Community Mental Health Service Outpatient Appointment Interval Compression and Crisis Relapse in Kenyan District Clinics: A Regression-Discontinuity Estimation of Scheduling Exposure

The scheduling interval between outpatient appointments in community mental health services is treated in Kenyan district clinics as an administrative variable, yet its relationship to crisis relapse has not been estimated with a design capable of separating scheduling exposure from patient severity. The framework is specified for district-clinic data structures, with attention to the compound assignment problem created by nurse-led triage, the compression of intervals during periods of caseload pressure, and the distinction between scheduled and realised intervals. Because no primary patient-level data are supplied, the paper is a methodological and conceptual contribution: it derives the identifying assumptions, specifies the estimation equation, characterises the conditions under which the design recovers a local average treatment effect, and identifies the threats to validity that district-clinic record systems pose. The contribution is a design that makes scheduling exposure estimable rather than assumed, and a set of propositions about when interval compression is likely to increase crisis relapse and when it is likely to be protective. The direction of the interval–relapse relationship is not a fixed clinical fact but a function of triage accuracy and caseload, and that regression-discontinuity estimation at the clinic threshold is the design best suited to recovering it.