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Pathways to psychiatric care in Ethiopia

Published online by Cambridge University Press:  08 July 2008

Y. Y. Bekele ,
A. J. Flisher ,
A. Alem  and
Y. Baheretebeb
Y. Y. Bekele*
Affiliation:
Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa Department of Psychiatry, Faculty of Medicine, Addis Ababa University, Ethiopia
A. J. Flisher
Affiliation:
Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa Research Centre for Health Promotion, University of Bergen, Norway
A. Alem
Affiliation:
Department of Psychiatry, Faculty of Medicine, Addis Ababa University, Ethiopia
Y. Baheretebeb
Affiliation:
Department of Psychiatry, Faculty of Medicine, Addis Ababa University, Ethiopia
*
*Address for correspondence: Dr Y. Y. Bekele, M.D., F.C.Psych (SA), M.Med (Psych), Whitby Mental Health Centre, 700 Gordon Street, Whitby, Ontario, L1N 5S9, Canada. (Email: [email protected])
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Abstract

Background

Understanding the pathways to psychiatric care and recognition of delay points are crucial for the development of interventions that aim to improve access to mental health-care services.

Method

Over a 2-month period in 2003, a total of 1044 patients at the commencement of new episodes of care at Amanuel Specialized Mental Hospital in Addis Ababa, Ethiopia were interviewed using the encounter form that was developed by the World Health Organization (WHO) for the study of pathways to psychiatric care.

Results

The mental hospital was contacted directly by 41% of patients. The remaining patients sought care from up to four different caregivers before arriving at the psychiatric hospital. Where the initial service was not received at the psychiatric hospital, 30.9% of patients sought care from priests/holy water/church. The median delay between onset of illness and arrival at the psychiatric hospital was 38 weeks. The longest delays before arriving at the mental hospital were associated with having no formal education, joblessness, and diagnoses of epilepsy and physical conditions.

Conclusions

Implementing a robust referral system and establishing a strong working relationship with both traditional and modern health-care providers, as well as designing a service delivery model that targets particular segments of the population, such as those who are uneducated, jobless and/or suffer from epilepsy and somatic conditions, should be the most important strategies towards improving mental health service delivery and shortening of undue delay for patients receiving psychiatric care in Ethiopia.

Keywords

Ethiopiahelp-seeking behaviourpathway to carepsychiatric services
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 3 , March 2009 , pp. 475 - 483
Copyright
Copyright © 2008 Cambridge University Press

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References

Abiodun, OA (1995). Pathway to mental health care in Nigeria. Psychiatric Services 46, 823–826.Google ScholarPubMed
Al-Jaddou, H, Malkawi, A (1997). Prevalence, recognition and management of mental disorders in primary health care in Northern Jordan. Acta Psychiatrica Scandinavica 1, 31–35.CrossRefGoogle Scholar
Alem, A, Jacobsson, L, Argaw, M (1993). Traditional perceptions and treatment of mental disorders in central Ethiopia. In Yearbook of Cross-Cultural Medicine and Psychotherapy, pp. 105–119. VWB: Berlin.Google Scholar
Amaddeo, F, Zambello, F, Tansella, M, Thornicroft, G (2001). Accessibility and pathways to psychiatric care in a community-based mental health system. Social Psychiatry and Psychiatric Epidemiology 36, 500–507.CrossRefGoogle Scholar
Araya, M, Aboud, FE (1993). Mental illness. In The Ecology of Health and Diseases in Ethiopia (ed. Kloos, H. and Zein, Z. A.), pp. 493–506. Westview Press: Boulder, CO.Google Scholar
Balestrieri, M, Bon, MG, Rodriguez-Sacristan, A, Tansella, M (1994). Pathways to psychiatric care in South Verona, Italy. Psychological Medicine 24, 641–649.CrossRefGoogle ScholarPubMed
CSA (1999). The 1994 Population and Housing Census of Ethiopia: Results of Country Level. Vol. II. Analytical Report. Central Statistical Authority: Addis Ababa, Ethiopia.Google Scholar
Gater, R, De Almeida, E, Sousa, B, Barrientos, G, Caraveo, J, Chandrashekar, CR, Dhadphale, M, Goldberg, D, Al Kathiri, AH, Mubbashar, M, Silhan, K, Thong, D, Torres-Gonzales, F, Sartorious, N (1991). The pathways to psychiatric care: a cross-cultural study. Psychological Medicine 21, 761–774.CrossRefGoogle Scholar
Gater, R, Goldberg, D (1991). Pathways to psychiatric care in South Manchester. British Journal of Psychiatry 159, 90–96.CrossRefGoogle ScholarPubMed
Giel, R, Gezahegn, Y, Van Luijk, JN (1968 a). Faith healing and spirit possession in Ghion Ethiopia. Social Science and Medicine 2, 63–79.CrossRefGoogle ScholarPubMed
Giel, R, Gezahegn, Y, Van Luijk, JN (1968 b). Psychiatric morbidity in 200 Ethiopian medical outpatients. Psychiatria, Neurologia, Neurochirurgia 71, 169–176.Google ScholarPubMed
Goldberg, D, Huxley, P (1980). Mental Illness in the Community: The Pathways to Psychiatric Care. Tavistock: London.Google Scholar
Harding, TW, De Arango, MV, Baltazar, J, Climent, CE, Ibrahim, HHA, Ladrido-Ignacio, L, Srinivasa Murthy, R, Wig, NN (1980). Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychological Medicine 10, 231–241.CrossRefGoogle ScholarPubMed
Kebede, D, Alem, A, Shibre, T, Negash, A, Fekadu, A, Fekadu, D, Deyessa, N, Jacobsson, L, Kullgren, G (2003). Onset and clinical course of schizophrenia in Butajira, Ethiopia. Social Psychiatry and Psychiatric Epidemiology 38, 625–631.CrossRefGoogle ScholarPubMed
Kilic, C, Rezaki, M, Ustun, TB, Gater, R (1994). Pathways to psychiatric care in Ankara. Social Psychiatry and Psychiatric Epidemiology 29, 131–136.CrossRefGoogle ScholarPubMed
Pradhan, SC, Singh, MM, Singh, RA, Das, J, Ram, D, Patil, B, Jain, AK, Thomas, JK (2001). First care givers of mentally ill patients: a multi-centre study. Indian Journal of Medical Science 55, 203–208.Google Scholar
Razali, SM, Najib, MA (2000). Help-seeking pathways among Malay psychiatric patients. International Journal of Social Psychiatry 46, 281–289.CrossRefGoogle ScholarPubMed
Reeler, AP (1992). Pathways to psychiatric care in Harare, Zimbabwe. Central African Journal of Medicine 38, 1–7.Google ScholarPubMed
Shiber, A, Maoz, B, Antonovsky, H (1990). Detection of emotional problems in the primary care clinic. Family Practice 3, 195–200.CrossRefGoogle Scholar
Vazquez-Baraquero, JL, Herrera Castanedo, S, Artal, JA, Cuesta Nunez, J, Gaite, L, Goldberg, D, Sartorius, N (1993). Pathways to psychiatric care in Cantabria. Acta Psychiatrica Scandinavica 88, 229–234.CrossRefGoogle Scholar
Vecchiato, NL (1993). Traditional medicine. In The Ecology of Health and Disease in Ethiopia (ed. Kloos, H. and Zein, Z. A.), pp. 157–178. Westview Press: Boulder, CO.Google Scholar