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Pathways to psychiatric care in Bangladesh

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Introduction

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.

Results

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.

Conclusion

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.

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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.

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Authors and Affiliations

  1. S. Z. Medical College Hospital, Bogra, Bangladesh

    Noor Ahmed Giasuddin

  2. BSM Medical University, Shahbag, Dhaka, Bangladesh

    Nafia Farzana Chowdhury

  3. Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Naoki Hashimoto

  4. Psycho-oncology Division, National Cancer Center East, Chiba, Japan

    Daisuke Fujisawa

  5. Dhaka Medical College Hospital, Dhaka, Bangladesh

    Shafquat Waheed

Authors
  1. Noor Ahmed Giasuddin
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  2. Nafia Farzana Chowdhury
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  3. Naoki Hashimoto
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  4. Daisuke Fujisawa
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  5. Shafquat Waheed
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Corresponding author

Correspondence to Noor Ahmed Giasuddin.

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Giasuddin, N.A., Chowdhury, N.F., Hashimoto, N. et al. Pathways to psychiatric care in Bangladesh. Soc Psychiatry Psychiatr Epidemiol 47, 129–136 (2012). https://doi.org/10.1007/s00127-010-0315-y

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  • DOI: https://doi.org/10.1007/s00127-010-0315-y

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