Barriers to care among people with schizophrenia attending a tertiary psychiatric hospital in Nigeria

Abstract

BackgroundIndividuals with schizophrenia in low- and middle-income countries and their caregivers face multiple barriers to care-seeking and continuous engagement with treatment services. Identifying specific barrier patterns would aid targeted interventions aimed at improving treatment access.AimThe aim of this study was to determine stigma- and non-stigma-related barriers to care-seeking among persons with schizophrenia in Nigeria.SettingThis study was conducted at the Outpatient Clinics of the Federal Neuro-Psychiatric Hospital, Benin City, Nigeria.MethodsA cross-sectional study of a dyad of persons with schizophrenia and caregivers (n = 161) attending outpatient services at a neuro-psychiatric hospital in Nigeria. Stigma- and non-stigma-related barriers were assessed using the 30-item Barriers to Access to Care Evaluation (BACE) scale.ResultsLack of insight, preference for alternative care, illness severity and financial constraints were common barriers to care-seeking among persons with schizophrenia. Females were significantly more likely to report greater overall treatment barrier (p < 0.01) and stigma-related barriers (p < 0.02).ConclusionThis study shows that attitudinal barriers impede care access and engagement among persons with schizophrenia in Nigeria.

Key Barriers to the Provision and Utilization of Mental Health Services in Low-and Middle-Income Countries: A Scope Study

“…B-2-2-Location, distance and transportation barriers: the findings revealed that challenges related to the transportation and location of existing MH services were the second structural barrier to the utilization of services in many LMICs. This problem is more dominant in the remote and real areas of these countries(13,17,18,23,25,44,47,49,54). B-2-3-Lack of family or social support: we found that shortage of support from others is a deterrent factor against utilization of MH services in some developing countries.…”

“…B-1-5-Willingness to take alternative forms of care: the results demonstrated that patients' preferences for alternative types of treatment is an attitudinal barrier to the utilization of formal MH services. Seeking help from religious and traditional healers is a prevalent issue in many LMICs that prevents patients from utilization of existing MH services (18,23,31,33,49).…”

“…B-1-7-Patients' self-reliance: this study showed that because of previous negative experiences or due to the concerns about stigma, patients prefer to handle their problem on own or may decide to wait for the disease to get better by itself (17,18,49).…”

“…On the other hand, some patients need support for emotional relief which is known as "implicit support" (53). Finally, patients with severe illnesses need someone to help them get professional care (18,49). In order to reduce these problems some strategies such as providing financial grant for poor families (23), improving peer support programs (53), as well as expanding adequate and community-based MH services (45) are suggested.…”

“…Long waiting times at out-patient facilities and hospitals may persuade some patients to give up treatments (44). Another challenge is problem with taking time off work or home responsibilities for employees and housekeepers (18,42,49). Transportation time is another time-related barrier that prevent access to MH services.…”