Implementation and impact of an extended-hours service in mental health care: lessons learned

To describe the activity and impact of an extended-hours mental health service established to meet perceived need and improve service efficiency. Lessons developed in evaluation could usefully inform development of services in similar settings.

A specialist mental health service providing assessment and treatment to 330 000 catchment residents of an Australian capital city.

Pragmatic mixed-methods evaluation, combining review of 12 months service data and interviews with 65 stakeholders; with integration of descriptive statistics and thematic analysis of qualitative data.

Over 12 months, 2040 individuals were provided with a range of services during extended-hours, indicating that some sort of service was needed. However, evaluation demonstrated that flaws in assumptions underpinning the extended-hours service design, particularly regarding the population seeking after-hours care, necessitated adaptation of the proposed model. Ambiguity in purpose contributed to perceived lack of a cohesive identity, compounded by critical differences in the philosophies of care teams from which the extended-hours service clinicians were drawn. Nonetheless the service was considered effective by many stakeholders and co-location of different teams built collegiality within the service.

A comprehensive needs analysis, enabling full description of target populations and their needs, should underpin establishment of any service. Such understanding is needed to ensure resources are appropriate. Importantly, because mental health clinicians are not interchangeable, matching philosophy of care and clinical skills to identified need is critical to quality and efficiency.