Emergency psychiatric services in England and WalesBMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7000.287 (Published 29 July 1995) Cite this as: BMJ 1995;311:287
- Correspondence to: Dr Johnson.
- Accepted 1 May 1995
Although few policies guide the local planning of emergency psychiatric services in Britain, service users and their carers frequently express a preference for local teams that can respond quickly to crises.1 Acute psychiatric services are now usually provided by sector teams for defined geographical catchment areas.2 The provision of emergency response as part of an integrated range of local services has substantial advantages in terms of continuity of care and service accessibility,3 but such care may be difficult to sustain at night and at weekends for a small sector.4 We describe how emergency services in England and Wales are currently organised and staffed, comparing patterns of provision outside office hours with those during the day.
We sent questionnaires to the general health manager of the mental health unit in every district in England and Wales (n=199). Reminders and, if necessary, follow up calls were used. We distributed briefer questionnaires to all 248 local groups of MIND (the National Association of Mental Health) and all 160 local groups of the National Schizophrenia Fellowship; the questionnaires asked them to rate aspects of their local emergency services on a five point scale and to comment on the greatest strengths and weaknesses of these services.
We obtained completed questionnaires from providers in 173 health districts (87%). Most respondents (100 (58%)) were consultant psychiatrists, and they often also held a managerial role. In 52 (30%) districts a senior manager completed the form, and most other respondents were senior nurses. At least one MIND or National Schizophrenia Fellowship group responded in 155 (78%) districts.
The settings and staff used for emergency assessments in office hours (9 am-5 pm) and at other times are shown in the table. Outside office hours accident and emergency departments and hospital wards are most used for emergency assessments, while home assessment relies on district duty psychiatrists and social workers.
Respondents were also asked open ended questions about the greatest weaknesses of their local emergency services. The three aspects most often identified as greatest weaknesses by providers were poor out of hours service (40/152 (26%)), too few staff (32/152 (21%)), and lack of a crisis intervention team (27/152 (18%)). Voluntary groups identified the greatest weaknesses as difficulty in gaining access to emergency services (60/207 (29%) groups), poor service outside office hours (59/207 29%)), and no crisis beds outside hospital (35/207 (17%)).
There are striking differences between psychiatric emergency services provided during and outside office hours. During office hours a wide range of settings are used for emergency assessment and intervention, including community bases such as mental health centres, day hospitals, and day centres. Specialist psychiatric emergency clinics usually open between 9 am and 5 pm on weekdays. Night time services for urgent assessment and treatment rely on accident and emergency departments in general hospitals and the wards of psychiatric hospitals. Community psychiatric nurses and crisis intervention teams are not generally available outside office hours, and sector mental health teams usually take responsibility for emergency cover only 40 hours a week, leaving duty doctors and social workers to provide a service for the remaining 128 hours of each week, generally for a whole district.5
Emergency community mental health teams are still in their infancy, and they do not yet go out at night. Purchasers and providers may need to respond to the dissatisfaction expressed by local MIND and National Schizophrenia Fellowship groups, as well as by clinicians and managers, by developing and evaluating service models which provide an effective emergency response at night and at weekends.
We thank Morven Leese for advice on the statistical analysis.
Funding Department of Health.
Conflict of interest None.