Abstract
BackgroundAlthough access to specialized services is one of the main components of the study of paths to mental health care worldwide, the factors related to the continuity of the patient’s link with Primary Care after admission to a Specialized Mental Health Services still need to be explored in greater depth. Thus, this study aimed to evaluate the determinants of timely access to Specialized Mental Health Services (outcome 1) and maintenance of a link with Primary Care after patients’ admission (outcome 2).MethodsThis is a cross-sectional study, conducted with 341 users of Specialized Mental Health Services at outpatient and community level in a medium-sized city in Brazil between August and November 2019. Associations between the outcomes and the other variables were explored with the use of Poisson regression models with robust variance estimators.ResultsFactors positively associated with timely access were the diagnosis of psychosis or psychoactive substance misuse. The inversely associated factors with this outcome were higher income, having their need for mental health care identified in an appointment for general complaints, having been referred to the current service by Primary Care, having attended the current service for up to 3 years and delay until the first appointment (in a previous service). Regarding the maintenance of a link with Primary Care, factors positively associated were being referred to the current service by Primary Care or private service and receiving visits from Community Health Agents. The inversely associated factors with this outcome were male sex, being employed, having a diagnosis of psychosis or psychoactive substance misuse, and a greater perception of social support.ConclusionsIn addition to individual factors, factors related to the organization of services and the referral between them stood out in influencing both the access and maintenance of the patients’ link with Primary Care. Thus, this study reinforces the idea that integration between Primary Care and Specialized Mental Health Services should be strengthened, both to reduce waiting times for between-service referrals and benefit of care continuity.
Highlights
Access to specialized services is one of the main components of the study of paths to mental health care worldwide, the factors related to the continuity of the patient’s link with Primary Care after admission to a Specialized Mental Health Services still need to be explored in greater depth
Characterization of participants A total of 341 users of Specialized Mental Health Services answered the questionnaire of our study, of which 33.7% (n = 115) were from Psychosocial Care Center II (PCC-II), 34.0% (n =116) were from Psychosocial Care Center for Psychoactive Substance Misuse (PCC-PSM), and 32.3% were from the Outpatient Clinic
The prevalence of timely care in Specialized Mental Health Services was 60.0%
Summary
Access to specialized services is one of the main components of the study of paths to mental health care worldwide, the factors related to the continuity of the patient’s link with Primary Care after admission to a Specialized Mental Health Services still need to be explored in greater depth. This study aimed to evaluate the determinants of timely access to Specialized Mental Health Services (outcome 1) and maintenance of a link with Primary Care after patients’ admission (outcome 2). Data obtained by pathways to mental health care studies may play a crucial role in formulating mental health policies and in the organization of psychiatric services [2]. This type of study is still emerging in low and middle-income countries, especially in Latin America. As observed in other countries, there is still an important treatment gap, with the lack of trained professionals to provide mental health care in Primary Care and the low integration with the mental health network being the main challenges [7]
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