Trends in the use of outpatient psychiatric services in the republic of Georgia

For a long time, in Georgia, as in most eastern European and post-soviet countries, mental health services have been mainly ran in large institutions with restricted financial and professional resources. In 2010, Ministry of Health and Social Affairs of Georgia declared the reforms in mental health care system. The ongoing reforms are actively supported by many international organizations, but there still some local and cultural barriers that should be carefully analyzed. The study aimed to identify factors affecting referral to the outpatient mental health services and to describe the trends of common therapeutic interventions. The cases of patients who referred to the outpatient mental health services during one year in 2011-12 have been studied. Investigation the trends of referral to outpatient psychiatric services in Georgia showed that patients with severe and chronic psychosis less likely apply to outpatient psychiatric services. In most of the cases they come for single consultation and revealed significant problems in treatment adherence. Patients from remote areas prefer to visit central outpatient clinic, rather than go to their local, free of charge facilities. The main reasons of referral appeared behavioural (hyperactivity, retardation) and emotional problems (depression, anxiety). Due to insufficient legislative and financial support patients could not receive psychological treatments. The treatment outcome significantly depends on treatment compliance and level of education. Educated patients were much more disciplined in keeping their prescription and appointments. The additional effort need to be focused on improving patients' attitude toward local psychiatric services and enhancing coordination between in and outpatient mental health services.