title: Pathways and access to mental health care services by persons living with severe mental disorders and epilepsy in Uganda, Liberia and Nepal: a qualitative study.
abstract: Access to mental health care services for patients with neuropsychiatric disorders remains low especially in post-conflict, low and middle income countries. Persons with mental health conditions and epilepsy take many different paths when they access formal and informal care for their conditions. This study conducted across three countries sought to provide preliminary data to inform program development on access to care. It thus sought to assess the different pathways persons with severe mental disorders and epilepsy take when accessing care. It also sought to identify the barriers to accessing care that patients face.
  
  
  
  Six in depth interviews, 27 focus group discussions and 77 key informants' interviews were conducted on a purposively selected sample of health care workers, policy makers, service users and care takers in Uganda, Liberia and Nepal. Data collected along predetermined themes was analysed using Atlas ti software in Uganda and QSR Nvivo 10 in Liberia and Nepal
  
  
  
  Individual's beliefs guide the paths they take when accessing care. Unlike other studies done in this area, majority of the study participants reported the hospital as their main source of care. Whereas traditional healers lie last in the hierarchy in Liberia and Nepal, they come after the hospital as a care option in Uganda. Systemic barriers such as: lack of psychotropic medicines, inadequate mental health specialists and services and negative attitudes of health care workers, family related and community related barriers were reported.
  
  
  
  Access to mental health care services by persons living with severe mental disorders and epilepsy remains low in these three post conflict countries. The reasons contributing to it are multi-faceted ranging from systemic, familial, community and individual. It is imperative that policies and programming address: negative attitudes and stigma from health care workers and community, regular provision of medicines and other supplies, enhancement of health care workers skills. Ultimately reducing the accessibility gap will also require use of expert clients and families to strengthen the treatment coalition.
authors: School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. kisarose@gmail.com.
authors: Rose
authors: R
authors: Kisa
authors: School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
authors: Florence
authors: F
authors: Baingana
authors: Transcultural Psychosocial Organisation- Uganda, P.O. Box 21646, Kampala, Uganda.
authors: Rehema
authors: R
authors: Kajungu
authors: Transcultural Psychosocial Organisation- Uganda, P.O. Box 21646, Kampala, Uganda.
authors: Patrick O
authors: PO
authors: Mangen
authors: Transcultural Psychosocial Organisation- Nepal, P.O.Box 8974/P.O.Box612, Baluwatar, Kathmandu, Nepal.
authors: Mangesh
authors: M
authors: Angdembe
authors: The Carter Center Mental Health Program in Liberia, Monrovia, Liberia.
authors: Wilfred
authors: W
authors: Gwaikolo
authors: The Carter Center Mental Health Program in Liberia, Monrovia, Liberia.
authors: Janice
authors: J
authors: Cooper
mesh_terms: D000328:Adult; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D007988:Liberia; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services; D008875:Middle Aged; D009390:Nepal; D036301:Qualitative Research; D014454:Uganda; D055815:Young Adult
keywords: Access; Pathways to care; Post conflict countries; Qualitative study; Severe mental disorders