[Factors implicated in the "routes of care" in mental health]

We analyze in this paper the way in which different sociodemographic and clinical factors influence, in different health areas of Cantabria (Spain), the pathways taken for patients suffering from "new psychiatric illness". The work is part of a Multicentric International Research Project developed by the World Health Organization aimed at evaluating and improving the quality of mental health care in different centres of the world. The general pathway to mental health services, in Cantabria, is dominated by the general practitioner (54.3%) and by the "hospital doctor/medical specialist" (26.4%), been therefore similar to the one found in other Spanish speaking centres, like Granada and Cuba; the differences are, however, much larger with the one found in Mexico city. It is also, possible to observe in our data that the pathways are influenced by clinical factors, among which the more relevant one is one related to the characteristics of the psychopathology. Thus in general we found that two factors like, the presence of "psycho-organic" syndromes and the severity of the psychopathology appears to influence: i) the degree of complexity of the pathway, which is higher in the "psycho-organic" and in the more severe forms of psychiatric disorders; ii) the protagonist which assumes, in detriment of the general practitioner, other "helping agencies" which is also increased in the "organic" and more severe disorders. We also found that other aspects like: the act of establishing "contact" with services, the delay in the obtention of help, and the prescription of psychotropic medicines, were also influenced by different sociodemographic, clinical and service related variables.