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Increasing initial attendance at mental health out-patient clinics: opt-in systems and other interventions

  • David S. J. Hawker (a1)
Extract

Out-patient appointments which are missed without prior notice are a major contributor to wasted resources in planned mental healthcare services. It is not unusual that a quarter to a third of patients referred to a service will miss their first appointment (Hoare et al, 1996). Non-attendance rates for second and subsequent appointments are lower. Early non-attendance predicts attrition later in treatment (Goode, 1997; Aubrey et al, 2003), leading to further wasted resources, with most first-time non-attenders never attending subsequent appointments.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Increasing initial attendance at mental health out-patient clinics: opt-in systems and other interventions

  • David S. J. Hawker (a1)
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eLetters

Mental Health Outpatient Clinics

Alexis R Bowers, Specialist Registrar in General Adult Psychiatry,
02 May 2007

Dear Editor,

Non-attendance at out-patient clinics costs the NHS £240 million per year.[1] Hawker’s (Psychiatric Bulletin, May 2007, 31, 179-182)[2] articleis therefore relevant to the need of addressing current service delivery models.

Killaspy (Advances in Psychiatric Treatment (2006) 12: 309-319)[3] inher review article mentions that the majority of new patient referrals have a diagnosis of depression or anxiety compared to follow-up patients (90% of the clinic population) who have diagnoses of severe and enduring mental health problems such as schizophrenia. This suggests that the majority of consultant psychiatrists initially assess patients with commonmental disorders but do not necessarily offer ongoing follow-up appointments to them.

We have introduced a Joint Assessment Clinic as part of our ‘New Waysof Working’[4] to enhance the interface between Primary and Secondary careand to minimise service user non-attendance. Our patients are offered an appointment (which requires them to opt-in) within two weeks of the referral with two mental health workers (including doctors). The assessments are then discussed in a multi-disciplinary forum with consultant support.

Our initial results indicate that only 32% of those referred were taken up by the CMHT with an associated initial non attendance rate of 8% (June- November 2006).

Not only does our service ensure that patients are seen in a timely fashion but also consultant time is freed up to concentrate on patients with more complex needs.

A point perhaps not clearly indicated in Hawker’s account is that those who do not initially attend may in fact be those with more severe psychopathology (such as severe depression or psychosis) which may cause them to not initially engage with services, however, this needs to be further evaluated.

Dr Alexis Bowers

1 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).

2 HAWKER, D (2007) Increasing initial attendance at mental health out-patient clinics: opt-in systems and other interventions. Psychiatric Bulletin, 31, 179-182.

3 KILLASPY, H (2006) Psychiatric out-patient services: origins and future. Advances in Psychiatric Treatment 12: 309-319

4 Department of Health (2006) New ways of working for psychiatrists: Enhancing effective, person-centred services through new ways of working in multidisciplinary and multiagency contexts. Final report 'but not the end of the story.’ London: Department of Health

Specialist Registrar in General Adult Psychiatry,Hertfordshire Partnership NHS Trust,St Albans CMHT,Edinburgh House,82-90 London Road,St Albans,Hertfordshire,AL1 1NG

Tel: 01727 830031 Fax: 0727 832237

Email: alexis.bowers@hpt.nhs.uk

Declaration of interest: None
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Conflict of interest: None Declared

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