Pathways to tertiary care adopted by individuals with psychiatric illness

• First consultation was mostly medical, with less than half approaching a psychiatrist.
• Dismally the average delay in getting tertiary psychiatric care was six years.
• A fourth had one, a third, two and the rest three referrals to get to psychiatric care.
• A relative or a friend had maximum influence on the choice of first consultation.
• Medical professionals should be educated about timely referral to tertiary centres.

Awareness of mental illness as a cause of morbidity is increasing the world over. Of the top ten causes of disability, five are psychiatric illnesses. Availability and accessibility of psychiatrists as well as treatment facilities is meagre, making pathways to psychiatric care tortuous hence delayed, affecting outcomes negatively.With an attempt to study the pathways to psychiatric care, a cross sectional study was undertaken, on 63 consecutive first contact patients in tertiary care centre in Bangalore, India. Socio demographic details, time taken to reach professional help, and reasons for delay were noted. Pathways to care were recorded using ‘WHO pathways to care’ proforma.One third of the study population were aged between 31 and 45 years, mostly Hindus. Two thirds of them had received about 10 years of formal education, hailed from urban areas and lived in nuclear families.Majority sought help from trained medical professionals, with almost 40% seeking psychiatric help initially itself. While the choice of consultation was influenced by people in the immediate environment, that of first contact was based on the physician or treating facility. Almost 57% had more than two referrals before reaching the tertiary care centre.Though the urban educated population are well aware of the nature of psychiatric illnesses, need for medical intervention and its availability, there was a delay in seeking help from a tertiary psychiatric centre. There is thus a need to educate medical professionals about timely referral to these centres, as early and appropriate interventions result in a favourable outcome.