The primary/secondary care interface in child and adolescent mental health services: the relevance of burden

The literature shows that as referral rates increase, waiting lists also increase. However, an increase in individual waiting times leads to a decrease in initial attendances, and the resulting wasted appointment times have the effect of further increasing waiting times. This suggests that once they come under pressure, the pressure on the specialist services may increase further without any further increase in demand. In other words, there may be threshold effects in the dynamics of demand and supply that do not relate simply to service volumes and referral rates once certain levels are reached.