Introduction

We now have substantial evidence from policy makers and researchers to guide clinical practice, yet real services often lag far behind best practice. The second section of this book addresses the challenge of implementation. Drs Geraldine Strathdee and colleagues sketch a framework within which a community orientated mental health service can be developed, and indicate that emergency services are only one component of this wider array of provision. While making large scale changes to move a service from a hospital to a community orientation is a major organisational challenge, the key issue is whether such a more local and disseminated service can gel to provide a better quality of care for patients in the long term. Professor Peter Tyrer draws upon his own experience to demonstrate the difficulties and successes of the Early Intervention Service in West London in this crucial consolidation phase. In practice, especially out of office hours, many such assessments take place in accident and emergency or emergency room facilities, and Drs Sonia Johnson and Howard Baderman address the special difficulties of undertaking a proper assessment in a general medical department.