The classification of mental disorders used to be based only on people seen by hospital psychiatrists. In fact, most people with a mental disorder were, and are, not seen by psychiatrists because of decisions made prior to psychiatric consultation. The first description of this ‘pathway’ to care and its levels and filters was published by Goldberg and Huxley in 1980.

To conduct a review of papers relevant to the application of the Goldberg–Huxley model in the 21st century.

Systematic review (PROSPERO registration CRD42021270603) of the pathway to psychiatric care in the 21st century. The review concentrates on community surveys and passage through the first filter (consultation in primary care or its equivalent). Ten databases were searched for papers meeting the defined inclusion criteria published between 2000 and 2019 and completed on 15 February 2020.

In total, 1824 papers were retrieved, 137 screened fully and 31 included in this review. The results are presented in a table comparing them with previous research. Despite major social, economic and health service changes since 1980, community prevalence and consultation rates remain remarkably consistent and in line with World Health Organization findings. Passage through the first filter is largely unchanged and there is evidence that the same factors operate internationally, especially gender and social parameters.

The Goldberg–Huxley model remains applicable internationally, but this may change owing to an increasingly mixed mental health economy and reduced access to primary care services.

Understanding the pathways to psychiatric care and recognition of delay points are crucial for the development of interventions that aim to improve access to mental health-care services.

Over a 2-month period in 2003, a total of 1044 patients at the commencement of new episodes of care at Amanuel Specialized Mental Hospital in Addis Ababa, Ethiopia were interviewed using the encounter form that was developed by the World Health Organization (WHO) for the study of pathways to psychiatric care.

The mental hospital was contacted directly by 41% of patients. The remaining patients sought care from up to four different caregivers before arriving at the psychiatric hospital. Where the initial service was not received at the psychiatric hospital, 30.9% of patients sought care from priests/holy water/church. The median delay between onset of illness and arrival at the psychiatric hospital was 38 weeks. The longest delays before arriving at the mental hospital were associated with having no formal education, joblessness, and diagnoses of epilepsy and physical conditions.

Implementing a robust referral system and establishing a strong working relationship with both traditional and modern health-care providers, as well as designing a service delivery model that targets particular segments of the population, such as those who are uneducated, jobless and/or suffer from epilepsy and somatic conditions, should be the most important strategies towards improving mental health service delivery and shortening of undue delay for patients receiving psychiatric care in Ethiopia.