The online version of this article (doi:10.1186/1752-4458-8-29) contains supplementary material, which is available to authorized users.
Financial competing interests: none to declare. Non-financial competing interests: BasicNeeds and Nav Bharat Jagriti Kendra are non-governmental organisations which advocate for improvements to mental healthcare.
PP prepared the study protocol, obtained funding and ethical approval, collected and analysed the data and drafted the manuscript. MS coordinated the data collection and was involved in revising the manuscript. SM helped with attempts to obtain ethical approval in India, participated in designing the study and was involved in revising the manuscript. MO helped to obtain ethical approval in the United Kingdom and was involved in revising the manuscript. SR conceived and helped design the study and was involved in revising the manuscript. All authors have read and approved the final manuscript.
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.
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.
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.
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.
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- A rapid appraisal of access to and utilisation of psychotropic medicines in Bihar, India
Saju C Mannarath
- BioMed Central
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