Abstract
Introduction: The last ten years has seen a comprehensive integration and mainstreaming of public mental health services with the general hospital system. This has produced profound changes in the mission of pre-integration psychiatric services that were formerly separate and located away from the general hospital system. Our service in south-east Melbourne established an Emergency Psychiatric Service (1997) that is comprised of elements including a community-based assessment and treatment team, together with elements traditionally hospital-based, that of the Accident & Emergency department, Consultation-Liaison, and inpatient psychiatric unit.
Objectives: Our aim was to analyse data variances in the site and outcomes of consultations, and the frequency of utilisation of different elements of the Service.
Method: A standard, comprehensive database was devised for completion by all clinicians for every psychiatric assessment performed in the Accident & Emergency department, community or after hours in the hospital wards.
Summary of Results: Analysis of data reflecting four months from September to December 1999, where the number of patient assessments was n = 484, showed the following: The most common place of assessment was hospital-based at 77%. By contrast, community-based assessments were at 23%. The most frequently deployed component of the service was hospital-based at 74%. By contrast the community team made 26% of assessments. The most common outcome in assessments was admission either to a psychiatric or medical bed at 33%. Community-based mental health service follow-up was 28%. Referrals to other non-public mental health providers including private psychiatrists, general practitioners and other counsellors were 18%. Discharges without follow-up came to 6%. Some 15% of Emergency Psychiatric Service consultations were on the ward as medical or seclusion reviews.
The results of this activity analysis demonstrate a high rate of psychiatric morbidity and an approximately even dispersion across community and hospital-based outcomes. Some 48% either admitted or seen on the ward and 52% were subsequently community treated or discharged. The high proportion of hospital-based assessments of psychiatric crisis in patients leads us to speculate on the possible perception of medical model of severe mental illness and reliance on the hospital system for relief of distress. However controlled studies incorporating appropriate rating scales are necessary to measure patient's perception of psychiatric emergency assessments and treatments.