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Advances in Psychiatric Treatment (2006) 12: 309-319
© 2006 The Royal College of Psychiatrists

Psychiatric out-patient services: origins and future

Helen Killaspy

Helen Killaspy is a senior lecturer and honorary consultant in rehabilitation psychiatry at University College London (Department of Mental Health Sciences, Hampstead Campus, University College London, Rowland Hill Street, London NW3 2PF, UK. Email: h.killaspy{at}medsch.ucl.ac.uk) and Camden and Islington Mental Health and Social Care Trust. Her interests include mental health services research and investigation of factors associated with successful rehabilitation of people with complex needs.

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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