Firoz AHM, Karim ME, Alam MF, Hamid MA (2006) Study of Morbidity and Referral System in Psychiatric Private Practice. Bangladesh J Psychiatry 20(2):43–49Google Scholar
  21. 21.
    Albert M, Becker T, McCrone P et al (1998) Social networks and mental health service utilization—a literature review. Int J Soc Psychiatry 44:248–266PubMedCrossRefGoogle Scholar
  22. 22.
    O’Callaghan E, Turner N, Renwick L, Jackson D, Sutton M, Foley SD, McWilliams S, Behan C, Fetherstone A, Kinsella A (2010) First episode psychosis and the trail to secondary care: help-seeking and health–system delays. Soc Psychiatry Psychiatr Epidemiol 45(3):381–391PubMedCrossRefGoogle Scholar
  23. 23.
    Hendrik S, Temmingh PietP (2008) Oosthuizen Pathways to care and treatment delays in first and multi episode psychosis: Findings from a developing country. Soc Psychiatry Psychitr Epidemiol 43:727–735CrossRefGoogle Scholar
  24. 24.
    Abiodun OA (1995) Pathways to mental health care in Nigeria. Psychiatr Serv 46(8):823–826PubMedGoogle Scholar
  25. 25.
    Pawlowski T, Kiejna A (2004) Pathways to psychiatric care and reform of the public health care system in Poland. Eur Psychiatry 19(3):168–171PubMedCrossRefGoogle Scholar
  26. 26.
    Balestrieri M, Bon MG, Rodriguez-Sacristan A, Tansella M (1994) Pathways to psychiatric care in south-Verona, Italy. Psychol Med 24(3):641–649PubMedCrossRefGoogle Scholar
  27. 27.
    Reeler AP (1992) Pathways to psychiatric care in Harare, Zimbabwe. Cent Afr J Med 38(1):1–7PubMedGoogle Scholar
  28. 28.
    Marshall M, Lewis S, Lockwood A (2005) Association between duration of untreated psychosis and outcome in cohorts of first episode patients—a systemic review. Arch Gen Psychiatry 62:975–983PubMedCrossRefGoogle Scholar
  29. 29.
    Fujisawa D, Hashimoto N, Masamune-Koizumi Y et al (2008) Pathway to psychiatric care in Japan: a multicenter observational study. Int J Ment Health Syst 2(1):14PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Noor Ahmed Giasuddin
    • 1
    Email author
  • Nafia Farzana Chowdhury
    • 2
  • Naoki Hashimoto
    • 3
  • Daisuke Fujisawa
    • 4
  • Shafquat Waheed
    • 5
  1. 1.S. Z. Medical College HospitalBograBangladesh
  2. 2.BSM Medical UniversityDhakaBangladesh
  3. 3.Department of Psychiatry, Graduate School of MedicineHokkaido UniversitySapporoJapan
  4. 4.Psycho-oncology DivisionNational Cancer Center EastChibaJapan
  5. 5.Dhaka Medical College HospitalDhakaBangladesh

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