The study population is served by CMHTs and in addition (in one sector) by a Crisis and Home Treatment Team.

To evaluate the recorded admission and discharge processes in the medical and nursing notes.

To record relevant clinical characteristics of the admission and the patient.

To assess recorded admission and discharge processes against standards defined in the protocol.

A random sample of 100 records, which met inclusion criteria, was selected. A protocol evaluating the recorded processes, and relevant information re the admission was completed by psychiatric trainees and senior nurses.

51% of admissions occurred on week-ends and 58% occurred “out of hours”. In 35% of admissions a further admission had occurred within 4 weeks. 34% of admissions derived from 2 areas, highly correlated with deprivation. Alcohol or drug misuse contributed to 69% of admissions. In 77% of admissions, the patient was known to the service. 10% of patients had a diagnosis of major mental illness.

Recorded medical and nursing assessments of admission were incomplete i.e. 66% of medical records and 80% of nursing records. Assessment of discharge records indicated similar failings in record -keeping.

The recurrent pattern of admissions(33%), the association with deprivation(34%) and drug or alcohol misuse(69%), indicate the need for more effective management of these patients. The failings in recording admission and discharge information are significant. Improvements in these processes could identify those patients who require additional support and /or are at risk of futher admissions.