Pathway to psychiatric care in Bali

The aim of the present study was to trace the help-seeking pathway of mental patients and to elucidate the role of traditional healing in Bali. The source of care before attending Bangli Mental Hospital (Bali) of 54 consecutive patients with no prior psychiatric treatment was investigated. Subjects who had sought help from traditional healers were asked to evaluate treatment effect retrospectively according to a 5-point scale. The pathway to psychiatric care was dominated by traditional healers. Of the patients, 47 (87.0%) consulted a healer (mean number 2.9) before visiting the mental hospital. Consultation with the healers was associated with treatment delay. However, of the 137 traditional healers on the pathway, 11 (8.0%) recommended that the subjects to go to a mental hospital, and all 11 subjects immediately followed the advice. Of the 47 subjects, 14 (29.8%) evaluated the treatment effect as much improved by at least one traditional healer on the pathway, although they ultimately attended the mental hospital. Subjects without psychotic symptoms tended to evaluate the treatment effect as much improved more often than psychotic subjects. Traditional healers function not only as a barrier to reaching psychiatric care, but as either an effective provider of care or a decision-making support for seeking help from psychiatric care for some mental patients in Bali. The knowledge and recognition of psychological disorders by the traditional healers are crucial for early treatment intervention for psychiatric patients.