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J Psychiatr Ment Health Nurs. 2000 Jun;7(3):241-7.

Gatekeeping access to services at the primary/secondary care interface.

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Mental Health Services of Salford NHS Trust/School of Nursing, Midwifery and Health Visiting, University of Manchester, Manchester, UK.


This paper examines the role that mental health clinicians play in gatekeeping access to services at the primary/secondary care interface. Layder's research map is used to explore the factors that influence gatekeeping decisions at four interrelated levels of social organization; self, situated activity, setting and context, plus a historical dimension that permeates each level. The main theme that emerges from the analysis is that the dilemmas that arise from attempting to control the demand for care are difficult to resolve for policy makers, managers or clinicians alike. A combination of factors make it difficult to establish consistent priorities including: the uneven distribution of specialist services, the lack of a consensus definition of severe mental illness and the difficulty of weighing the potential benefits of care for the individual against the need to ensure that resources are distributed fairly. It is suggested that there are no easy answers to these dilemmas because gatekeeping is a socially contested process, in which there will be winners and losers.

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