Specialist services for acute psychiatric disorder

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The patients referred to specialist care

Patients treated by the psychiatric services are a subgroup of people with mental disorder. In some countries patients can go directly to a specialist so that patients treated by the psychiatric services may not be very different from those treated in primary care. In countries such as the UK where the general practitioner acts as the 'gatekeeper' to specialist services, the number and types of patient reaching the psychiatric services depend on:

•  The willingness of general practitioners to treat psychiatric disorder;

•  The treatment skills and resources of the primary care team;

•  Patients willingness to attend for specialist psychiatric advice;

•  The general practitioner's criteria for referral to the psychiatric services.

In the UK , most of the patients in contact with the psychiatric services have severe and chronic anxiety disorders and related conditions, severe mood disorder, schizophrenia, or dementia. Among patients particularly likely to be cared for by specialists are those who are suicidal, those who are dangerous to others, and those with dual diagnoses.

Providers of specialist care

In the UK and some other countries, the organization of specialist services is made difficult by a division of responsibilities between different providers with separate funding and different priorities. In the UK , for example, central government provides funds for hospital-based community services, whilst local authorities employ social workers and provide day activities and sheltered accommodation. Voluntary organizations also playa part in providing care. Social services might, for example, assign the highest priority to services for children, whereas psychiatric services might assign the highest priority to patients with serious mental illness, and the voluntary services might have the elderly as their priority. Unless there is close liaison between these various providers, services become uncoordinated and deficient. With planning, the different priorities of the several providers can be taken into account to arrive at a more balanced and comprehensive service.