Distance and affordability as barriers to accessing mental health services for poor living in slums of Karachi: Findings from a mixed-methods study

Background & Purpose The mental disorders contribute 12% to the global burden of disease affecting 25% of a global population and have emerged as a major challenge for developing countries in the SDGs era. Our study explored... [ view full abstract ]

Background & Purpose
The mental disorders contribute 12% to the global burden of disease affecting 25% of a global population and have emerged as a major challenge for developing countries in the SDGs era. Our study explored access, cost & consequences of limited accessibility to mental health services in terms of caregiving for the mentally ill in the urban communities.

Methods
A sequential mixed-methods study was conducted in the slums of Karachi from July – September 2015 using purposive sampling. The cross-sectional survey explored the service utilization patterns and costs of accessing mental health services. The qualitative inquiry (FGDs and interviews) explored the determinants of reduced access and reasons behind preference for not-for-profit NGO set up compared to public and private sectors.

Results
Out of 115, around 90% patients accessed the NGO services in past 3 months with almost all having switched from public sector services. Only 31% earned regularly with two-thirds earning less than 5000 Pakistan Rupee a month. As for caregivers, 53% considered the overall treatment costs as high and non-affordable, whereas, at least 70% considered the expenses incurred in separate cost components (consultation fee, medicines, and travel) as high. More than 50% preferred the NGO set up over public and private sectors (21% each) and cited easy accessibility (96.5%) and availability of low-cost medicines (84%) as a reason for continuing the treatment and preferring the NGO services. The qualitative inquiry augmented these findings with all the stakeholders agreeing the cost of transport and medicines as limiting factors for the poor in terms of accessibility. This coupled with persistent poverty negatively affected the prognosis and quality of caregiving.

Conclusions
The limited accessibility and unavailability of cost-effective and affordable services for poor result in compromised quality of care and health outcomes as well as less than optimal services utilization.