Published: 16/12/2004, Volume II4, No. 5936 Page 32

Ah, Christmas. At a time of year when the majority of hospital services have all but shut up, there are some exceptions to the rule. And for the managers in those areas It is business as usual at best.

Newcastle and North Tyneside trust crisis service manager Steve Niemiec is one of those: mental health is a serious issue over the festive season. 'Families come together from all over the place.

Some have a great time and some have a bad time, ' says Steve.

Similarly, there are those without family who feel increasingly isolated over the festive period. 'And That is on top of everything we would normally be doing: crisis, acute psychiatric problems etc.' This alone would not be so much of a challenge, but coupled with the seasonal changes to the rest of the health service - community mental health teams may not be at full strength - it is a combination that means more stress for hospital mental health operations.

'There is an increase in workload of maybe 15-20 per cent. It might be a little bit higher - 30 per cent, ' says Steve.

Because staffing levels are kept to the norm it means that everyone is busier.

Daily assessment boards carry on as usual, nursing levels are the same and for Steve, a psychiatric nurse, and the two consultants psychiatrists that lead the team, it is a case of one off, two covering.

Although there is normally no particular pressure on beds and there remains a general effort to provide patients with home-based treatment, Steve says the seasonal pressures force changes.

At any one time there are normally 45-60 patients on the home treatment board, but this can rise to 65-70 over Christmas and New Year.

'That is too many, simply because of the size of the team. Some people need to be seen two or three times a day, ' says Steve.

'When we get to 60 and over we are starting to get close to saturation.

'It means we would probably start admitting people even if home-treatable because we haven't got the capacity within our service to take them on.' It is enough to make you want to avoid the problem and take a holiday over the period to some exotic-sounding location, like Timbuktu... which is exactly where Chris Davies, assistant general manager for emergency services at United Bristol Healthcare trust, will be on Christmas Day.

It is an understandable move, particularly when you consider Steve's comment about mental health operations: 'It is a bit like accident and emergency.

Everyone else has a holiday except us.' Although Christmas can be a busier time for A&E departments, Chris says that part of the problem is the lack of predictability, 'but you have to be geared up for the worst case'.

He says the number of cases involving drunks, assaults and drugs are much like the usual Friday or Saturday night and are dealt with pretty much as normal.

It is a tough job, but Chris is full of praise for the workload his colleagues handle over the Christmas period, from reception staff to doctors: 'They cope very well with everything thrown at them'.