Triage in emergency psychiatry

Sir: The concept of triage in emergency psychiatry is an interesting one, clearly elucidated by Morrison et al (Psychiatric Bulletin, July 2000, 24, 261-264). Their flow chart elegantly illustrates the process by which cases should be allocated for assessment and one would hope that these considerations would be made in all cases as the number of urgent referrals constantly increases.

However, the final tier of the diagram is perhaps unrepresentative of the resources and manpower available in many departments of psychiatry. There may not be a specialist registrar within the unit and clinical assistants are often part-time, or employed for specific sessions such as day hospital or out-patient clinics. This reduces the staff available to the consultant and senior house officer(s) or the ‘on-call’ senior house officer. I suspect in practice that the majority of general hospital and accident and emergency referrals are in the first instance dealt with by junior staff, as well as a large proportion of urgent general practitioner referrals. Difficulties may be compounded by manpower shortages and reluctance of locum consultant staff to take on urgent work, other than in a supervisory capacity. In addition, there is rarely a good system in place for monitoring the level of, and response to, emergency referrals.

Although with adequate supervision emergency assessments provide an excellent learning experience for trainees, I feel that their role in the triage and assessment of emergency psychiatric referrals should be clarified and the experience of a senior colleague in providing effective triage utilised to the full.