Offering mental health users a weekend service provides continuity and a sense of security for patients and their families - and is in line with national policy.
The national service framework for adult mental health says all mental health service users on the care programme approach should receive care which optimises engagement, prevents or anticipates crisis and reduces risk, and should be accessible at any time.
We have been running a weekend crisis team for more than four years in north-east Essex.
Originally, the service was available from 9am-5pm on Saturdays and Sundays. But these hours have since been extended to 9am-9pm.
The team is staffed by community psychiatric nurses, senior occupational therapists and charge nurses and aims to provide whatever support the client needs over the weekend.
Staff can provide telephone advice, make home visits, bring a client into day hospital and carry out assessments or admit to acute wards when necessary.
The team members take overall assessments while they are on duty. They can do this without back-up from the acute unit, but they also liaise with the duty senior house officer.
Assessments can be carried out at the client's home, in accident and emergency, general hospital wards or, occasionally, at a police station.
The team sees clients with a diagnosis of schizophrenia, those with depression and anxiety and other conditions.Most are already known to the mental health services, but a few are new referrals. Nearly all clients supported by the weekend service come from north Essex.
The weekend crisis team's work falls into two types. In 2000-01, around four-fifths (597) of referrals were for clients thought to be on the point of needing hospital admission over the weekend, and one-fifth (157) were formal assessments for inpatient admission. The team does not know in advance which clients will cope over the weekend and which will need formal assessment.Half the assessments are referred by A&E.
Finding staff to extend the team's hours took six months.With the benefit of hindsight, the cover arrangements could have been more explicit since community mental health team managers expressed concern about receiving replacement resources for staff time lost to the weekend team.
A creative solution was found - one community mental health manager was prepared to make a grade G nurse available each weekend in exchange for a half-time grade E nurse previously working in an inpatient ward, acting up to F grade.This is not easily repeatable as it removes experienced staff from the wards, which are also short of staff.We are looking for a workable solution.
Questionnaires sent to clients showed that they found reassurance in knowing the service was there.When long-term clients feel crisis is imminent, their experience dictates that they should seek help while they still can.
Knowing that help was at hand, if necessary, developed confidence and reduced uncertainty for clients.Most of those referring clients found accessing the service easy.They liked the 'one stop shop' approach and did not want inpatient admission if avoidable.
Some of those referring clients valued the choice of contacting the weekend team or the wards direct.
But some said they would welcome one central referral point.
In the year to March 2001, the team received an average of 15 referrals per weekend.The community mental health team was the main source of referrals and the next largest number was self-referrals, followed by A&E.
This represents a change from the beginnings of the service, when GPs were one of the main sources of referrals. But it seems pointless to make clients who already know about the service go through their GPs.
We assessed two-thirds of evening and overnight referrals in less than two hours, but were much less efficient between 5am and 9am when only onethird were seen in less than two hours.The rise in the number of A&E referrals at weekends, and especially bank holidays, was disproportionate to the numbers of patients seen.The next service extension will be bank holidays, but further work is needed on why existing delays occur.
Out-of-hours services reduce stress on professionals by letting them go home knowing that, if needed, someone is there for their client.
There are plans to extend the service to a seven-day out-of-hours service. l