Psychiatric emergency clinic attenders: what can we learn from them?

Patients attending the Royal Edinburgh Hospital emergency psychiatric clinic over a four month period were assessed by semi-structured interview. General Practitioner and self-referrals were compared with respect to presenting features and subsequent management. Self-referral was associated with young age, male sex, unemployment, poor social cohesion, problem drinking, a forensic history, and mild levels of psychiatric disorder. Only 10% of self-referrals were considered appropriate psychiatric emergencies, but 69% of General Practitioner referrals. Five per cent of self- and 34% of General Practitioner-referrals were admitted. These findings indicate that if the psychiatric emergency clinic is to be of benefit to those it serves, it must not confine itself simply to assessment of mental disorder, but seek to facilitate crisis resolution.