Pathways to psychiatric care in Ankara.

This paper describes the pathways that patients take to reach psychiatric services in Ankara. A total of 582 patients were seen in a calendar month in seven centres, two of them being child psychiatric clinics. The pathway in Ankara, unlike may other centres in Europe, is dominated by direct referrals. Only 4% of patients in our sample contacted their general practitioner (GP) first, compared with 42% who first saw hospital doctors and 53% who came direct. Religious healers appeared in the pathway of only 1% of patients, and the delay associated with them was longer. Male patients had longer delays than female patients, and delays were also longer for patients presenting with somatic symptoms. Although the availability of psychiatric services is limited, the median time taken to be seen by the psychiatric services after contacting any carer was only 1 week. The results showed that the referral system for the mental health services is still far from a GP-based system. The patients presenting with somatic symptoms consulted hospital doctors more frequently and were delayed more, pointing to the need for the training of hospital doctors, in addition to GPs, in the recognition and management of common psychiatric disorders.