The Value of Psychiatric Liaison Services

Paul GillLiaison PsychiatristSheffield

The Value of Psychiatric Liaison Services

Background Liaison Psychiatry

Description Role Liaison teams Activities PLAN Benefits

Why focus on psychological/psychiatric care?

NHS Choice Consultation Survey Recurring theme

“We want an NHS that meets not only our physical needs but our

emotional ones too”

Experience of being ill is always more than simply a physical event

People with physical illness

Twice the rate of mental health problems, compared to general population 1

Identified as a vulnerable group in NSF for Mental Health

Fourfold risk of self harm 2,3

People with severe mental illness

Excessive morbidity and mortality from physical health problems

Almost twice as likely to die from heart disease

Four times as likely to die from respiratory disease

Physical health needs likely to be Unrecognised Unnoticed Poorly managed

Choosing Health : supporting the physical health

needs of people with severe mental illness:commissioning framework. DoH. 2006

Depression and heart disease Having

depression is an independent risk factor

(i.e. even after controlling for smoking, obesity …)

for:

Risk of developing heart disease (quadruples risk) 5

Death following a heart attack 6

Cardiac events following bypass surgery 7

Preoperatively - for mortality following cardiac valve surgery 8

But

Depression in patients with heart disease is:under recognisedunder detectedunder treated

Lesperance & Frasure-Smith 2000

Importance of psychological care stressed:Kennedy Report, Local Reports (e.g.

Cantrill)

Increasingly addressed:

NSFs, NICE Guidance, DoH CDM strategy, Primary care QOFs

Chronic disease management5% of inpatients account for 40% of inpatients days

10% inpatients account for55% of inpatient days

DoH 2004

Frequent admittees accounted for 35.6% of all bed daysFF = pts admitted/ subsequently readmitted 3x+ within 12 months (01-

02)

Dr Foster’s case notes. (2005) BMJ

Effective management

requires: Bio psychosocial

model Psychological

assessment of complex presentations

Manchester study

Frequent attendees with depression or similar mental health problems incurred 46% greater health costs than physically ill patients who did not have a mental health problem

Costs - more A and E visits, longer stays, more visits to GPs…

People with chronic obstructive pulmonary disease were most likely to also have a mental health problem

HSJ, 2006

What is liaison psychiatry?

1) General hospital psychiatry – traditional view

2) The sub-speciality of psychiatry that focuses on people with physical health problems, or who present with physical symptoms.

1) Generally in acute hospital setting2) Increasingly, services are also working

with primary care

The role of liaison psychiatry

The provision of a mental health service, which understands, and is geared to, the needs of the acute hospital

Service should be prompt and practical

Provision of training on mental health issues to staff in the acute hospital

Advice about matters relating to mental health and capacity legislation

Liaison teams (per 750 acute beds)

Medical: Consultant liaison psychiatrist (with doctors(s) in training)

Nursing: Band 8 3X band 7’s

Clinical/health psychologist (Social workers, OT’s, etc)

PIG recommendations

Activities of liaison psychiatry services

Timely assessment & management of people who have harmed themselves: A&E Medical & surgical wards

Assessment & management of people with MH problems in acute hospital wards. Aim to assist in achieving optimal

management of physical condition May include advice about treatment for

physical condition

Activities of liaison psychiatry services

Use of Mental Health Act in the acute hospital

Advice about the use of the Mental Capacity Act

Involved in the decision making process in some cases of elective surgery

Part of MDT in managing complex cases with LTCs

Complex cases of medically unexplained symptoms

Aims of PLAN

• To help liaison teams consolidate and improve, year on year, meeting best practice standards and providing top quality care.

• To demonstrate the quality of care they provide to service users and carers, their wider organisation and commissioners.

• To give funding bodies the confidence to invest in liaison services

• To foster a network of joint learning and support 16

The PLAN audit cycle

Different types of liaison psychiatry service – current situation

• None at all• Input to A&E and CDU only• Self harm assessments only• Input to particular directorates only• Service to:

Inpatients Outpatients Primary care

Services vary regarding: Age ranges covered Disciplines involved Therapeutic options available

Benefits of Liaison Psychiatry Concurrent management of mental &

physical health problems: Better care Reduced utilisation of resources Reduced lengths of stay Reduced repeat admissions

Training acute hospital staff: Earlier identification of MH problems

Medically unexplained symptoms: Reduced utilisation of resources

Liaison Psychiatry in Acute Care

Can it be delivered by other MH teams? Generic? Crisis team?

Need to respond quickly Need to understand the needs of the

patients, & those of the acute hospital

Need to be able to work with the acute hospital team

References

1. Department of Health (1999) National Service Framework for Mental Health. Department of Health. London

2. Royal College of Psychiatrists/British Association for Accident and Emergency Medicine (2004) Psychiatric services to accident and emergency services. Council Report CR118.

3. De Leo D, Scocco et al (1999) Physical illness and parasuicide: evidence from the European Parasuicide Study Interview Schedule (EPIS/WHO-EURO). International

4. Hippisley-Cox J, Fielding K and Pringle M (1998) Depression as a risk factor for ischaemic heart disease in men: population based controlled study. British Medical Journal 316:1714

5. British Heart Foundation. (2005) British Heart Foundation Coronary Heart Disease Statistics. www.bhf.org.uk

6. Rosanski, A., Blumenthal, JA., Davidson, KW. et al. (2005) The Epidemiology, Pathophysiology, and Management of Psychosocial Risk Factors in Cardiac Practice: State of the Art Paper. J American College of Cardiology 24.5;637-51

7. Lesperance, F. and Frasure-Smith, N. (2000) Depression in patients with cardiac disease: a practical review. Journal of Psychosomatic Research, 48, 379-391

8. Connerney, I., Shapiro, PA., et al (2001) Relationship between depression after coronary artery bypass surgery and 12 month outcome: a prospective study. The Lancet, 38, 1766-1771

9. Leahy M, Douglass J, Jarman M, Barley V, Cooper G. Audiotaping the heart surgery consultation: qualitative study of patient’s experiences. Heart. 2005;91:1469-1470

Thank you