Every acute hospital needs a liaison psychiatry service to manage the mental health needs of patients being treated primarily for physical health conditions, a new report has claimed.
The report, Liaison psychiatry for every acute hospital, by the Royal College of Psychiatrists, says that implementing liaison services could improve quality of care for patients, reduce rates of readmission, decrease length of stay, and save trusts millions of pounds.
At any one time 30-60% patients in general hospital will have problems related to their mental health – a figure much higher than in the general population, according to the report. The most common mental health problems in general hospital patients are self-harm, depression, dementia and alcohol-related disorders. But many acute hospital staff lack the training, knowledge and skills to recognise and manage these conditions. Indeed, almost 1 in 3 liaison psychiatry staff (33%) believe this has adversely affected patient care.
Liaison psychiatry teams – which should include psychiatrists, mental health nurses, mental health pharmacists and other specialist staff – work with general hospital staff to improve the quality of care, reduce stigma and contribute to better clinical outcomes in people with a range of physical conditions.
This report has the backing of six other professional bodies: the College of Emergency Medicine, College of Mental Health Pharmacy, Royal College of General Practitioners, Royal College of Nursing, Royal College of Physicians and the Society for Acute Medicine.
Research shows that having a liaison service in place can have financial benefits for hospitals by reducing patients’ length of stay, decreasing rates of readmissions and investigations, and improving the care of people with medically unexplained symptoms, dementia and long-term conditions.
The report makes recommendations on how liaison services should be designed, including:
• Liaison psychiatry services should be funded and planned in conjunction with physical services, so that patients’ physical and mental health problems can be well managed
• Patients in acute hospitals should have equitable access to a consultant psychiatrist for mental health problems, as well as to a consultant for their physical health
• All liaison psychiatry service functions should be provided five days a week, and all emergency or urgent clinical problems should be covered seven days a week
• Liaison services should aim for a maximum response time of within 1 hour for emergency referrals and 1 day (usually within 5 working hours) for urgent referrals.
Dr Janet Butler, joint chair of the working group that produced the report and member of the RCPsych Faculty of Liaison Psychiatry, said: “This report shows that liaison psychiatry is a crucial service for every acute hospital. This will improve quality of care and safety for patients as well as improving efficiency that is vital to the sustainability of our hospital systems.”
Dr Anne Hicks, joint chair of the working group and representative of the College of Emergency Medicine, said: “There is an unprecedented support nationally for developing liaison psychiatry as an essential component of a modern, acute hospital. This important document provides a bedrock to help inform people’s delivery of liaison psychiatry.”
Dr Alistair Douglas, president of the Society for Acute Medicine, added: “This report highlights the need for improvement in supporting doctors and nurses working in acute hospitals (i.e. those with acute medical units and/or A&E departments) to manage patients with physical illnesses who have also serious mental health needs. These can be some of the most challenging patients to treat well and in the majority of hospitals current services are patchy, fragmented and often difficult to access. Adopting the guidelines in this report will go a long way to achieving better care for these patients in line with the Society for Acute Medicine's Quality Standard.”