Indian Journal of Private Psychiatry

Register      Login

VOLUME 16 , ISSUE 1 ( January-June, 2022 ) > List of Articles


How Lengthy and Tortuous is the Pathway to Psychiatric Care among Patients Visiting a Tertiary Care Hospital in South India? A Cross-sectional Study

Manjula Simiyon, Swetha Joju, Pradeep Thilakan, Manikandan Mani

Keywords : Duration of untreated illness, India, Pathway, Traditional healers

Citation Information : Simiyon M, Joju S, Thilakan P, Mani M. How Lengthy and Tortuous is the Pathway to Psychiatric Care among Patients Visiting a Tertiary Care Hospital in South India? A Cross-sectional Study. Ind J Priv Psychiatry 2022; 16 (1):3-9.

DOI: 10.5005/jp-journals-10067-0106

License: CC BY-NC 4.0

Published Online: 16-03-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Mental illnesses (MI) are commonly linked with a higher burden of disease. A large number of patients with mental illnesses do not present to the mental health services directly rather they adopt a pathway that is usually prolonged and tortuous. By the time they reach the mental health services the illness becomes chronic and the resources are exhausted. It is all the more relevant in countries like India where traditional healing practices are easily accessible in contrary to mental health services. Aims and objectives: The aims and objectives of this study were to measure the number of encounters patients with psychiatric illnesses had before meeting a mental health professional and the duration of untreated illness (DUI). Materials and methods: In this cross-sectional questionnaire-based study, we interviewed 150 patients and their caregivers visiting the outpatient services of a tertiary care teaching hospital in South India. Results: The median time taken for any help, from traditional healers, general hospitals, or a mental health practitioner was 12 months (IQR 2–47.25). The median DUI was 18 months (IQR 2.75–60), and the median total duration of illness was 24 months (IQR 4–87). The mean number of encounters was 2.7 (SD ± 1.77). As the first point of contact, 12% had met a traditional healer and 40% had met a psychiatrist. Friends and relatives in 80% of the patients initiated help-seeking. In multivariate analysis, age, male gender, and lower educational status were significant predictors for a longer duration of illness. Conclusion: Patients in India continue to take a long and tortuous pathway to psychiatric care that goes through many encounters.

