Psychiatry at the front line: CPNs working outside regular hours in an inner-city A&E department.

This paper reports on a study that examines the characteristics of patients with mental health problems, seen outside regular working hours, by CPNs working within an in an inner-city A&E department. The study examined the range of presenting problems for each individual attendance rather than the primary diagnosis or main presenting problem. There were significant differences in the pattern of presentations between patients with and without a mental health professional (MHP) involved in their care. Patients with a MHP involved in their care were much more likely to present with psychosis and suicidal ideation in the absence of deliberate self-harm. Those without a MHP were much more likely to have deliberately harmed themselves, to have interpersonal problems, to have misused alcohol or drugs or to have work/financial problems. The CPNs worked in an autonomous manner and appeared to reduce the intensity of the duty psychiatrists' workload by filtering out patients judged not to be in need of their specialist input.