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Paul Gill: The value of psychiatric liaison services

Paul Gill: The value of psychiatric liaison services



Dr Paul Gill, Consultant Psychiatrist at Sheffield Liaison Psychiatry Service, explains what liaison psychiatry is and how it can help provide better outcomes across secondary and acute points of ...

Dr Paul Gill, Consultant Psychiatrist at Sheffield Liaison Psychiatry Service, explains what liaison psychiatry is and how it can help provide better outcomes across secondary and acute points of care.



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    Paul Gill: The value of psychiatric liaison services Paul Gill: The value of psychiatric liaison services Presentation Transcript

    • The Value of Psychiatric Liaison Services
      Paul Gill
      Liaison Psychiatrist
    • The Value of Psychiatric Liaison Services
      Liaison Psychiatry
      Liaison teams
    • 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 …)
      • 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 recognised
      • under detected
      • under 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 management
      5% of inpatients account for
      40% of inpatients days
      10% inpatients account for
      55% of inpatient days
      Frequent admittees accounted for
      35.6% of all bed days
      FF = pts admitted/ subsequently
      readmitted 3x+ within 12 months (01-02)
      Dr Foster’s case notes. (2005) BMJ
      Effective management
      • 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?
      General hospital psychiatry – traditional view
      The sub-speciality of psychiatry that focuses on people with physical health problems, or who present with physical symptoms.
      Generally in acute hospital setting
      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)
      Consultant liaison psychiatrist
      (with doctors(s) in training)
      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:
      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
      • 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
    • 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:
      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?
      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
      Department of Health (1999) National Service Framework for Mental Health. Department of Health. London
      Royal College of Psychiatrists/British Association for Accident and Emergency Medicine (2004) Psychiatric services to accident and emergency services. Council Report CR118.
      De Leo D, Scocco et al (1999) Physical illness and parasuicide: evidence from the European Parasuicide Study Interview Schedule (EPIS/WHO-EURO). International
      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 Journal316:1714
      British Heart Foundation. (2005) British Heart Foundation Coronary HeartDisease Statistics. www.bhf.org.uk
      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 Cardiology24.5;637-51
      Lesperance, F. and Frasure-Smith, N. (2000) Depression in patients with cardiac disease: a practical review. Journal of Psychosomatic Research, 48, 379-391
      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
      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