Pathways to psychiatric care in Bangladesh
- 297 Downloads
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.
KeywordsPathway 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.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
- 7.Goldberg D, Huxley P (1980) Mental Illness in the Community. Tavistock, LondonGoogle Scholar
- 8.Goldberg D, Huxley P (1992) Common mental disorders: a bio-social model. Routledge, LondonGoogle Scholar
- 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
- 11.Islam S (ed.) (2003) Genocide 1971, Refugee, Birangana, Flood. Banglapedia: National Encyclopaedia of Bangladesh, Dhaka, Asiatic Society of Bangladesh. Retrieved from http://www.banglapedia.org
- 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.Website information from http://data.worldbank.org/about/country-classifications. Accessed on July 18 2010
- 14.WHO-AIMS (2006) Report on Mental Health System in Bangladesh, WHO and Ministry of Health & Family Welfare, Dhaka, BangladeshGoogle Scholar
- 16.The ICD-10 Classification of Mental and Behavioural Disorders (1992) Clinical descriptions and diagnostic guidelines. Geneva, Switzerland: World Health OrganizationGoogle Scholar
- 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.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.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