  1. Jain N, Gautam S, Jain S, et al. Pathway to psychiatric care in a tertiary mental health facility in Jaipur, India. Asian J Psychiatry 2012;5(4):303–308. DOI: 10.1016/j.ajp.2012.04.003.
  2. Lahariya C, Singhal S, Gupta S, et al. Pathway of care among psychiatric patients attending a mental health institution in central India. Indian J Psychiatry 2010;52(4):333. DOI: 10.4103/0019-5545.74308.
  3. Farooq S, Large M, Nielssen O, et al. The relationship between the duration of untreated psychosis and outcome in low-and-middle income countries: a systematic review and meta analysis. Schizophr Res 2009;109(1–3):15–23. DOI: 10.1016/j.schres.2009.01.008.
  4. Thirthalli J, Channaveerachari NK, Subbakrishna DK, et al. Prospective study of duration of untreated psychosis and outcome of never-treated patients with schizophrenia in India. Indian J Psychiatry 2011;53(4):319. DOI: 10.4103/0019-5545.91905.
  5. Gururaj G, Varghese M, Benegal V, et al. National mental health survey of India, 2015–16: summary. Bengaluru Natl Inst Ment Health Neurosci.
  6. Biswal R, Subudhi C, Acharya SK. Healers and healing practices of mental illness in India: the role of proposed eclectic healing model. J Health Res Rev 2017;4(3):89. DOI: 10.4103/jhrr.jhrr_64_17.
  7. Schoonover J, Lipkin S, Javid M, et al. Perceptions of traditional healing for mental illness in rural Gujarat. Ann Glob Health 2014;80(2):96–102. DOI: 10.1016/j.aogh.2014.04.013.
  8. Kauye F, Udedi M, Mafuta C. Pathway to care for psychiatric patients in a developing country: Malawi. Int J Soc Psychiatry 2015;61(2):121–128. DOI: 10.1177/0020764014537235.
  9. Kurihara T, Kato M, Reverger R, et al. Pathway to psychiatric care in Bali. Psychiatry Clin Neurosci 2006;60:204–210. DOI: 10.1111/j.1440-1819.2006.01487.x.
  10. Ibrahim A, Hor S, Bahar OS, et al. Pathways to psychiatric care for mental disorders: a retrospective study of patients seeking mental health services at a public psychiatric facility in Ghana. Int J Ment Health Syst 2016;10:63. DOI: 10.1186/s13033-016-0095-1.
  11. Gater R, Sousa DBAE, Barrientos G, et al. The pathways to psychiatric care: a cross-cultural study. Psychol Med 1991;21(3):761–774. DOI: 10.1017/s003329170002239x.
  12. Gupta D, Sidana R, Behari M, et al. Help-seeking behavior and pathways to care among patients seeking treatment at a private psychiatric hospital in North India. J Ment Health Hum Behav 2018;23(1):63. DOI: 10.4103/jmhhb.jmhhb_49_17.
  13. Janca A, Chandrashekar CR, World Health Organization. Division of Mental Health. Catalogue of WHO psychiatric assessment instruments/prepared by A. Janca and C. R. Chandrashekar. 1995. Available from:
  14. Population of Puducherry. 2017. Available from: [Accessed October 13, 2018].
  15. Mishra N, Nagpal SS, Chadda RK, et al. Help-seeking behavior of patients with mental health problems visiting a tertiary care center in north India. Indian J Psychiatry 2011;53(3):234. DOI: 10.4103/0019-5545.86814.
  16. Ramasubramanian C, Mohandoss AA, Namasivayam RK. Employability of mentally ill persons in India: a self-report-based population study. Ind Psychiatry J 2016;25(2):171–178. DOI: 10.4103/ipj.ipj_72_16.
  17. Khemani MC, Premarajan KC, Menon V, et al. Pathways to care among patients with severe mental disorders attending a tertiary health-care facility in Puducherry, South India. Indian J Psychiatry 2020;62(6):664. DOI: 10.4103/psychiatry.IndianJPsychiatry_512_19.
  18. Mishra N, Nagpal SS, Chadda RK, et al. Help-seeking behavior of patients with mental health problems visiting a tertiary care center in north India. Indian J Psychiatry 2011;53(3):234–238. DOI: 10.4103/0019-5545.86814.
  19. Chaudhary R, Mishra B. Knowledge and practices of general practitioners regarding psychiatric problems. Ind Psychiatry J 2009;18(1):22. DOI: 10.4103/0972-6748.57853.
  20. Gater R, Jordanova V, Maric N, et al. Pathways to psychiatric care in Eastern Europe. Br J Psychiatry J Ment Sci 2005;186:529–535. DOI: 10.1192/bjp.186.6.529.
  21. Girma E, Tesfaye M. Patterns of treatment seeking behavior for mental illnesses in Southwest Ethiopia: a hospital based study. BMC Psychiatry 2011;11:138. DOI: 10.1186/1471-244X-11-138.
  22. Jeyagurunathan A, Abdin E, Shafie S, et al. Pathways to care among psychiatric outpatients in a tertiary mental health institution in Singapore. Int J Soc Psychiatry 2018;64(6):554–562. DOI: 10.1177/0020764018784632.
  23. Joju S, Simiyon M, Thilakan P, et al. A qualitative analysis of patients’ experiences during their pathway to psychiatric care. Ind J Priv Psychiatry 2019;13(2):37–43. DOI: 10.5005/jp-journals-10067-0046.
  24. Li X, Zhang W, Lin Y, et al. Pathways to psychiatric care of patients from rural regions: a general-hospital-based study. Int J Soc Psychiatry 2014;60(3):280–289. DOI: 10.1177/0020764013485364.
  25. Naik SK, Pattanayak S, Gupta CS, et al. Help-seeking behaviors among caregivers of schizophrenia and other psychotic patients: a hospital-based study in two geographically and culturally distinct Indian cities. Indian J Psychol Med 2012;34(4):338. DOI: 10.4103/0253-7176.108214.
  26. Faizan S, Raveesh B, Ravindra L, et al. Pathways to psychiatric care in South India and their sociodemographic and attitudinal correlates. BMC Proc 2012;6(Suppl. 4):P13, 1753-6561-6-S4-P13. DOI: 10.1186/1753-6561-6-S4-P13.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.