'Walk-Ins': Developing a Nursing Role to Manage Unscheduled Presentations to a Community Mental Health Clinic

By Crismani, Christopher; Galletly, Cherrie | Contemporary Nurse : a Journal for the Australian Nursing Profession, August 1, 2011 | Go to article overview

'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


INTRODUCTION

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). Some of the benefi ts of the centre included timely health care for minor illness and injury, the development of new roles and relationships for the health care workforce, and empowering the client to seek the right type of health care at the right time (Ainsworth & Hayward, 2010).

Developing a nursing role to manage walk-ins is challenging given the unscheduled nature of the workload and the wide range of presenting problems. Rosen and Mountford (2002) report the primary challenge of developing the NHS walkin nurse role was the lack of consensus about the most appropriate nursing skill mix and the competencies required by the nurses. In the development of the Emergency Mental Health Triage and Consultancy Service (McDonough et al., 2003) nurses were provided with a four-month preparatory training program which was found to be instrumental in facilitating their movement to an advanced practitioner level (McDonough et al., 2003). There is little guidance in the adult mental health literature in regards to developing a walkin clinic, although Young, Dick, Herring, and Lee (2008) do describe the process of setting up a walk-in therapy clinic for children and families in Toronto, Canada.

This paper aims to describe our experiences in setting up a high quality walk-in service for adults seeking immediate access to mental health clinicians. …

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