The impact of awareness of psychotic disorder on pathways to psychiatric care for first episode psychosis in India

ABSTRACT

Besides the availability of mental health services, the role of non-psychiatric healthcare providers (HCPs) and help seeking behaviour of patients/caregivers are important determinants of the pathway for early engagement with psychiatric services. We explored the help seeking behaviour of 151 persons with first episode non-affective psychosis for their preferences for making contacts/consultations with various types of HCPs; and the role of HCPs in psychiatric referrals using a modified encounter form of the World Health Organization. The most common type of the first and subsequent HCPs were faith healers, followed by local practitioners, general medical practitioners and mental health professionals. The average number of contacts before reaching the study centre was 7.19. Study centre referral was mainly by significant individuals/organizations in the community. The consequent pathway map of the pathway to psychiatric care was complex and multidirectional without a definite pattern of hierarchy of HCPs and was dominated by faith healers/local practitioners. In view of faith healers/local practitioners being the main type of HCPs in the pathway, and the non-HCPs individual/organizations being the most common referral source to study centre, the authors’advocate minimal mental health training of non-psychiatrist HCPs and non-HCPs individuals/organizations.

KEYWORDS:

• Pathway to care
• psychiatric referral
• first episode non affective psychosis
• health care providers in developing countries
• faith healers

Acknowledgements

Late Professor Jitendra Kumar Trivedi (JKT) was a par excellence academician, researcher and clinician. He was the chief guide of this thesis work and actively supervised the study. I (AQJ) am indebted to him for his kind and excellent guidance. The authors acknowledge the great contribution of JKT to this paper. The authors would also like to acknowledge Faraz Ahmad Khan, Diplomate of National Board, who reviewed manuscript and provided technical guidance for statistical analysis.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Dr. Abdul Qadir Jilani is post-graduate (MD Psychiatry & DNB Psychiatry) and super-specialized (DM Geriatric Psychiatry) from King George’s Medical University, Lucknow, India. He has authored/co-authored 14 publications. He has been awarded Young Psychiatrist Track award at the 22nd world congress of Social Psychiatry, New Delhi, India. Recently, he has been nominated for Young Psychiatrist Travel Grant award at the upcoming WPA XVII World Congress of Psychiatry, Berlin 2017.

Dr. Rahul Saha is post-graduate (MD Psychiatry) from King George’s Medical University, Lucknow, India in year 2011. Dr. Saha is working as Assistant Professor of Psychiatry at VMMC and Safdarjung Hospital, New Delhi – 110 029, India. He has authored/co-authored more than 10 research publications.

Dr. Pronob K. Dalal did his post-graduation (MD Psychiatry) in 1984 from King George’s Medical University, Lucknow, India; he is also Professor and head of the department at the same institute. His name bears hundred research articles including many book chapters and one book entitled Synopsis of the clinical practice guideline on the substance use disorder.

Dr. Roy Abraham Kallivayalil is the current General Secretary of ‘World Psychiatry Association’ (WPA) and present President of ‘World Association of Social Psychiatry’ (WASP). Also Dr. Roy is Vice-Principal, Professor & Head, Dept. of Psychiatry at Pushpagiri Institute of Medical Sciences (Tiruvalla, Kerala), India. He has authored and co-authored over 36 scientific publications.

Dr. Anshuman Tiwari recently completed his post-graduation (MD Psychiatry) from Era’s Lucknow Medical College (ELMCH), Lucknow, India. He is working as Assistant Professor at the department of Psychiatry, Shaikh-ul-Hind Maulana Mahmood Hasan Medical College, Saharanpur, India. He has six years of teaching experience and five publications.

Dr. Sujit Kumar Kar did his post-graduation (MD Psychiatry) from King George’s Medical university, Lucknow in 2010 and is working as Assistant Professor at the same institution. He has authored and co-authored more than 20 research publications.