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Impact of ‘open access’ to specialist services—the case of community psychogeriatrics

To compare patients referred via traditional, medical sources with those referred under an ‘open access’ policy to a community‐based multidisciplinary psychogeriatric service, we studied 1477 first referrals to the service over 58 months. General practitioners referred 45% of all patients, but 53% of all with delirium and 49% of all with depressive syndromes. Social workers referred 20% of all patients, but only 10% of all with depression; they referred 38% of all with alcohol problems and 34% of all with paranoid disorders. Ten per cent of those referred by social workers and 12% of those referred by general practitioners had no psychiatric disorder. Had the service been confined to patients referred from traditional (ie medical) sources, 463 patients with a psychiatric diagnosis would have had to await referral via these sources. There was no evidence that more inappropriate referrals are produced by ‘open access’ to this psychogeriatric service; the assessment of depression by social workers and delirium by general practitioners merits further study.