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Psychiatric out-patient services: origins and future

  • Helen Killaspy

Abstract

Psychiatric out-patient services originated in the early-20th century to enable triage of new referrals to the asylum in order to differentiate between treatable and untreatable cases. They evolved to provide community follow-up of patients discharged from hospital and assessment of those newly referred to psychiatric services. Non-attendance at out-patient appointments represents an enormous waste of clinical and administrative resources and has potentially serious clinical implications for those who are most psychiatrically unwell. The place of out-patient clinics in modern community mental health services is explored with reference to the reasons for, and clinical and cost implications of, missed appointments. An alternative model is described that incorporates recent UK government guidance on the roles and implementation of community mental health teams, liaison with primary care and new roles for consultant psychiatrists.

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References

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Adair, C. E., McDougall, G. M., Mitton, C. R. et al (2005) Continuity of care and health outcomes among persons with severe mental illness. Psychiatric Services, 56, 10611069.
Andrews, J., Briggs, A., Porter, R. et al (1997) The History of Bethlem. London: Routledge.
Appleby, L., Dennehy, J., Thomas, C. S. et al (1999) Aftercare and clinical characteristics of people with mental illness who commit suicide: a case–control study. Lancet, 353, 13971400.
Baekland, F. & Lundwall, L. (1975) Dropping out of treatment: a critical review. Psychological Bulletin, 82, 738783.
Bateman, A. & Fonagy, P. (1999) The effectiveness of partial hospitalization in the treatment of borderline personality disorder – a randomised controlled trial. American Journal of Psychiatry, 156, 15631569.
Bethlem Hospital Annual Report (1917) Reports of Asylums and Mental Deficiency Committee for the period 1915–1919. Bethlem Royal Hospital Archives and Museum, London. Inventory identifier LAR-15. Series Box Number G0060.
Bethlem Hospital Governors' Report (1927) Reports for the Years Ending 31 January 1924 and 1925, and the Periods 1 February 1925–31 December 1926, 1927–1931 and 1932–1935. Bethlem Royal Hospital Archives and Museum, London. Inventory identifier MSR-01. Series Box Number G0060.
British Medical Association (2004) New Roles for Psychiatrists. London: BMA Publications.
Burgoyne, R. W., Acosta, F. X. & Yamamoto, J. (1983) Telephone prompting to increase attendance at a psychiatric outpatient clinic. American Journal of Psychiatry, 140, 345347.
Caldwell, J. R., Cobb, S., Dowling, M. D. et al (1970) The dropout problem in antihypertension treatment. Journal of Chronic Disease, 122, 579592.
Carpenter, P. J., Morrow, G. R., Del Gaudio, A. C. et al (1981) Who keeps the first outpatient appointment? American Journal of Psychiatry, 138, 102105.
Catty, J., Burns, T., Knapp, M. et al (2002) Home treatment for mental health problems: a systematic review. Psychological Medicine, 32, 383401.
Darling, C. & Tyrer, P. (1990) Brief encounters in general practice: liaison in general practice psychiatry clinics. Psychiatric Bulletin, 14, 592594.
Department of Health (1990) The Care Programme Approach for People with a Mental Illness Referred to the Specialist Psychiatric Services. London: Department of Health.
Department of Health (1999a) National Service Framework for Mental Health: Modern Standards and Service Models. London: Department of Health.
Department of Health (1999b) Modernising the Care Programme Approach: Effective Co-ordination of Mental Health Services. London: Department of Health.
Department of Health (2002) Mental Health Policy Implementation Guide. Community Mental Health Teams. London: Department of Health.
Department of Health (2004) The National Service Framework for Mental Health – Five Years On. London: Department of Health.
Department of Health (2006) Our Health, Our Care, Our Say: A New Direction for Community Services. London: Department of Health.
Deyo, R.A. & Inui, T.S. (1980) Dropouts and broken appointments. A literature review and agenda for future research. Medical Care, 18, 11461157.
Frankel, S. Farrow, A. & West, R. (1989) Non-attendance or non-invitation? A case–control study of failed outpatient appointments. BMJ, 298, 13431345.
Hunter, R. & MacAlpine, I. (1974) Psychiatry for the Poor. 1851 Colney Hatch Asylum – Friern Hospital 1973: A Medical and Social History. Folkestone: Dawsons.
Johnson, D. A. W. (1973) An analysis of out-patient services. British Journal of Psychiatry, 122, 301306.
Kaesar, A. C. & Cooper, B. (1971) The psychiatric patient, the general practitioner, the outpatient clinic: an operational study and a review. Psychological Medicine, 1, 312325.
