What to do with people who fall through the gaps?

Unless people present a danger to themselves or others mental health services don't treat them until they voluntarily seek help. Psychologists now think that people might be at risk of developing psychosis for a while before they become severely ill. Developing psychosis can have a massive impact on people's lives but so can being labelled as mentally ill and the side effects of antipsychotic drugs so that intervening in the lives of people who are 'at risk' for psychosis is a vexed issue, both medically and ethically. Researchers from the Institute of Psychiatry, King's College London attempted to shed a little more light on this debate in a study of people who had been referred to mental-health services by their GP. The study found that 21.2% of people had not turned up for their appointment with mental-health services. Around half this group subsequently received a diagnosis of mental illness and over a fifth of the 'no-shows' were later given a diagnosis of psychosis with nearly 70% of them seeking help from other mental-health services. People who did go on to their appointments with mental-health services were more likely to be employed. The authors of the study argue that there is a case for mental-health services chasing up people who have been referred to them by GPs but who have not turned up for their appointments.

Green, C. E. L. ... [et al] - Outreach and Support in South London (OASIS). Outcomes of non-attenders to a service for people at high risk of psychosis: the case for a more assertive approach to assessment Psychological Medicine (2011), 41, 243–250