Objective: The aim of the study is to determine the pathways to care of children and adolescents with mental disorders between initial symptom recognition and psychiatric consultation and to examine the demographic and clinical factors influencing access to care. Methods: This is cross-sectional analytic study that entailed interview and/ or review of charts of children and adolescents with mental disorders evaluated at the Child Psychiatry section, Child Neuroscience Division of the Philippine Children's Medical Center from January 2002 to March 2006. Kruskal-Wallis Test and Mann-Whitney U Test were used to determine if there was significant difference in time intervals from symptom recognition to psychiatric consultation among the different groups of children and adolescents according to demographic and clinical factors. Results: Majority (56%) of the caregivers of the patients cited lack of concern over patient symptoms as the reason why it took a long time for them to seek psychiatric consultation. Twenty seven percent of caregivers claimed that they were concerned about their child's symptoms yet did not know where to consult. Institutionalized children and adolescents and those with psychosomatic symptoms had much shorter time interval. Psychotic patients had the next shortest time interval while those with hyperactive impulsive disorders had the longest time interval between symptom recognition and consultation. Surrogate parents also showed the shortest interval from symptom recognition to psychiatric consultation. Only 36% of cases reviewed were brought directly while 44% were initially brought to non-psychiatric PCMC trainees before eventual referral to psychiatry. Almost all (98%) of the psychiatric cases brought to non-psychiatric CNS fellow and a high proportion (92%) of those bought to non- CNS fellows and pediatric residents (88%) were subsequently referred to child psychiatry. Only half of the psychiatric cases reviewed were first seen by physicians outside PCMC and approximately one-third were first seen by psychologists before being brought to PCMC. Of all the professionals initially consulted the "herbolario" had the shortest time interval from symptom recognition to first attempt to seeking care. The mean time interval from symptom recognition to first attempt to seeking care of the cases reviewed was 20.7 months. The mean interval from symptom recognition to psychiatric consultation was 23.7 months. Conclusion: Knowledge of the pathway to psychiatric care and the different factors that influence this is vital in preventing delay in the diagnosis and management of children and adolescents with psychiatric problems. These children's mental conditions have an impact not just at the individual, but also on the familial and societal level. Impeding psychiatric assessment and intervention can lead to further deterioration in the functioning and intrapersonal relationships of these patients. Thus, it is very important to address factors that delay psychiatric consultation.
.