Mental Health Services in Çorum: The Specialist Shortage and Seeking Support

What does the data say about mental health services in Çorum? Specialist doctor numbers, the community mental health centre and barriers to seeking help.

"I don't know who to go to", "I can't get an appointment", "What if someone sees me?" Many people facing a psychological difficulty run into these sentences the moment they decide to seek support. Data on mental health services in Çorum suggests that part of this experience may have structural causes. According to calculations based on the Ministry of Health's Health Statistics Yearbook 2023, there are about 77 specialist doctors per 100,000 people in Çorum; in Turkey the figure is about 119. By contrast, the density of nurses and midwives and the number of hospital beds are slightly above the Turkey average. In other words, what is missing is not buildings or beds, but specialist workforce. In this article we look at these data, the structure of services in the mental health field and the psychological barriers to seeking help, and set out the steps someone looking for support can take.

Mental Health Services in Çorum: What Do the Figures Say?

The key indicators, compiled from the Health Statistics Yearbook 2023 and mostly calculated in proportion to the population, are as follows:

• Total doctors: In 2023 there were 973 doctors in the province (405 specialists, 397 general practitioners, 171 residents). The number of doctors per 100,000 people is about 184; in Turkey it is about 239.
• Specialist doctors: There are about 77 specialist doctors per 100,000 people; in Turkey about 119. The gap is largest in this category.
• General practitioners: About 75 per 100,000; in Turkey about 64. In other words, at primary care level the province is slightly above the national average.
• Family medicine: There are 189 family medicine units in the province, with 2,796 people per unit; in Turkey the figure is 3,043.
• Nurses and midwives: About 402 per 100,000; in Turkey about 361.
• Beds: 32.3 beds per 10,000 people; in Turkey 31.2.
• Frequency of visits: The number of doctor visits per person is 12.2; in Turkey 11.4.
• Community Mental Health Centre (TRSM): There is a TRSM in the province, operating since 2011 and attached to Erol Olçok Training and Research Hospital. The centre provides services such as individual sessions, psychoeducation, family education, group work, a mobile team and anti-stigma activities for people diagnosed with severe mental illnesses such as schizophrenia, schizoaffective disorder, delusional disorder or bipolar disorder.

The limits of the data

The doctor density values are approximate figures calculated by dividing the raw numbers in the yearbook by the population. More importantly, the Health Statistics Yearbook does not include the distribution of specialities at provincial level. For this reason, the number of psychiatrists and psychologists in Çorum could not be found in our research. It is not possible to say with certainty to what extent the shortage of specialist doctors is reflected in the mental health field. Public-sector capacity for common mental health problems such as anxiety and depression is not published at provincial level either. The TRSM, meanwhile, is a service model with a specific target group, focusing only on severe mental illness.

Possible Factors Affecting Access to Mental Health Services in Çorum

The journey of someone seeking support is not determined by the number of services alone. Several structural and social factors may play a part together:

Limited specialist workforce. Specialist doctor density being below the Turkey average may lengthen waiting times for appointments in areas requiring specialist care and lead some people to turn to big cities.

An older and rural population. The share of the population aged over 65 in the province was 16.6 per cent in 2023 (Turkey 10.2 per cent), and the rural population share was 39.2 per cent. An older population in which chronic illnesses become more common increases demand on the health system. For those living in villages and small districts, coming to the centre also means transport, time and cost.

Strong primary care. Family medicine units serving relatively small populations and a density of general practitioners above the national average are an important advantage. The family doctor is also a door that can be knocked on first for psychological complaints and who can refer people on.

The physical language of psychological distress. There may be many reasons why the number of doctor visits per person is slightly higher than the Turkey average; the older population structure is foremost among them. Even so, it is well known that psychological distress in our society is often expressed through physical complaints such as headaches, stomach problems or palpitations. This can lead a person into a cycle of going from department to department without the real problem ever being discussed. Of course, physical complaints should first be assessed medically; but when tests reveal no cause, also talking about the psychological dimension protects both the person's time and their hope.

A small city and privacy. In settings where everyone knows each other, the worry that "someone will see me outside the psychiatry clinic at the hospital" can delay seeking help.

These factors are not definite causes but possible explanations that may help us understand the process of seeking support.

A Psychological Reading: The Inner Barriers to Seeking Support

Reaching services is in one sense a structural problem; but in another, it is a threshold a person crosses within their own inner world.

Fear of stigma

Remarks such as "You're going to a psychologist? Are you really that bad?" or "Things like that don't happen in our family" can make getting psychological support look like a weakness or a source of shame. This fear can lead a person to carry their distress alone for months or even years.

The belief that "I'll sort it out myself"

People who have grown up in settings where being strong and not talking about one's troubles is valued may see asking for help as a personal failure. This belief often allows the problem to deepen. Yet just as going to the dentist for toothache is natural, getting support for long-lasting psychological distress is just as natural.

Anxiety about waiting and uncertainty

Not being able to get an appointment, long waiting lists or the feeling that "I don't know who I should go to" can create additional helplessness in someone already going through a difficult time. In our article on hospital appointment stress, we looked at how this waiting process can increase anxiety.

Not being able to talk within the family

Let us say that a 35-year-old woman has not been able to sleep for months, finds it hard to get up in the mornings and constantly wants to cry. Her husband says, "Get some rest, it'll pass"; her mother asks, "Be thankful, what are you lacking?" The woman tells her family doctor only about her headaches and goes home with painkillers. In this example the problem is not a lack of knowledge; it is that no room is made for her feelings to be put into words.

