Evaluation of a community based service for urgent psychiatric assessment

Abstract

The Urgent Assessment Service (UAS) was set up to provide community based urgent psychiatric assessment to a range of referrers. The work of the service was assessed over a six month period. Results show that it was popular with a broad range of medical and non-medical professionals. Patients generally presented with depression or psychotic illnesses and those referred from non-medical sources were more likely to be suffering from schizophrenia and assessed as being at least as unwell as those referred by GPs and hospital based doctors. Rates of referral to hospital services were low with the vast majority of patients being referred back to their general practitioner after initial assessment and treatment.

Urgent Psychiatric Services: A Scoping Review

“…The rationale for a multidisciplinary approach was rarely explicitly stated; however, it may be intended to expand the volume of patients who could be seen (for example, through joint assessment, either in a single appointment or asynchronously) and (or) to expand the comprehensiveness of services (for example, psychotherapies). 10,22,23 Few programs specifically described how providers of different disciplines interfaced in the care of patients. Thus it is unclear whether care was truly interprofessional and teambased (as opposed to multidisciplinary), how roles were defined and negotiated, how communication occurred, and how clinical deterioration and (or) risks were handled.…”

“…Community-based programs were located within general or mental health-specific community health centres. [22][23][24]…”

“…Response Time Most hospital-based programs aimed to see patients for their first appointment within 7 days (range 2 to 10 days), as did the 1 community-based program that had a similar model of assessment and brief treatment. 23 Three programs reported actual wait times for first appointments, which were 2 to 3 days longer than their target wait times and ranged from 6 to 12 days. 10,17,27 One community program was a walk-in service 22 and 1 community program provided triage only.…”

“…In most programs, treatment approaches were pragmatic and flexible, rather than diagnosis-based or preordained. 10,17,20,23,25,26 Clinician activities commonly included patient and (or) family psychoeducation, 20,21,26,27,31,32 brief psychotherapy 10,17,18,[20][21][22][23][25][26][27]31,32 (cognitive, behavioural, dynamic, mindfulness, solution-focused, or supportive), initiation or adjustment of pharmacotherapy, 10,17,18,20,22,23,25 and referrals to community supports or professional care. 10,17,18,[20][21][22][23][25][26][27]31,32 Coordination and Continuity of Care Continuity of care can be conceptualized as patients "experiencing care over time as coherent and linked," 33, p i and may rest on the continuity of therapeutic relationships, the accumulation, transfer, and use of knowledge about patients in their care, and a smooth and flexible progression through accessible, consistent, and coordinated services.…”