title: Pathways to the first contact with specialist mental health care.
abstract: OBJECTIVE
  To examine the pathways to mental health care followed by patients presenting for the first time to community- and hospital-based services and the degree to which individual characteristics, cultural background, illness type, severity and service-related variables influence the time and pathways taken to reach care.
  
  
  METHODS
  One hundred and forty-six consecutive Australian-born, Asian and Arabic-speaking patients making their first lifetime contact with mental health services in two area health regions were included. Symptom severity was assessed using the Health of the Nations Outcome Scales. Illness explanatory models, social support, English-language proficiency and acculturation were also assessed.
  
  
  RESULTS
  An average of three professional consultations were made prior to first contact with public mental health services. Family physicians occupied a pivotal role in the help-seeking pathway with 53% of patients consulting a general practitioner. The median time taken to reach specialist mental health services was 6 months, with significantly shorter time for patients with psychotic disorders. Individual variables such as gender, social support, ethnicity and English fluency were not associated with delays in receiving public mental health care. Ethnicity was associated with lower utilization of allied health professionals.
  
  
  CONCLUSIONS
  The data suggest that social and cultural factors influence the range of professionals consulted by those with a mental illness but do not delay their presentation to public mental health services.
authors.affiliation: Center for Population Mental Health Research, Psychiatry Research & Teaching Unit, Liverpool Hospital, New South Wales, and School of Public Health, University of Sydney, Australia. z.steel@unsw.edu.au
authors.forename: Zachary
authors.initials: Z
authors.lastname: Steel
authors.forename: Robert
authors.initials: R
authors.lastname: McDonald
authors.forename: Derrick
authors.initials: D
authors.lastname: Silove
authors.forename: Adrian
authors.initials: A
authors.lastname: Bauman
authors.forename: Phil
authors.initials: P
authors.lastname: Sandford
authors.forename: Jennifer
authors.initials: J
authors.lastname: Herron
authors.forename: I Harry
authors.initials: IH
authors.lastname: Minas
mesh_terms: D000069:Acculturation; D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002391:Catchment Area, Health; D005194:Family Practice; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011369:Professional-Patient Relations; D011570:Psychiatry; D011586:Psychology, Clinical; D012017:Referral and Consultation; D012944:Social Support; D013997:Time Factors