Paul Gill: The value of psychiatric liaison services
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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.
    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