Pathways to care for first psychiatric admissions in Lisbon

Objectives: This report characterizes pathways to first psychiatric admission and describes their relationship to patients' sociodemographic and clinical features. Methods: Eighty-four patients consecutively admitted for the first time in 2009-2010 to a Lisbon district psychiatric department were interviewed. Associations between pathways and clinical and sociodemographic variables were explored through univariate and multivariate analysis. Results: Most patients (N=49, 58%) went directly to the psychiatric emergency department and were admitted, without contacting anyother care providers. This pathwaywas significantly associated with male gender, involuntary admission, referral by a family member, fewer people per room in the household, and lower probability of previous contact with mental health services. Conclusions: The most striking feature was the high prevalence of direct access to the psychiatric emergency department with subsequent admission. Use of this direct pathway suggests that these patients were bypassing care filters, with negative consequences. Specific sociodemographic variables, but not diagnosis, were associated with filter bypass.