title: Factors influencing access to psychiatric treatment in persons with schizophrenia: A qualitative study in a rural community.
abstract: OBJECTIVE
  In low and middle-income countries, about 80% of those who need mental health services do not receive them. Reasons for this have not been systematically studied. In this qualitative study, we explored this issue in a rural community of South India among schizophrenia patients.
  
  
  METHODS
  Patients who had never sought psychiatric treatment despite long-standing psychotic illnesses were identified as part of a community intervention program. In-depth interviews were conducted with patients' caregivers to understand factors preventing them seeking psychiatric treatment. Interviews were audio-recorded and transcribed. Reasons cited by family members were listed and grouped into factors based on themes. Interview process was iteratively followed till no new factor emerged. Sixteen caregivers were thus interviewed.
  
  
  RESULTS
  Content analysis brought out 75 reasons, which were further grouped under the following 15 factors [n (%)]: Lack of awareness about the illness: 15 (93.75%); lack of family support: Nine (56.25%); religious attributions: Nine (56.25%); financial constraints: Six (37.5%); family dynamics: Seven (43.75%); family's tolerance: Seven (43.75%); lack of insight: Five (31.25%); families resilience: Four (25.0%); community beliefs regarding mental illnesses: Four (25%), and others. In each patient, a complex interplay of several of these factors precluded the family from seeking psychiatric treatment.
  
  
  CONCLUSIONS
  In addition to the well-known factors, many hitherto less-understood factors (e.g., families' conflicts, dynamics, resilience and acceptance, and community support, etc.) were identified which prevented patients and their families from seeking treatment. These findings have important policy implications.
authors.affiliation: Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Shanivaram Krishnareddy
authors.initials: SK
authors.lastname: Reddy
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Jagadisha
authors.initials: J
authors.lastname: Thirthalli
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Naveen Kumar
authors.initials: NK
authors.lastname: Channaveerachari
authors.affiliation: Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Krishna Najareddy
authors.initials: KN
authors.lastname: Reddy
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Renukadevi Neralur
authors.initials: RN
authors.lastname: Ramareddy
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Vikram Singh
authors.initials: VS
authors.lastname: Rawat
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Manjunatha
authors.initials: M
authors.lastname: Narayana
authors.affiliation: Department of Mental Health Education, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Jayashree
authors.initials: J
authors.lastname: Ramkrishna
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Bangalore Nanjundayya
authors.initials: BN
authors.lastname: Gangadhar
keywords: Factors; qualitative study; rural community; schizophrenia; treatment access