Psychiatric out-patient services: origins and future

Psychiatric out-patient services have recently come under close scrutiny. Until April 2005, nonattendance rates at first appointments were one of the performance indicators used by the Commission for Healthcare Improvement (now the Health Care Commission) in awarding ‘star ratings’ to National Health Service (NHS) trusts for service efficiency. This attention has allowed some creative thinking about the role of the out-patient clinic in modern mental health services. To understand why outpatient services have been such a mainstay of mental health services, it is important to understand a little about their origins.