National Service Framework

Sir: As Deahl et al (Psychiatric Bulletin, June 2000, 24, 207-210) recently pointed out, whether those considering committing suicide will use NHS Direct, and therefore lower the number of suicides and meet a standard of the National Service Framework (NSF) for Mental Health (Department of Health, 1999), is uncertain. How NHS Direct will be used by people for mental health related problems of any nature is also uncertain, even though there is an emphasis on its use for this client group in the NSF.

In order to work towards the implementation of the NSF we carried out a small pilot study in one NHS Direct site to learn more about how people with mental health related problems were using the service. For the period of 1 week we collected data on all mental health related calls to the site. This was done by asking nurses to complete data forms for every mental health call, and by looking at the presenting complaints of all other calls to pick up any that were obviously mental health related. We identified 33 mental health related calls during the week, which accounted for 2.6% of the work-load. Given that nurse advisers did not complete a data collection form for every mental health call, and that the data on presenting complaints were unreliable, we were able to estimate that mental health is more likely to account for approximately 4% of NHS Direct's workload.

The 33 calls related to 24 callers, the majority of whom (67%) were calling on their own behalf. Of these 24, 37.5% presented with more than one problem, some of which were complex and time consuming for nurse advisers to deal with. Just over one-third of the calls were prioritised as either immediate or urgent, the same figure not urgent, and the majority (66%) were referred to another service. This differed to all calls received during the study period where 57% were prioritised as not urgent and only 43% were referred onto another service.

The study demonstrated that NHS Direct is being used by people for their mental health problems and already performing one of the tasks in the NSF of enabling this client to contact another service. How well this task is being undertaken is something that needs to be monitored. Work is currently underway to evaluate the £1 million investment the Government has given to ensuring NHS Direct can meet this task, and results will be available shortly.