Pathways to psychiatric care in Cantabria.

This article delineates the pathways taken in different health areas of Cantabria (Spain) by a series of newly referred patients to the mental health services and explores the influence of sociodemographic, medical and service-related factors on the delays in referral. The work forms part of an ongoing World Health Organization multicentre research programme aimed at exploring and optimizing the quality of mental health care in different centres of the world. We found that, in a rural health area, the majority of newly referred patients establish the first contact with the general practitioner and to a lesser extent with the hospital doctor and from there directly progress to the psychiatric services; in the urban health area there is a greater tendency to contact specialized medical and psychiatric services. Delays in these health areas are remarkably short and are comparable to the ones in other European centres. Our data also show that somatic symptoms are the main presenting problem both at the primary care and at the mental health level; and that, in general, psychotropic drug prescriptions are high both in hospital and in general medical settings, and that women were more often prescribed psychotropic medication than men.

[Factors implicated in the "routes of care" in mental health]. / Factores implicados en las "rutas asistenciales" en salud mental.

We analyze in this paper the way in which different sociodemographic and clinical factors influence, in different health areas of Cantabria (Spain), the pathways taken for patients suffering from "new psychiatric illness". The work is part of a Multicentric International Research Project developed by the World Health Organization aimed at evaluating and improving the quality of mental health care in different centres of the world. The general pathway to mental health services, in Cantabria, is dominated by the general practitioner (54.3%) and by the "hospital doctor/medical specialist" (26.4%), been therefore similar to the one found in other Spanish speaking centres, like Granada and Cuba; the differences are, however, much larger with the one found in Mexico city. It is also, possible to observe in our data that the pathways are influenced by clinical factors, among which the more relevant one is one related to the characteristics of the psychopathology. Thus in general we found that two factors like, the presence of "psycho-organic" syndromes and the severity of the psychopathology appears to influence: i) the degree of complexity of the pathway, which is higher in the "psycho-organic" and in the more severe forms of psychiatric disorders; ii) the protagonist which assumes, in detriment of the general practitioner, other "helping agencies" which is also increased in the "organic" and more severe disorders. We also found that other aspects like: the act of establishing "contact" with services, the delay in the obtention of help, and the prescription of psychotropic medicines, were also influenced by different sociodemographic, clinical and service related variables.

Patterns of psychotropic drug use in a Spanish rural community.

Psychotropic drug use was investigated using a two-stage survey of a random sample of persons aged 17 and over from a rural Spanish community. It was found that 6.9%, 11.8% and 25.1% of the population were consuming psychotropic, analgesic and somatic medicines respectively. Women presented a higher rate of psychotropic use than men (prevalence for women 10.7%, for men 2.6%). This female predominance was found to be significantly related to sociodemographic and medical factors. Psychotropic use was also associated with the physical health of the respondent. The coexistence of physical and mental illness generated an increase of consumption, whereas the absence of both types of illness was associated with a very low rate. The rates for physical and for mental illness alone were intermediate and were almost equal.