Consumer satisfaction with a psychiatric out-patient clinic

Abstract

The patients who appeared to benefit most from the clinic were suffering from schizophrenia. Their reattendance rate was significantly higher than nonschizophrenic patients. Out of 63 schizophrenic patients, 30 became long attenders compared to 65 out of 197 non-schizophrenic patients (X 2 =5, P < 0.025). It was felt that the open access policy was pivotal in this respect. The mental state of many of these patients was stabilised or improved. It is likely that some would have deteriorated rapidly without psychiatric care, eventually requiring hospital admission. Of the chronic schizophrenic patients, 37 (59%) had not been receiving psychiatric care for six months prior to their first consultation with us, suggesting that they had been lost to previous follow-up. Despite this about half became long attenders at our clinic.Sixty-two per cent were initially managed at the clinic; 80/0 were admitted voluntarily to hospital; 80/0 to a detoxification unit and 5% to our sick bay. Over half of patients attended only once. There are many factors underlying this. Our non-prescribing policy for opiates and reluctance to prescribe benzodiazipines except on a short-term basis was undoubtedly unattractive to some. Others had only self-limiting problems, in particular those with neurosis or personality disorder in crisis, and follow-up in such cases would not be expected. However, we were also aware that some mentally ill homeless did not reattend more out ofchoice than for obvious external reasons. It is also likely that despite the ease of access to our clinic some homeless would still not attend.It is not unique for psychiatrists to work in a general practice setting and this is usually found to be satisfactory. This system has many advantages in dealing with the single homeless. Referrals can be