title: Pathways to psychiatric care in Ethiopia.
abstract: BACKGROUND
  Understanding the pathways to psychiatric care and recognition of delay points are crucial for the development of interventions that aim to improve access to mental health-care services.
  
  
  METHODS
  Over a 2-month period in 2003, a total of 1044 patients at the commencement of new episodes of care at Amanuel Specialized Mental Hospital in Addis Ababa, Ethiopia were interviewed using the encounter form that was developed by the World Health Organization (WHO) for the study of pathways to psychiatric care.
  
  
  RESULTS
  The mental hospital was contacted directly by 41% of patients. The remaining patients sought care from up to four different caregivers before arriving at the psychiatric hospital. Where the initial service was not received at the psychiatric hospital, 30.9% of patients sought care from priests/holy water/church. The median delay between onset of illness and arrival at the psychiatric hospital was 38 weeks. The longest delays before arriving at the mental hospital were associated with having no formal education, joblessness, and diagnoses of epilepsy and physical conditions.
  
  
  CONCLUSIONS
  Implementing a robust referral system and establishing a strong working relationship with both traditional and modern health-care providers, as well as designing a service delivery model that targets particular segments of the population, such as those who are uneducated, jobless and/or suffer from epilepsy and somatic conditions, should be the most important strategies towards improving mental health service delivery and shortening of undue delay for patients receiving psychiatric care in Ethiopia.
authors.affiliation: Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa. yilma_yitayew@yahoo.com
authors.forename: Y Y
authors.initials: YY
authors.lastname: Bekele
authors.forename: A J
authors.initials: AJ
authors.lastname: Flisher
authors.forename: A
authors.initials: A
authors.lastname: Alem
authors.forename: Y
authors.initials: Y
authors.lastname: Baheretebeb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044383:Black People; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D005002:Ethiopia / Q000208:ethnology; D005260:Female; D019538:Health Care Surveys; D006778:Hospitals, Psychiatric / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D016488:Medicine, African Traditional; D001523:Mental Disorders / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy*; D008875:Middle Aged; D017146:Models, Organizational; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012017:Referral and Consultation; D013997:Time Factors