The Study of Pathways to Care in Elderly Mentally ill patients; A case series 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 reducing 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.