Dual diagnosis and their care pathways for help-seeking: A multicenter study from India

Area of Science:

• Dual Diagnosis (DD) Care Pathways
• Mental Health Services Research
• Substance Use Disorder (SUD) Treatment

Background:

• Understanding care pathways is crucial for organizing dual diagnosis (DD) services.
• Facilitating training and referral across healthcare sectors is essential for effective DD care.
• Characterizing patient journeys helps identify gaps and opportunities in DD treatment.

Purpose of the Study:

• To characterize stepwise healthcare and other contacts for patients with DD.
• To compare first contact characteristics for common mental disorder (CMD) vs. severe mental illness (SMI).
• To estimate the likelihood of receiving appropriate DD treatment across different contact levels.

Main Methods:

• Cross-sectional, descriptive study in eight Indian centers (April 2022 - February 2023).
• Included 589 newly enrolled patients with DD.
• Utilized the WHO Pathways Encounter Form to categorize healthcare contacts.

Main Results:

• Median age 32 years, 96% males; Alcohol was the most common substance.
• SMI and CMD were equally represented (50.8%).
• Traditional healers were a common first contact (18.5%), but integrated DD care dominated later contacts.
• Assistance likelihood increased significantly from first (23.1%) to second (62.1%) and fifth (97.4%) contacts.
• CMD patients initially sought help for SUD symptoms from general hospitals/private practitioners; SMI patients sought help for psychiatric symptoms from relatives/traditional healers.

Conclusions:

• Recognizing cultural nuances is vital for effective DD care.
• Advocating for integrated care models can bridge treatment gaps.
• Addressing systemic challenges is necessary to improve DD service delivery.