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.

1. The Value of Psychiatric Liaison Services Paul Gill Liaison Psychiatrist Sheffield

2. The Value of Psychiatric Liaison Services Background Liaison Psychiatry Description Role Liaison teams Activities PLAN Benefits

3. 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”

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

5. 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

8. Unnoticed

9. Poorly managedChoosing Health : supporting the physical health needs of people with severe mental illness: commissioning framework. DoH. 2006

11. Death following a heart attack 6

12. Cardiac events following bypass surgery 7

14. under detected

18. 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

19. 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

20. 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

21. 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

22. 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

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

25. To give funding bodies the confidence to invest in liaison services

26. To foster a network of joint learning and support 16

27. The PLAN audit cycle

29. Input to A&E and CDU only

30. Self harm assessments only

31. Input to particular directorates only

32. Service to:Inpatients Outpatients Primary care Services vary regarding: Age ranges covered Disciplines involved Therapeutic options available

33. 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

34. 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

35. 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

36. Thank you