Introduction

The first section of this book presents the historical background to current thinking about emergency mental health services, the evidence we have about its development, and summarises the evidence on whether such services are indeed effective. Professor Heinz Katschnig bases his findings upon an authoritative review for the World Health Organisation of emergency services throughout Europe, and brings together this vast range of practical experience into themes to guide future service development. Drs Sonia Johnson and Graham Thornicroft fill in the background to this book by detailing the historical roots of current emergency mental health service theories, and by detailing different models of care that have been proposed. It is striking that when users of mental health services express their views, their priorities are often very different from those of professionals. Liz Sayce and colleagues give voice to these priorities, and particularly emphasise that emergency services out of office hours seem guided more by convenience to staff than patients' needs.

For situations in which a patient may not agree to accept mental health treatment and care in an emergency, the provisions of mental health law are commonly applied. Ian Bynoe and colleagues demonstrate that the ethical and clinical dilemmas in such situations need to be framed within mental health legislation that explicitly addresses modern community practices, and that law framed in the era of hospital treatment is now decreasingly relevant. There is increasing recognition that the economics of mental health is an important area of study.