Paul Gill: The value of psychiatric liaison services

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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

  1. 1. The Value of Psychiatric Liaison Services<br />Paul Gill<br />Liaison Psychiatrist<br />Sheffield<br />
  2. 2. The Value of Psychiatric Liaison Services<br />Background<br />Liaison Psychiatry<br />Description<br />Role<br />Liaison teams<br />Activities<br />PLAN<br />Benefits<br />
  3. 3. Why focus on psychological/psychiatric care? <br />NHS Choice Consultation Survey<br />Recurring theme<br />“We want an NHS that meets not only our physical needs but our emotional ones too”<br />
  4. 4. Experience of being ill is always more than simply a physical event <br />
  5. 5. People with physical illness<br />Twice the rate of mental health problems, compared to general population 1<br />Identified as a vulnerable group in NSF for Mental Health <br />Fourfold risk of self harm 2,3<br />
  6. 6. People with severe mental illness <br />Excessive morbidity and mortality from physical health problems <br /><ul><li>Almost twice as likely to die from heart disease
  7. 7. Four times as likely to die from respiratory disease </li></ul>Physical health needs likely to be <br /><ul><li>Unrecognised
  8. 8. Unnoticed
  9. 9. Poorly managed</li></ul>Choosing Health : supporting the physical health <br />needs of people with severe mental illness:<br />commissioning framework. DoH. 2006<br />
  10. 10. Depression and heart disease<br />Having depression is an independent risk factor<br /> (i.e. even after controlling for smoking, obesity …)<br />for: <br /><ul><li>Risk of developing heart disease (quadruples risk)5
  11. 11. Death following a heart attack 6
  12. 12. Cardiac events following bypass surgery 7
  13. 13. Preoperatively - for mortality following cardiac valve surgery 8</li></li></ul><li>But<br />Depression in patients with heart disease is:<br /><ul><li>under recognised
  14. 14. under detected
  15. 15. under treated</li></ul>Lesperance& Frasure-Smith 2000<br /> Importance of psychological care stressed:<br /><ul><li>Kennedy Report,
  16. 16. Local Reports (e.g. Cantrill)</li></ul>Increasingly addressed:<br /><ul><li>NSFs, NICE Guidance, DoH CDM strategy, Primary care QOFs </li></li></ul><li>Chronic disease management<br />5% of inpatients account for <br />40% of inpatients days<br />10% inpatients account for<br />55% of inpatient days<br />DoH2004 <br />Frequent admittees accounted for <br />35.6% of all bed days<br />FF = pts admitted/ subsequently <br />readmitted 3x+ within 12 months (01-02)<br />Dr Foster’s case notes. (2005) BMJ <br />Effective management<br />requires: <br /><ul><li>Bio psychosocial model
  17. 17. Psychological assessment of complex presentations</li></li></ul><li>Manchester study <br />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 <br />Costs - more A and E visits, longer stays, more visits to GPs…<br />People with chronic obstructive pulmonary disease were most likely to also have a mental health problem <br />HSJ, 2006<br />
  18. 18. What is liaison psychiatry?<br />General hospital psychiatry – traditional view<br />The sub-speciality of psychiatry that focuses on people with physical health problems, or who present with physical symptoms.<br />Generally in acute hospital setting<br />Increasingly, services are also working with primary care<br />
  19. 19. The role of liaison psychiatry<br />The provision of a mental health service, which understands, and is geared to, the needs of the acute hospital<br />Service should be prompt and practical<br />Provision of training on mental health issues to staff in the acute hospital<br />Advice about matters relating to mental health and capacity legislation<br />
  20. 20. Liaison teams (per 750 acute beds)<br />Medical:<br />Consultant liaison psychiatrist<br />(with doctors(s) in training)<br />Nursing:<br />Band 8<br />3X band 7’s<br />Clinical/health psychologist<br />(Social workers, OT’s, etc)<br />PIG recommendations<br />
  21. 21. Activities of liaison psychiatry services<br />Timely assessment & management of people who have harmed themselves:<br />A&E<br />Medical & surgical wards<br />Assessment & management of people with MH problems in acute hospital wards.<br />Aim to assist in achieving optimal management of physical condition<br />May include advice about treatment for physical condition<br />
  22. 22. Activities of liaison psychiatry services<br />Use of Mental Health Act in the acute hospital<br />Advice about the use of the Mental Capacity Act<br />Involved in the decision making process in some cases of elective surgery<br />Part of MDT in managing complex cases with LTCs<br />Complex cases of medically unexplained symptoms<br />
  23. 23. Aims of <br />PLAN<br /><ul><li>To help liaison teams consolidate and improve, year on year, meeting best practice standards and providing top quality care.
  24. 24. To demonstrate the quality of care they provide to service users and carers, their wider organisation and commissioners.
  25. 25. To give funding bodies the confidence to invest in liaison services
  26. 26. To foster a network of joint learning and support </li></ul>16<br />
  27. 27. The PLAN audit cycle<br />
  28. 28. Different types of liaison psychiatry service – current situation<br /><ul><li>None at all
  29. 29. Input to A&E and CDU only
  30. 30. Self harm assessments only
  31. 31. Input to particular directorates only
  32. 32. Service to:</li></ul>Inpatients<br />Outpatients<br />Primary care<br />Services vary regarding:<br />Age ranges covered<br />Disciplines involved<br />Therapeutic options available<br />
  33. 33. Benefits of Liaison Psychiatry<br />Concurrent management of mental & physical health problems:<br />Better care<br />Reduced utilisation of resources<br />Reduced lengths of stay<br />Reduced repeat admissions<br />Training acute hospital staff:<br />Earlier identification of MH problems<br />Medically unexplained symptoms:<br />Reduced utilisation of resources<br />
  34. 34. Liaison Psychiatry in Acute Care<br />Can it be delivered by other MH teams?<br />Generic?<br />Crisis team?<br />Need to respond quickly<br />Need to understand the needs of the patients, & those of the acute hospital<br />Need to be able to work with the acute hospital team<br />
  35. 35. References<br />Department of Health (1999) National Service Framework for Mental Health. Department of Health. London <br />Royal College of Psychiatrists/British Association for Accident and Emergency Medicine (2004) Psychiatric services to accident and emergency services. Council Report CR118. <br />De Leo D, Scocco et al (1999) Physical illness and parasuicide: evidence from the European Parasuicide Study Interview Schedule (EPIS/WHO-EURO). International<br />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 <br />British Heart Foundation. (2005) British Heart Foundation Coronary HeartDisease Statistics. www.bhf.org.uk <br />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<br />Lesperance, F. and Frasure-Smith, N. (2000) Depression in patients with cardiac disease: a practical review. Journal of Psychosomatic Research, 48, 379-391<br />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<br />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<br />
  36. 36. Thank you<br />

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