An evaluation of a psychiatric emergency clinic

Abstract

With the development of community care in Britain, the management of out-of-hours psychiatric crises is an increasing problem in inner city areas, and impacts on the wellbeing of clients and carers and the credibility of services. The paper describes a detailed examination of a 24-hour, 7-days-a-week walk-in Emergency Clinic (EC). There were 763 attenders, accounting for 1181 attendances over a 3- month period from November 1995. Data were collected on all of these, using various sources of information including direct interview and a standard recording form. There were four streams of patients with clearly distinct characteristics reflecting different functions of the EC. These were selfreferrals (65%), GP referrals (8%), CMHT referrals (7%) and police referrals (7%). At the time of attendance, most people (68%) were not felt to be acutely disturbed. However, 17% were unpredictable or violent, and a further 15% were disturbed to a lesser degree. The police-referred group attended late at night and were often disturbed or violent. Sector team referrals attended for additional support, while GPS largely used the clinic to provide an urgent assessment service for patients with mainly neurotic problems. This type of Emergency Clinic is one answer to the problem of providing an effective backup service to inner city community psychiatry. It clearly fulfils several distinct functions, but is expensive. However, alternative ways of deploying the resources invested in it are unlikely to be able to maintain all of its functions.