'Walk-Ins': Developing a Nursing Role to Manage Unscheduled Presentations to a Community Mental Health Clinic
Crismani, Christopher, Galletly, Cherrie, Contemporary Nurse : a Journal for the Australian Nursing Profession
This paper reports on the evolution of the role of a 'walk-in' nurse at an Australian urban community mental health clinic. Despite the lack of any indication that a walk-in service was available, people persisted in presenting to the community mental health clinic requesting immediate help. A nursing position was therefore established to assess people presenting as walk-ins and address the issues identifi ed. Data was collected over a 33 week period. Many people presented with social issues, and about half were referred to agencies outside the mental health system. A number of diffi culties in the nursing role were identifi ed including the variable workload, problems obtaining adequate clinical supervision, and lack of clarity about the place of the service within the established pathways to care. With further development, the mental health walk-in clinic role would be suitable for a nurse practitioner. Our study suggested that a walk-in clinic is preferred by many consumers, is effi cient in terms of staff time, and is able to provide a high quality service responding to a wide range of presenting problems.
KEYWORDS: mental health services; psychiatry; community mental health services; accessibility of health services; nurses; nurse's role
Walk-in mental health clinics
Walk-in centres, where people are able to present for immediate mental health assistance without a referral or appointment, can provide convenient, timely access to mental health care. While the literature on walk-in mental health clinics is minimal, research suggests that there is a community need for such a service. Boerstler and Figueiredo (2003) defi ned 'walk-ins' as consumers who seek treatment without scheduling an appointment. They found that almost two-thirds of low-income minority consumers seeking outpatient psychiatric treatment had initially presented as walk-ins. Research conducted within an Australian hospital emergency department found that in the year 2000, 514 people did not wait to be assessed and many of these people were identifi ed during their initial triage as having mental health-related problems (McDonough et al., 2003). In response, the emergency department developed a nurse-led Emergency Mental Health Triage and Consultancy Service (McDonough et al., 2003) to provide prompt and effective care to clients presenting with mental health/psychosocial problems.
Primary care walk-in centres, utilising a nurse-led model of care, have been in operation within the National Health Service (NHS) in the UK since January 2000 (Anderson, 2002). Introduction of the walk-in centres has proven successful in reducing demand on other health services and supporting consumer self-reliance by encouraging self-referral (Salisbury & Munro, 2003). A nation-wide evaluation of 40 walk-in clinics found that 80% of consumers were 'very satisfi ed' with the NHS walk-in services (Salisbury, Manku-Scott, Moore, Chalder, & Sharp, 2002). Currently these walk-in centres treat about three million people per year (National Health Service Choices, 2010).
More recently, Coster, O'Cathain, Nicholl, and Salisbury (2009) described a pilot project setting up commuter walk-in health clinics close to national railway stations in the UK. Almost 70% of users indicated they were 'very satisfi ed' with the commuter walk-in service (Coster et al., 2009). Evaluation of a walk-in clinic located in a retail centre in Minnesota, USA found that the service increased access without increasing early return visits (Rohrer, Angstman, & Furst, 2009).
The fi rst walk-in primary health centre in Australia opened in May 2010 on the grounds of the Canberra Hospital campus in the Australian Capital Territory (ACT; Ainsworth & Hayward, 2010). Based on the NHS walk-in centre model, this nurse-led centre aimed to reduce pressure on ACT emergency departments and general practices. More than 3,000 patients were treated in the fi rst 12 weeks of operation (Ainsworth & Hayward, 2010). …