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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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