Managing Workload and Patient Flow in a Community Mental Health Team: A Prospective Quality Improvement Initiative
G. MurtazaIntroduction
Community Mental Health Teams (CMHTs)manage individuals with complex psychiatric needs in resource-limited settings. Structured approaches to referral triage, discharge planning, and follow-up of non-engagement are key to ensuring equitable access and safe caseloads. This quality improvement project aimed to optimise patient flow and improve service efficiency.
Objectives
To evaluate caseload activity in a CMHT over six months, focusing on discharges, non-engagement, and new referrals.
Methods
This prospective QI initiative was conducted at CMHT Swords – Orange Team, North Dublin Mental Health Services, between January 13 and July 13, 2025. A total of 131 existing patients and 20 new assessments were reviewed. Outcomes were categorised by discharge type, engagement status, or administrative transfers and reviewed through MDT discussions and GP correspondence.
Results
Out of 151 total patients, 48 (31.8%) exited CMHT care during the audit period. This included 19 (12.6%) discharged due to persistent non-attendance or disengagement — most with EUPD, EUPD traits, or mild anxiety/depression, and none deemed high-risk. Additionally, 4 patients (2.6%) were discharged stable to primary care, 2 (1.3%) due to behavioural non-engagement, 5 (3.3%) were transferred following relocation, and 1 (0.7%) was referred for high-support residential care. Of 20 new assessments, 16 (10.6%) were discharged with GP follow-up advice, and 4 (2.6%) were linked for ongoing care.