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An analysis of whether a working-age ward-based liaison psychiatry service requires the input of a liaison psychiatrist

  • Elspeth A. Guthrie (a1), Aaron T. McMeekin (a2), Sylvia Khan (a3), Sally Makin (a4), Ben Shaw (a5) and Damien Longson (a6)...
Abstract
Aims and method

This article presents a 12-month case series to determine the fraction of ward referrals of adults of working age who needed a liaison psychiatrist in a busy tertiary referral teaching hospital.

Results

The service received 344 referrals resulting in 1259 face-to-face contacts. Depression accounted for the most face-to-face contacts. We deemed the involvement of a liaison psychiatrist necessary in 241 (70.1%) referrals, with medication management as the most common reason.

Clinical implications

A substantial amount of liaison ward work involves the treatment and management of severe and complex mental health problems. Our analysis suggests that in the majority of cases the input of a liaison psychiatrist is required.

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Copyright
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Aaron T. McMeekin (aaronmcmeekin@nhs.net)
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Declaration of interest

None.

Footnotes
References
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1 Tadros, G, Salama, RA, Kingston, P, Mustafa, N, Johnson, E, Pannel, R, et al. Impact of an integrated rapid response psychiatric liaison team on quality improvement and cost savings: the Birmingham RAID model. Psychiatrist 2013; 37: 410.
2 Barrett, J, Aitken, P, Lee, W. Report of the 2nd Annual Survey of Liaison Psychiatry in England. Royal College of Psychiatrists, 2015 (crisiscareconcordat.org.uk/wp-content/uploads/2015/10/2a-Report-of-the-2nd-Annual-Survey-of-Liaison-Psychiatry-in-England-20-.pdf).
3 Aitken, P, Robens, S, Emmens, T. Liaison Psychiatry Services – Guidance. Devon Partnership NHS Trust, 2014.
4 World Health Organization. ICD-10 Classification of Mental and Behavioural Disorders Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
5 Creed, F, Guthrie, E, Black, D, Tranmer, M. Psychiatric referrals within the general hospital: comparison with referrals to general practitioners. Br J Psychiatry 1993; 162: 204–11.
6 Who Cares Wins. Improving the Outcome for Older People Admitted to the General Hospital: Guidelines for the Development of Liaison Mental Health Services for Older People. Royal College of Psychiatrists, 2005.
7 Aitken, P, Robens, S, Emmens, T, (eds). Model Service Specifications for Liaison Psychiatry Services – Guidance for Commissioning Support. Devon Partnership NHS Trust, 2014. Available at http://mentalhealthpartnerships.com/resource/model-service-specifications-for-liaison-psychiatry-services/ (accessed 5 September 2016).
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BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
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An analysis of whether a working-age ward-based liaison psychiatry service requires the input of a liaison psychiatrist

  • Elspeth A. Guthrie (a1), Aaron T. McMeekin (a2), Sylvia Khan (a3), Sally Makin (a4), Ben Shaw (a5) and Damien Longson (a6)...
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eLetters

Psychiatrists are doctors.

John T Elliott, Retired Consultant Psychiatrist, Fellow of Royal College of Psychiatrists
05 October 2017

Guthrie et al (1) emphasise the importance of psychiatry as a necessary speciality within the setting of a general hospital trust. As I have previously indicated (2), this was the recommendation of the 1957 Mental Health Act. All other specialities had already recognised the need for readily available consultation with colleagues in other disciplines in order to continue professional education, provide appropriate clinical care, and to facilitate better interaction with the local population and its primary care services. Few single-speciality hospitals survive.

What more can one do to identify psychiatrists as doctors whose role is to detect treatable disease within the brain?

It is the lack of clarity between treatable disease and manageable ill health that lay behind the stigma attached to various afflictions over the centuries, for example epilepsy, cancer, tuberculosis, and venereal disease. Sadly, the common view of mental pathology and its treatment has become limited to within the relatively impregnable boundaries of the skull, and hence the stigma of psychiatry lingers on.

The immense progress in investigative technology should make it incumbent upon psychiatrists, as doctors, to challenge the prevailing and destructive myths that obfuscate the distinction between mental illness and mental ill health. ‘Mental Health’ is a continuum that is preserved by the employment of individual and social – not medical – resources, until such time as the brain itself becomes diseased.

REFERENCES

(1)Guthrie, E. et al. An analysis of whether a working-age ward-based liaison psychiatry service requires the input of a liaison psychiatrist. BJPsych Bull Jun 2017, 41 (3) 151-155

(2)Elliott, JT. Liaison psychiatry: a brief history. BJPsych Bull Dec 2016, 40 (6) 348-349

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Conflict of interest: None Declared

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