Men and older people: quieter help-seekers

Social expectations can make it harder for men to show their feelings and ask for help. Someone who grew up with the idea that "real men don't cry" may show their distress indirectly, through anger, irritability, overwork or withdrawal. In older people, psychological symptoms are often regarded as a natural consequence of "old age" or physical illness and go unnoticed. In a province with a relatively large older population, it is therefore especially important to ask whether forgetfulness, lack of motivation, sleeplessness and frequent physical complaints have a psychological dimension. In both groups, family members gently noticing and encouraging them to seek support can make the first step easier.

The different needs of young people

Young people often get information about mental health problems from the internet and prefer to talk to friends first rather than go to a professional in person. For young people who want support without telling their family, or who are unsure how their family will approach the subject, the support of a trusted adult, the school counsellor or the family doctor can be an important bridge.

People with severe mental illness and their families

People living with severe mental illnesses such as schizophrenia or bipolar disorder, and their families, struggle both with the illness itself and with prejudice in society. That is why community mental health centres focus not only on treatment but also on family education, social skills and combating stigma. For families, knowing these centres exist matters for feeling that they are not alone.

Asking for support is not a weakness but an act of care towards yourself and your loved ones; the first step in seeking help is often the hardest.

A Practical Roadmap for Those Seeking Support

Reaching mental health support can seem complicated. The following steps may offer guidance:

• Talk to your family doctor. Describe your complaints about sleep, appetite, mood and anxiety as they are, not only as physical symptoms. Your family doctor can refer you to the appropriate service.
• Know the difference between a psychologist and a psychiatrist. Psychiatrists are medical doctors and can plan medication treatment where needed; psychologists carry out psychological assessment and psychotherapy. We explained in detail who to turn to in which situation in our article on the difference between a psychologist and a psychiatrist.
• If severe mental illness is involved, find out about the TRSM. If a relative of yours has been diagnosed with a severe mental illness, you can get information about the family education and follow-up services offered by the community mental health centre.
• Consider online options. If you find it hard to meet face to face because of transport difficulties, privacy concerns or a busy work schedule, online sessions can be an option.
• Look after yourself while you wait. Regular sleep, short walks and talking to someone you trust can ease the burden in the time until you receive support.

For families: If you notice a change in someone close to you, listen without judging, ask "Would you like to talk to a professional?" and, if needed, accompany them through the appointment process.

For institutions: Mental health awareness work in schools, workplaces and neighbourhood offices (muhtarlık) can help reduce stigma and encourage people to seek support earlier.

When Should You Seek Professional Support?

Everyone has times when they feel sad, anxious or tired. However, it is important to consult a mental health professional in the following situations:

• If sadness, anxiety or lack of motivation has lasted longer than two weeks
• If there are marked changes in sleep, appetite or energy levels
• If work, school or household responsibilities can no longer be carried out
• If you have visited doctors repeatedly for unexplained physical complaints but no cause has been found
• If symptoms such as losing touch with reality, hearing voices or extreme suspiciousness appear
• If there are thoughts of self-harm or of ending your life

If there are thoughts of self-harm or an immediate danger, call 112 (emergency services) without waiting, or go to the nearest emergency department. These signs do not amount to a diagnosis on their own, but they may call for an assessment by a professional.

How Is the Process of Seeking Support Addressed in Therapy?

Starting psychotherapy is a step full of unknowns for most people. For this reason, the first session usually involves talking together about the difficulty the person is experiencing, their expectations and their worries; how therapy will proceed is shared transparently. The following topics may be addressed during the process:

• Defining the problem: Understanding together the symptoms the person is experiencing and their effect on daily life.
• Cognitive Behavioural Therapy (CBT): Working on the relationship between thoughts, feelings and behaviour in common problems such as anxiety and depression.
• Worry about stigma: Talking about the shame or fear that comes with saying "I'm going to therapy".
• Collaboration: Coordinating with a psychiatrist or family doctor where needed.
• Family involvement: Involving the family in the process where appropriate.

For those who find it hard to meet face to face because of transport or privacy, online therapy can be an option. Psychological support can also be received face to face in Çorum; what matters is that the person chooses the path that suits them and is able to take the first step.

Frequently Asked Questions

Why does the number of specialist doctors in Çorum appear low?

According to the Health Statistics Yearbook 2023, there are about 77 specialist doctors per 100,000 people in the province, compared with about 119 in Turkey. The reasons may include nationwide trends such as specialists being concentrated in big cities. Provincial data specific to the mental health field, however, has not been published.

Who does a Community Mental Health Centre serve?

TRSMs provide community-based services for people diagnosed with severe mental illnesses such as schizophrenia, schizoaffective disorder, delusional disorder or bipolar disorder, and for their families. For common problems such as anxiety or mild depression, the first points of contact are usually the family doctor, psychiatry outpatient clinics and psychologists.

Where should I go first for psychological complaints?

Your family doctor can be a good starting point; when you describe your complaints openly, they can refer you to the appropriate service. You can turn to psychologists for psychotherapy needs and to psychiatrists in situations where medication may be needed.

Is online therapy a substitute for face-to-face therapy?

For many common problems, online therapy can offer support similar to face-to-face sessions and makes things easier for those with transport or privacy concerns. However, emergencies and some severe conditions may require a face-to-face assessment.

• #mental health
• #help-seeking
• #health services
• #Çorum

Yazar

Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

Eğitimler