Emergency referrals to an acute psychiatric service: Demographic, social and clinical characteristics and comparisons with those receiving continuing services

Abstract

The characteristics of individuals referred to psychiatric emergency services serve as one indicator of the functioning of the service system as a whole. Evaluations of emergency services have been relatively sparse in the research literature. A two-month cohort of emergency referrals is described and comparisons made with a Community Mental Health Team (CMHT) caseload group. The characteristics of the individual, dimensions of the crisis, and the outcome of the emergency assessment were recorded in each case. Health of the Nation Outcome Scales (HoNOS) and Global Assessment of Functioning scale (GAF) ratings were obtained. Those referred form a heterogeneous group, some of whom have serious mental illnesses and many of whom were identified as having poor coping and psycho-social problems. The comparison group (CMHT caseloads) had significantly greater problems of symptoms and functioning. The study raises the issue of whether prioritising of specialist mental health services to those with severe and enduring mental illnesses serves to exclude other vulnerable groups. While most individuals in the study had a history of episodic psychiatric contact, many would be unlikely to satisfy the criteria for continuing support. Some may only have transient needs related to a life crisis; for others with more chronic difficulties, an emergency response alone cannot be expected to make an impact.