The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.
Pathways to care for patients with bipolar disorder
Article first published online: 17 MAY 2005
Volume 7, Issue 3, pages 236–245, June 2005
How to Cite
Bhugra, D. and Flick, G. R. (2005), Pathways to care for patients with bipolar disorder. Bipolar Disorders, 7: 236–245. doi: 10.1111/j.1399-5618.2005.00202.x
- Issue published online: 17 MAY 2005
- Article first published online: 17 MAY 2005
- Received 1 July 2004, revised and accepted for publication 18 February 2005
- barriers to access;
- bipolar disorder;
- mental health care
Bipolar disorder is a chronic, debilitating psychiatric illness with serious ramifications for patients, their families, and society. Despite the availability of effective treatments, this disease often goes untreated due to medical, financial, legal/governmental, and cultural barriers. In this review we explore possible reasons for this problem. Misdiagnosis of bipolar disorders is a common medical barrier. One pathway to care for individuals with bipolar disorder is through referral from primary care, but primary care physicians generally have not received special training in the recognition and management of bipolar disorder. This often leads to diagnostic delays or errors, which prevents timely ‘filtering’ of patients into specialized care. Using data bases we explored these pathways. Legislation in the USA, such as the Emergency Medical Treatment and Active Labor Act (EMTALA), designed to ensure access to inpatient mental health care, has instead given hospitals financial incentives to limit inpatient mental health care capacities. Reimbursement of mental health care expenses is a significant issue impacting a patient's ability to gain access to care, as bipolar disorder is a costly disease to treat. Improving access to care among the bipolar community will require multilateral strategies to influence the actions and attitudes of patients, communities, providers, health care systems, and state/national governments. In other cultures, barriers to care differ according to a number of factors such as type of services, explanatory models of illness, misdiagnosis and perceptions of care givers. It is essential that clinicians are aware of pathways and barriers so that appropriate and accessible care can be provided.