liaison psychiatry

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Introduction

Liaison psychiatry is a subspecialty of general adult psychiatry which provides, as the name implies, a liaison, or advice and assessment service to general hospitals. The liaison psychiatry team usually consists of doctors, psychiatric liaison nurses (PLNs) and sometimes a team manager and administration staff. The team is usually based in or near the general hospital it provides services to (and may provide services to more than one hospital in the locality) and takes referrals from any department, including A&E.

What we already know

Liaison psychiatry is a fascinating area to work in, particularly as most of the patients referred have complex overlapping medical and psychiatric complaints. It is a relatively modern service model, gaining traction since the 1970s. It is estimated that 5% of all emergency department presentations are due to mental disorders.

In 2013 Tadros et al published data about a service model termed ‘RAID’ (Rapid Assessment, Interface and Discharge), which showed a total saving in bed days of 43-64 beds per day, by reducing length of stay and readmissions. The majority of bed savings were in elderly care wards. You can read more about that study here.

An economic evaluation based on this work estimated that a liaison psychiatry service in a typical 500-bed general hospital could generate savings of up to £5 million per year.

Areas of uncertainty

Not every general or acute hospital has an in-house liaison psychiatry service and it this is something that will need to be addressed in future. Teams are expanding their roles and are gradually moving into primary care settings, in addition to general hospitals, but uncertainty remains (as with most acute hospital services) about the future direction that liaison psychiatry may take.

What’s in the pipeline

The Psychiatric Liaison Accreditation Network (PLAN) aims to set standards for liaison psychiatry services to be commissioned and reviewed against, for example one criterion states that patients referred for emergency mental health care are seen within 60 minutes. As more liaison teams sign up for accreditation, the more that quality, safety and efficiency will improve according to these standards.

There remains variation in provision and, as the Centre for Mental Health described it, liaison psychiatry “needs to be recognised as a essential ingredient of modern health care”.

References

Tadros, G., Salama, R. A., Kingston, P., Mustafa, N., Johnson, E., Pannell, R., & Hashmi, M. (2013). Impact of an integrated rapid response psychiatric liaison team on quality improvement and cost savings: the Birmingham RAID model. The Psychiatrist, 37(1), 4–10. doi:10.1192/pb.bp.111.037366 [Abstract]

Acknowledgement

Written by: Josephine Neale
Reviewed by:
Last updated: Sep 2015
Review due: Sep 2016

Our liaison psychiatry Blogs

People with severe mental illness have more adverse outcomes from medical or surgical treatment

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Laoise Renwick considers the findings of a recent systematic review on the safety of service users with severe mental illness receiving inpatient care on medical and surgical wards.

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Quality of general hospital care through the liaison psychiatry lens?

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Kirsten Lawson explores a recent study of liaison psychiatry professionals’ views of general hospital care for patients with mental illness.

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Bridging the gap between mental and physical healthcare in general hospitals #TreatAsOne

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Kirsten Lawson presents the findings and recommendations of the recent National Confidential Enquiry into Patient Outcome and Death #TreatAsOne report.

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Antipsychotics for delirium in palliative care: new RCT suggests non-drug alternatives are needed

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Samei Huda highlights a recent RCT of antipsychotics (risperidone and haloperidol) versus placebo for symptoms of delirium in palliative care, which suggests we need non-drug alternatives for this group of patients.

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Depression and coronary heart disease: reasons to remain UPBEAT-UK

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Kirsten Lawson summarises the UPBEAT-UK programme of research into the relationship between coronary heart disease and depression and anxiety in primary care patients.

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Bringing together physical and mental health: King’s Fund report on integrated care

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Kirsten Lawson takes us through the key messages from the recent King’s Fund report on bringing together physical and mental health.

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Making parity a reality: RCPsych launch manifesto to improve the nation’s mental health

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The Royal College of Psychiatrists have launched a new manifesto today, which calls on the next government to ensure that mental and physical health are given equal value. André Tomlin summarises the key aims and reflects on what has changed in the world of mental health in the 3 years since the Mental Elf was launched.

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The cost-effectiveness of liaison psychiatry: the case of RAID

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Liaison psychiatry brings together medical and psychiatric staff in hospital wards and emergency departments, with the aim of more adequately addressing comorbidities between physical and mental health. It’s something that’s been discussed in the Woodland before, with recommendations for wider implementation. The Guardian recently published an article discussing the findings of a recent study and [read the full story…]

Liaison Psychiatry for all!!

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When I am not being an elf, I am very proud to work within Liaison Psychiatry and to be actively developing Liaison services across Kent and Medway. For those of you who haven’t come across Liaison before,  we work within the overlapping area between physical health and mental health, so dealing with physical health problems and [read the full story…]

New NHS Confederation briefing on the future of liaison psychiatry

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The NHS Confederation have published a new report on liaison psychiatry services that has been written by the Centre for Mental Health. Liaison psychiatry is concerned with the interface between medicine and psychiatry and typically involves patients with medical conditions that also result in psychiatric or behavioural symptoms, such as delirium. The study set out [read the full story…]