eprintid: 25135
rev_number: 11
eprint_status: archive
userid: 1589
dir: disk0/00/02/51/35
datestamp: 2018-07-23 09:25:34
lastmod: 2024-05-09 07:34:53
status_changed: 2018-07-23 09:25:34
type: article
metadata_visibility: show
creators_name: Nuri, Nazmun Nahar
creators_name: Sarker, Malabika
creators_name: Ahmed, Helal Uddin
creators_name: Hossain, Mohammad Didar
creators_name: Beiersmann, Claudia
creators_name: Jahn, Albrecht
title: Pathways to care of patients with mental health problems in Bangladesh
subjects: ddc-610
divisions: i-912800
abstract: Background: Health systems in Bangladesh are not fully organized to provide optimal care services to patients with mental health problems. There is both a lack of resources and a disproportional distribution of the available resources. To design an equitable health system and plan interventions to improve access to care, a better understanding of mental health care-seeking behavior and care pathways are crucial.

Methods: A facility-based cross-sectional study was conducted using a mixed-method design at the National Institute of Mental Health (NIMH), in Bangladesh. A total of 40 patients (or their attendants) visiting the outpatient department of NIMH were selected by purposive sampling.

Results: As their first contact point for care services, 27.5% of the patients consulted a psychiatric care provider, 30% went to non-medical provider, and the majority, 42.5%, went to non-psychiatric medical care providers. Only 32.5% of the patients had been advised to go to NIMH by a private physician, hospital personnel or psychiatrist. Among all individual categories of providers, private psychiatrists were the most frequent caregivers (n = 12), followed by traditional healers (n = 9). A total of 70% of the patients had chosen a provider within 20 km. In three out of four of the cases, the family had decided on the first provider. From the start of the symptoms the median delay in the first contact with any provider was 6 months, and in reaching any psychiatric care provider was 1 year. The most common reasons for a delay in seeking care were a lack of knowledge about mental health problems, a lack of information about the place for appropriate care, and not considering the problem as serious enough to seek care. Each of those reasons were mentioned by one in every four respondents.

Conclusions: The majority of the patients with mental health problems in Bangladesh access various categories of providers before reaching a psychiatric care provider, and use a diverse range of pathways and loops, which results in a delay or missing appropriate care. We hope that our findings are useful for planning interventions to improve access to mental health care in general, in Bangladesh, and improving referral policies and structures in particular.
date: 2018
publisher: BioMed Central
id_scheme: DOI
ppn_swb: 1655783696
own_urn: urn:nbn:de:bsz:16-heidok-251358
language: eng
bibsort: NURINAZMUNPATHWAYSTO2018
full_text_status: public
publication: International journal of mental health systems
volume: 12
number: 39
place_of_pub: London
pagerange: 1-12
issn: 1752-4458
citation:   Nuri, Nazmun Nahar ; Sarker, Malabika ; Ahmed, Helal Uddin ; Hossain, Mohammad Didar ; Beiersmann, Claudia ; Jahn, Albrecht  (2018) Pathways to care of patients with mental health problems in Bangladesh.  International journal of mental health systems, 12 (39).  pp. 1-12.  ISSN 1752-4458     
document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/25135/1/13033_2018_Article_218.pdf