Published: 02/06/2005, Volume II5, No. 5958 Page 24

It is not uncommon for mental health services to be available but inaccessible. A multi-agency service is a practical and effective way to offer choice from a single point of referral.

In Leeds we merged a community mental health team and a MIND day centre to create creative health options in community environments (CHOICE). Working together with service users, we added a range of additional services, including counselling, home support, advice work, healthy living groups, complementary therapies and adult education.

The stepped care model offers multi-agency assessment, casemanagement, medical treatments and access to other agencies. These services are accessible though a single point of access. The service was commissioned by Leeds North West primary care trust.

We receive over 290 referrals a year from an adult population of over 39,000. Of the referrals, 81 per cent come from GPs and 27 per cent are urgent. Most referrals pass through CHOICE, although some go to crisis services. The referrals are handled by a CMHT duty system when urgent and by the full CHOICE assessment team, including the CMHT, if routine.

At any one time CHOICE has 20 people using complementary therapies, 18 in counselling, 14 with 'befrienders' and four volunteer service users. CMHT case-manages around 100 people and medical clinics manage approximately 250.

The day centre sees up to 30 people daily.

Referral analysis shows outcomes recorded for 94 per cent of service users. Non-medical assessors see 36 per cent of referrals, 30 per cent are seen by doctors and 24 per cent are re-routed to more appropriate services.

Two years before the creation of CHOICE, CMHT returned 40 per cent of referrals to referrers. Now only 4 per cent of referrals are returned to GPs because they cannot be rerouted or assessed directly.

Dr David Yeomans is consultant psychiatrist at CHOICE.

david. yeomans@leedsmh. nhs. uk