Chapter

Access: Office hours, shifts, or 24/7 availability?

Tom Burns and Mike Firn

in Outreach in Community Mental Health Care

Second edition

Published on behalf of Oxford University Press

Published in print June 2017 | ISBN: 9780198754237
Published online July 2017 | e-ISBN: 9780191816116 | DOI: http://dx.doi.org/10.1093/med/9780198754237.003.0006
Access: Office hours, shifts, or 24/7 availability?

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Crisis intervention is an important component of community outreach, so the arrangements for flexible and timely access have always been important. The original ACT model stressed 24/7 availability, but this has proven difficult to sustain. This chapter critically examines the need for such availability, and describes a series of less resource-intense alternatives. These include shift working, flexible evening and weekend working, and shared access arrangements. With the development of crisis resolution/home treatment (CRHT) teams in the UK, outreach out of hours has increasingly been restricted to them. We examine the differences between reality and rhetoric in the benefits of extended working and note the costs, both in terms of manpower, but also of information exchange, in some of these over-elaborate systems. We a also examine effective contingency arrangements to ensure patient safety out of hours.

Chapter.  3032 words. 

Subjects: Psychiatry ; Community Medical Services

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