title: Pathway to psychiatric care in Japan: A multicenter observational study.
abstract: BACKGROUND
  This study examines pathways to psychiatric care in Japan using the same method as the collaborative study carried out in 1991 under the auspices of the World Health Organization.
  
  
  METHODS
  Thirteen psychiatric facilities in Japan were involved. Of the 228 patients who contacted psychiatric facilities with any psychiatric illness, eighty four visiting psychiatric facilities for the first time were enrolled. Pathways to psychiatric care, delays from the onset of illness to treatment prior to reaching psychiatrists were surveyed.
  
  
  RESULTS
  Thirty three patients (39.4%) directly accessed mental health professionals, 32 patients (38.1%) reached them via general hospital, and 13 patients (15.5%) via private practitioners. The patients who consulted mental health professionals as their first carers took a longer time before consulting psychiatrists than the patients who consulted non-mental health professionals as their first carers. The patients who presented somatic symptoms as their main problem experienced longer delay from the onset of illness to psychiatric care than the patients who complained about depressive or anxiety symptoms. Prior to the visit to mental health professionals, patients were rarely informed about their diagnosis and did not receive appropriate treatments from their physicians. Private practitioners were more likely to prescribe psychotropics than physicians in general hospitals, but were less likely to inform their patients of their diagnosis.
  
  
  CONCLUSIONS
  This first pathway to psychiatric care study in Japan demonstrated that referral pathway in Japan heavily relies on medical resources. The study indicates possible fields and gives indications, underlining the importance of improving skills and knowledge that will facilitate the recognition of psychiatric disorders presenting with somatic and depressive symptoms in the general health care system and by private practitioners.
authors.affiliation: Japan Young Psychiatrists Organization Pathway Study Group, Shibuya-ku, Tokyo, Japan. fujisawa@sc.itc.keio.ac.jp
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fujisawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Masamune-Koizumi
authors.forename: Kotaro
authors.initials: K
authors.lastname: Otsuka
authors.forename: Masaru
authors.initials: M
authors.lastname: Tateno
authors.forename: Gaku
authors.initials: G
authors.lastname: Okugawa
authors.forename: Atsuo
authors.initials: A
authors.lastname: Nakagawa
authors.forename: Ryoko
authors.initials: R
authors.lastname: Sato
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kikuchi
authors.forename: Eita
authors.initials: E
authors.lastname: Tonai
authors.forename: Kosuke
authors.initials: K
authors.lastname: Yoshida
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Mori
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Takahashi
authors.forename: Soichiro
authors.initials: S
authors.lastname: Sato
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Igimi
authors.forename: Yoshibumi
authors.initials: Y
authors.lastname: Waseda
authors.forename: Takefumi
authors.initials: T
authors.lastname: Ueno
authors.forename: Ippei
authors.initials: I
authors.lastname: Morokuma
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Takahashi
authors.forename: Norman
authors.initials: N
authors.lastname: Sartorius