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Examines the knowledge and expectations of patients newly referred to one hospital psychiatric clinic. A total of 57 adults completed a structured questionnaire before their first outpatient appointment. The casenotes of all 45 non‐anonymous respondents were reviewed six months later, to discover how their expectations regarding management compared with reality. Forty‐four (77 per cent) referrals expected to see a doctor who dealt with mental health and emotional problems, 41 (72 per cent) anticipated that their problem was treatable, and 41 (72 per cent) wanted, primarily, a chance to talk. Thirty‐four respondents (61 per cent) significantly underestimated their actual appointment duration. Patients received psychotropic medication or were referred to another mental health professional twice as often as they expected. Nevertheless, 25 out of 35 patients (71 per cent) correctly predicted their broad clinical management. Patients are becoming more informed users of mental health care services. Addressing their attitudes and expectations directly at the first outpatient attendance may help in predicting final clinical outcome, and assist in the efficient management of limited resources.

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