A systematic review of care pathways for psychosis in low-and middle-income countries

Pathways to care for psychosis in high-income countries have been well studied, with the finding of an association between longer duration of untreated psychosis (DUP) and poorer outcomes focusing interest on care pathways to minimise treatment delay. Little is known about how people with psychosis in low-to middle-income countries (LMIC) present for help and specific care pathways that might be associated with treatment delays in those contexts. We conducted a systematic review using electronic databases (MEDLINE, PsychINFO, Embase, Ovid) to explore what proportion of patients with psychosis in LMIC are accessing care through traditional healers and whether this is associated with treatment delay. Studies were included if they assessed the pathway to care for participants with a psychotic illness in a LMIC. From 3929 results, 15 studies met our inclusion criteria. In 7 out of 15 studies first contact for the majority of patients were traditional health practitioners (THPs). In 5 out of 15 studies, mental health practitioners (MHPs) were most often the initial care pathway and in 3 studies first contact was with primary care. DUP ranged from a mean of 30 weeks to 225 weeks. Accessing THPs as initial contact was associated with a longer DUP. In LMICs, a large proportion of patients use THP as their first point of contact for accessing care. This is associated with longer DUP. Services in these countries need to focus both on raising public awareness and collaborative working with THPs to facilitate access to biomedical care

Development of adolescent mental health services in Sri Lanka

Sri Lanka has faced two major catastrophes in recent history: the civil war (1983–2009) and the tsunami (2004). Furthermore, there is a continuously changing socioeconomic situation which is becoming ever more challenging. Nearly a quarter of the Sri Lankan population is a youth or adolescent, and this age group is particularly vulnerable to adversity. Over the past decade Sri Lanka has acknowledged the need to support these young people and embarked on developing adolescent mental health services, but they require further expansion. This article provides a critical review of the state of current adolescent mental health services in our country and makes suggestions for improvement