British Journal of Psychiatry, 186(6), June 2005, pp.529-535.
Publisher:
Cambridge University Press
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. The aim was to improve understanding of prior care-seeking and treatment of new patients seen at mental health services. 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. 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. 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.
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. The aim was to improve understanding of prior care-seeking and treatment of new patients seen at mental health services. 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. 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. 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.
Subject terms:
medical treatment, medication, mental health problems, psychiatric care, primary care, doctors;
Content type:
research
Location(s):
Albania, Croatia, Macedonia, Romania, Serbia and Montenegro
British Journal of Psychiatry, 183(12), December 2003, pp.540-546.
Publisher:
Cambridge University Press
In war-affected societies it is assumed that the major mental health problem facing the population will be stress reactions. The aim was to describe the creation of a child and adolescent mental health service (CAMHS) in Kosovo after the military conflict ended in 1999, and to establish the range of problems and diagnoses that presented. Data were collected on 559 patients over 2 years, including their referring problems and diagnoses. Stress-related disorders constituted only a fifth of the case-load in year 1. A substantial number of patients were symptom-free but attended because they had been exposed to a traumatic event, and believed it might make them ill. Non-organic enuresis and learning disability were the most common diagnoses in year 2. Many patients had a complex mix of social and psychological difficulties that did not fit conventional diagnostic categories. Mental health services that only address traumatic stress may fail to meet the needs of war-affected children. A comprehensive, culturally appropriate CAMHS is needed to address a wide range of problems including learning disability. It should be developed through local actors, and build on existing local infrastructure. Services can also have an educational role in 'depathologising' normative responses.
In war-affected societies it is assumed that the major mental health problem facing the population will be stress reactions. The aim was to describe the creation of a child and adolescent mental health service (CAMHS) in Kosovo after the military conflict ended in 1999, and to establish the range of problems and diagnoses that presented. Data were collected on 559 patients over 2 years, including their referring problems and diagnoses. Stress-related disorders constituted only a fifth of the case-load in year 1. A substantial number of patients were symptom-free but attended because they had been exposed to a traumatic event, and believed it might make them ill. Non-organic enuresis and learning disability were the most common diagnoses in year 2. Many patients had a complex mix of social and psychological difficulties that did not fit conventional diagnostic categories. Mental health services that only address traumatic stress may fail to meet the needs of war-affected children. A comprehensive, culturally appropriate CAMHS is needed to address a wide range of problems including learning disability. It should be developed through local actors, and build on existing local infrastructure. Services can also have an educational role in 'depathologising' normative responses.
Subject terms:
learning disabilities, mental health problems, mental health services, psychiatry, severe learning disabilities, traumas, war, child and adolescent mental health services, children, children in need, community mental health teams, diagnosis;