The Study of Pathways to Care in Elderly Mentally ill patients: A Cross-Sectional study

Abstract

Background – Pathway to care is a detailed and systematic description of sources of
care used by the patients before seeking help from mental health professionals, and
also of the factors that modify it. Understanding pathways to care is crucial to
facilitate mental health referrals and reduce the time to consultation.
Aim – To evaluate the pathway to care of elderly mentally ill patients.
Materials and Methods – The Study was approved by the ethical committee of the
institution (S.N. Medical College, Bagalkot). A convenient Sample size of 100
patients was included in this study. The patients and caregivers were interviewed, and
the Pathways Interview Schedule (Encounter Form), developed by the WHO to
gather systematic information about the sources of care used by patients before
seeing a mental health professional, was used in this study.
Results – Most participants were females (n = 100, 57). The mean age was 64.9
(SD = 5.9) years. In our study, the most prevalent mental disorder was Depression,
present in 69% of the cases, and 66% of the patients had a duration of illness of 1 or
more years. Of the patients that first sought care at the psychiatric hospital was only
15%; another 42% sought non-psychiatric treatment from religious or traditional
healing centers as their first contact; 28% sought treatment from a non-psychiatric
general hospital as their first point of contact, and 14% sought help from community
health nurse and other community medical practitioners as their first point of mental
health care contact. Around 48% contacted psychiatric services, 15% to religious
healers, followed by 14% to a medical practitioner in the first referral after the
decision taken by relatives/friends in 34%, followed by 25% by the medical
practitioner.
Conclusion – The prolonged duration of untreated mental illness augurs poorly for
the patient and increases the cost of treatment. Understanding the routes people take
to obtain care may facilitate the development of services that decrease the time from
first symptoms to effective treatment.