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The British Journal of Psychiatry (2005) 186: 529-535
© 2005 The Royal College of Psychiatrists

Pathways to psychiatric care in Eastern Europe

RICHARD GATER, MD, FRCPsych

University of Manchester and Lancashire Care NHS Trust, Preston, UK

VESNA JORDANOVA, MD, MSc

Institute of Psychiatry, Section of Epidemiology, London, UK

NADJA MARIC, MD, PhD

Medical School University of Belgrade, Institute of Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia & Montenegro

VALBONA ALIKAJ, MD

University Hospital Center "Mother Teresa", Clinic of Psychiatry, Tirana, Albania

MAJA BAJS, MD

University Hospital Dubrava, Department of Psychiatry, Zagreb, Croatia

TAMARA CAVIC, MD, PhD

Counselling Department, Institute for Neuropsychiatry "Dr Laza Lazarevic", Belgrade, Serbia & Montenegro

HRISTO DIMITROV, MD

Psychiatric Department, University Hospital "Alexandrovska", Medical University Sofia, Sofia, Bulgaria

DIANA IOSUB, MD

Clinical Hospital of Psychiatry "Al. Obregia", Bucharest, Romania

ADRIANA MIHAI, MD, PhD

University of Medicine and Pharmacy, Tg. Mures, Romania

ANDREEA SILVANA SZALONTAY, MD

Department of Psychiatry and Health Psychology, University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Department of Psychiatry and Health Psychology, University Hospital of Psychiatry "Socola", Iasi, Romania

HANFRIED HELMCHEN, MD

Charite-University Medicine of Berlin, Psychiatric Department, Berlin, Germany

NORMAN SARTORIUS, MD, PhD, FRCPsych

Universities of Prague and Zagreb, and University of London, UK

Correspondence: Dr R. Gater, The Lantern Centre, off Watling Street Road, Fulwood, Preston PR2 8DY, UK. E-mail: richard.a.gater{at}manchester.ac.uk

Declaration of interest None.

Background There has been almost no research into mental health services in Eastern Europe. A pathways study is a quick and useful starting point, requiring few resources.

Aims To improve understanding of prior care-seeking and treatment of new patients seen at mental health services.

Method Pathways diagrams were drawn showing the routes of care-seeking for 50 new patients in eight centres. Patterns of care-seeking, durations and previous treatments were compared for ICD-10 diagnostic groups.

Results The diagnoses varied according to the organisation of services. Major pathways included general practitioners, direct access and hospital doctors. General practitioners have a limited role as ‘gatekeeper’ in centres in Albania, Croatia, Macedonia, Romania and Serbia-Montenegro, and rarely prescribed treatment, except sedatives, for mental disorders.

Conclusions Findings highlight areas that require attention if aspirations for community-oriented mental health care are to be realised, particularly integration of mental health into primary care.




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