Pathways to care and duration of untreated illness in patients attending a state psychiatric hospital

Background: In India, due to various factors, mentally ill often turn to a variety of carers for treatment. It results in a longer duration of untreated illness (DUI) with poor long term prognosis. Studies on pathways to care, seek to find out predictors of mentally ill person’s help-seeking behaviour. There is a dearth of literature in this subject in Kerala setting. Methods: Cross-sectional study was conducted on 250 consecutive first-time outpatients. The diagnosis was made according to DSM 5. A pilot-tested, semi-structured proforma was used for socio-demographic details and Encounter form by WHO for pathways to care. The analysis was done using Epi Info software. Results and discussion: Four gateways to care identified: Psychiatrist- 71.2%, faith healers – 14.8%, non-psychiatrist modern medicine doctors- 9.2%, alternate systems of medicine- 4.8%. Median DUI was seven months. Faith healers as first carers were more in BPL compared to APL families (p=0.004). Substance use disorders had longer median DUI than psychotic and anxiety disorders and mental retardation. Major neurocognitive disorder had more delays than the schizophrenia spectrum and other psychotic disorders and mental retardation (p=0.000). Among first carers, longer DUI was with faith healers and alternate systems of medicine when compared to psychiatrists. (p=0.000). Those from higher socioeconomic status and a diagnosis of substance use disorder more often have a psychiatrist as the first carer. Being male was associated with lengthier pathways. Conclusion: Faith healers & alternate systems of medicine practitioners form the first portal of psychiatric care for a small yet significant proportion of the patients. Reduction in DUI in case of psychiatric disorders needs attention to this aspect also.