title: A rapid appraisal of access to and utilisation of psychotropic medicines in Bihar, India.
abstract: BACKGROUND
  A major aspect of providing mental healthcare is access to and use of psychotropic medications. Bihar is a state in northeast India with limited mental healthcare provision; consequently access to and utilisation of psychotropic medications are likely to be limited. However, to date there has been no research assessing the situation. This study therefore aims to analyse the psychotropic medications management cycle (selection, procurement, distribution and use), and identify the barriers to access and utilisation, and their underlying causes.
  
  
  METHODS
  A rapid appraisal method was used in which primary and secondary data sources were collected and analysed. Semi-structured interviews were conducted with twenty-two stakeholders and twenty-one service users from the government, non-governmental organisation (NGO) and private sectors. The qualitative data collected was analysed using a comparative thematic approach. The research was supported by the NGOs BasicNeeds and Nav Bharat Jagriti Kendra.
  
  
  RESULTS
  Availability, distance and cost were the main barriers to access and utilisation. At the medical college hospital level a lack of supply appears to be due to a discrepancy between orders made by the hospital and medications supplied by the manufacturers. At the primary health centre and district hospital level the main barrier is a cycle between lack of demand for treatments for mental illness by doctors and patients.
  
  
  CONCLUSIONS
  Further investigation and monitoring is necessary to ensure the availability of psychotropic medications at the medical college hospital level. In addition, implementation of the District Mental Health Programme is likely to address the access and utilisation barriers due to its potential to break the current cycle of lack of demand.
authors: Faculty of Medicine and Health, University of Leeds, Worsley Building, Leeds LS2 9JT, UK.
authors: Prianka
authors: P
authors: Padmanathan
authors: Nav Bharat Jagriti Kendra, Amritnagar, Korrah, Hazaribag 825301, Jharkhand, India.
authors: Manoj
authors: M
authors: Singh
authors: BasicNeeds, 114 4th Cross-, OMBR Layout, Banasawadi, Bangalore 560 043, India.
authors: Saju C
authors: SC
authors: Mannarath
authors: The Nuffield Centre for International Health & Development, Leeds Institute of Health Sciences, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, UK.
authors: Mayeh
authors: M
authors: Omar
authors: BasicNeeds, 114 4th Cross-, OMBR Layout, Banasawadi, Bangalore 560 043, India.
authors: Shoba
authors: S
authors: Raja
keywords: Access; India; LMICS; Low- and middle-income countries; Low-income settings; Psychotropic medicines; Resource-limited settings; Utilisation