Pathway to care for psychiatric patients in a developing country: Malawi

Background: Paramedics dominate primary health care in Malawi where native healers also play a major role in the provision of health care and psychiatric nurses are the backbone of district mental health services. Aim: The aim is to improve understanding of prior care-seeking and treatment of new patients seen at mental health services in a developing country like Malawi. Method: For one calendar month, 128 newly referred patients to the mental health services in the three psychiatric units in Malawi were interviewed using an encounter form. Results: Most of the patients went through a first carer before attending a psychiatric unit with only 11.7% going straight to a psychiatric unit. All patients who went straight to a psychiatric unit involved the private/Christian Health Association of Malawi (CHAM) unit in the northern region of Malawi. About 22.7% of the patients had a native healer as a first carer. Only 23% of all patients seen went through a second carer, with none going through a third carer. Over 8% of those who had a paramedic as their first carer had a native healer as their second carer. Duration of stay at different carers varied a lot with about half (48.2%) of all patients who saw a native healer as the first carer spending more than 2 weeks before referral while about 67.0% of those who saw convectional health workers spent 3 days or less before referral. Conclusion: The pathway to care for patients with psychological problems in Malawi is not very much different to pathways to care in other developing countries whereby native healers and paramedics play a significant role. With the high proportion of patients being seen by native healers and the fact that most patients stay longer at native healers before referral, there is need for official collaboration and training of native healers on mental health.