Killaspy, H., Gledhill, J. & Banerjee, S. (1998) Satisfaction of attenders and non-attenders with their treatments at psychiatric out-patient clinics. Psychiatric Bulletin, 10, 612615.
Killaspy, H., Banerjee, S., King, M. et al (1999) Non-attendance at psychiatric outpatient clinics: communication and implications for primary care. British Journal of General Practice, 49, 880883.
Killaspy, H., Banerjee, S., King, M. et al (2000) A prospective controlled study of psychiatric out-patient non-attendance. Characteristics and outcome. British Journal of Psychiatry, 176, 160165.
Killaspy, H., Bebbington, P., Blizard, R. et al (2006) REACT: A Randomised Evaluation of Assertive Community Treatment in North London. BMJ, 332, 815819.
Kisely, S., Campbell, L. A. & Preston, N. (2005) Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews, issue 3, DOI: 10/1002/14651858.CD004008.pub2. Chichester: Wiley InterScience.
Koch, A. & Gillis, L. S. (1991) Non-attendance of psychiatric outpatients. South African Medical Journal, 80, 289291.
Linehan, M. M., Armstrong, H. E., Suarez, A. et al (1991) Cognitive–behavioural treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 10601064.
Lloyd, M., Bradford, C. & Webb, S. (1993) Non-attendance at outpatient clinics: is it related to the referral process? Family Practice, 10, 111117.
McGlade, K. J., Bradley, T., Murphy, G. J. J. et al (1988) Referrals to hospital by general practitioners: a study of compliance and communication. BMJ, 297, 12461248.
Morgan, D. (1989) Psychiatric cases: an ethnography of the referral process. Psychological Medicine, 19, 743753.
National Audit Office (1995) National Health Service Outpatient Services in England and Wales. Report by The Comptroller and Auditor General. London: TSO (The Stationery Office).
National Working Group on New Roles for Psychiatrists (2004) New Roles for Psychiatrists. London: British Medical Association.
Nelson, A. E., Maruish, M. E. & Axler, J. L. (2000) Effects of discharge planning and compliance with outpatient appointments on readmission rates. Psychiatric Services, 51, 885889.
National Institute for Clinical Excellence (2002) Clinical Guideline 1. Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. London: NICE.
Nosé, M., Corrado, B., Gray, R. et al (2003) Clinical interventions for treatment non-aherence in psychosis: meta-analysis. British Journal of Psychiatry, 183, 197206.
Osborn, D. P., King, M. B. & Nazareth, I. (2003) Participation in cardiovascular risk screening by people with schizophrenia or similar mental illnesses. A cross sectional study in general practice. BMJ, 326, 11221123.
Pang, A. H., Lum, F. C., Ungvari, G. S. et al (1996) A prospective outcome study of patients missing regular psychiatric outpatient appointments. Social Psychiatry and Psychiatric Epidemiology, 31, 299302.
Pomeroy, J. C. & Ricketts, B. (1985) Long-term attendance in the psychiatric outpatient department for non-psychotic illness. British Journal of Psychiatry, 147, 508516.
Potamitis, T., Chell, P. B., Jones, H. S. et al (1994) Non-attendance at ophthalmology outpatient clinics. Journal of the Royal Society of Medicine, 87, 591593.
Reda, S. & Makhoul, S. (2001) Prompts to encourage appointment attendance for people with serious mental illness. Cochrane Database of Systematic Reviews, issue 2, DOI: 10.1002/14651858. CD002085. Oxford: Update Software.
Schneider, J., Carpenter, J. & Brandon, T. (1999) Operation and organisation of services for people with severe mental illness in the UK. A survey of the Care Programme Approach. British Journal of Psychiatry, 175, 422425.
Skuse, D.H. (1975) Attitudes to the psychiatric outpatient clinic. BMJ, 3, 469471.
Smyth, M., Vostanis, P. & Dean, C. (1990) Psychiatric out-patient non-attenders: a cause for relief or concern? Psychiatric Bulletin, 14, 147149.
Sparr, L. F., Moffitt, M. A. & Ward, M. (1993) Missed psychiatric appointments: who returns and who stays away. American Journal of Psychiatry, 150, 801804.
Strathdee, G. & Williams, P. (1984) A survey of psychiatrists in primary care: the silent growth of a new service. Journal of the Royal College of General Practitioners, 34, 615618.
Thornicroft, G., Wykes, T., Holloway, F. et al (1998) From efficacy to effectiveness in community mental health services. PRiSM Psychosis Study 10. British Journal of Psychiatry, 173, 423427.
Tyrer, P. (1984) Psychiatric clinics in general practice. An extension of community care. British Journal of Psychiatry, 145, 914.
UK 700 Group (1999) Intensive versus standard case management for severe psychotic illness: a randomised trial. Lancet, 353, 2185–9.
Verbov, J. (1992) Why 100 patients failed to keep an outpatient appointment – audit in a dermatology department. Journal of the Royal Society of Medicine, 85, 277278.

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Psychiatric out-patient services: origins and future

  • Helen Killaspy
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