We were interested that a recent editorial in The Lancet used a model of referral to specialist psychiatric services from 1980 (Reference Peen and DakkerPeen & Dakker, 2004). The original model (Reference Goldberg and HuxleyGoldberg & Huxley, 1980) has been refined (Reference GoldbergGoldberg, 1995). One important prediction it makes is the number of adults who will be in contact with the totality of specialist mental health services. We decided to test the relevance of this model for north-east Edinburgh in 2003.

We received 1390 new referrals from the population aged 18-64 years inclusive. (Our records were hand-searched to ensure each individual was counted only once.) This is equivalent to 2.3% of the catchment population in 1 year, or 230 people per 10 000 population (95% confidence interval 220-240). The model predicts a figure of 208 adults in contact with the totality of specialist mental health services.

We conclude that the model substantially underestimated the utilisation of specialist psychiatric services. It would take a great deal more work to calculate the variance; we would have to add to the patients newly referred, patients already known to our own service, services for the elderly, NHS psychotherapy, and clinics for people with alcohol, drug and eating problems.

We do not know to what extent our findings can be generalised. We only hope that those who purchase general adult psychiatric services are not doing so on the basis of this model.