Exploring barriers to access mental health services in first-episode psychosis: A cross-sectional study from Eastern Nepal.

Résumé

BACKGROUND: There are multiple barriers for psychotic patients to access mental health services, resulting in delays in treatment. Fewer studies are there exploring these barriers in the country. Identifying these barriers will contribute to management strategies.AIMS: To explore barriers to accessing mental health care in first-episode psychotic (FEP) patients and their association with clinical and demographic factors and duration of untreated psychosis (DUP).SETTING AND DESIGN: This was a cross-sectional, descriptive study conducted in the Department of Psychiatry in a tertiary hospital in Eastern Nepal.MATERIALS AND METHODS: Eighty-six FEP patients were enrolled. International Classification of Mental and Behavioral Disorders - Research Diagnostic criteria (10 Revision) was used for making the diagnosis. The Barriers to Access to Care Evaluation (BACE) Nepali version assessed barriers to seeking help. DUP was determined using the Nottingham Onset Schedule-DUP version (NOS-DUP). Chi-square, parametric, and nonparametric tests were applied wherever appropriate.RESULTS: Attitudinal-related barriers (preference for traditional/religious treatment) were the most common major barrier. Unemployed patients from nuclear families and insidious modes of onset of psychosis had more barriers to the treatment. DUP was significantly correlated ( value < 0.001) with attitudinal barriers (r = 0.606), instrumental barriers (r = 0.476), and total BACE score (r = 0.632).CONCLUSION: People's preferences for alternative treatment methods should be acknowledged, and multidimensional approaches for bringing the patient into standard care should be emphasized.