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

Acute hospital wards: caring for people with mental health problems

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Kate Chartres summarises a recent qualitative study that provides a greater understanding of the experience of delivering care to people with mental health problems in an acute hospital.

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Advanced Decision-Making: promoting self-determination in mental health law

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Bethany Green summarises a report that recommends legal reform in England and Wales in regards to advanced decision-making in mental health.

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Psychosocial assessment, self-harm repetition and the role of the assessor

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Katherine Chartes reviews a cohort study comparing risk of repeat self-harm after psychosocial assessment, which suggests that psychosocial assessments can reduce re-attendance by 30% within a 12-month timeframe.

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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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