Skip to main content
×
×
Home

Liaison psychiatry services in Wales

  • Divya Sakhuja (a1) and Jonathan I. Bisson (a2)
Abstract
Aims and Method

To determine the nature of current liaison psychiatry services in Wales, a structured telephone interview was conducted with representatives of all 11 National Health Service trusts.

Results

Three trusts (27%) had no dedicated liaison psychiatry service and only one of the eight (13%) with a service had a full-time consultant liaison psychiatrist. Only two services (25%) had a full-time junior doctor and three (37%) were not multidisciplinary, comprising nursing staff alone. No team had a clinical psychologist and only two (25%) provided a psychological treatment service.

Clinical Implications

Liaison psychiatry services across Wales are fragmented, under-resourced and unlikely to meet patients' needs. They fall well short of the recommendations of the Royal Colleges of Physicians and Psychiatrists.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Liaison psychiatry services in Wales
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Liaison psychiatry services in Wales
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Liaison psychiatry services in Wales
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
Hide All
Bell, G., Reinstein, D.Z., Rajiyah, G., et al (1991) Psychiatric screening of admissions to an accident and emergency ward. British Journal of Psychiatry, 158, 554557.
Howe, A., Hendry, J. & Potokar, J. (2003) A survey of liaison psychiatry services in the south-west of England. Psychiatric Bulletin, 27, 9092.
Kewley, T. & Bolton, J. (2006) A survey of liaison psychiatry services in general hospitals and accident and emergency departments: do we have the balance right? Psychiatric Bulletin, 30, 260263.
Marchesi, C., Brusamonti, E., Borghi, C., et al (2004) Anxiety and depressive disorders in an emergency department ward of a general hospital: a control study. Emergency Medicine Journal, 21, 175179.
Mayou, R., Anderson, H., Feinmann, C., et al (1990) The present state of consultation and liaison psychiatry. Psychiatric Bulletin, 14, 321325.
Morgan, J. F. & Killoughery, M. (2003) Hospital doctors' management of psychological problems – Mayou & Smith revisited. British Journal of Psychiatry, 182, 153157.
Royal College of Physicians & Royal College of Psychiatrists (2003) The Psychological Care of Medical Patients: A Practical Guide (Council Report CR108). Royal College of Physicians & Royal College of Psychiatrists.
Ruddy, R. & House, A. (2003) A standard liaison psychiatry service structure? A study of the liaison psychiatry services within six strategic health authorities. Psychiatric Bulletin, 27, 457460.
Swift, G. & Guthrie, E. (2003) Liaison psychiatry continues to expand: developing services in the British Isles. Psychiatric Bulletin, 27, 339341.
Welsh Assembly Government (2005) Revised National Service Framework for Adult Mental Health Services in Wales: Raising the Standard. Welsh Assembly Government.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 7 *
Loading metrics...

Abstract views

Total abstract views: 46 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 20th July 2018. This data will be updated every 24 hours.

Liaison psychiatry services in Wales

  • Divya Sakhuja (a1) and Jonathan I. Bisson (a2)
Submit a response

eLetters

Value Your Liaison Psychiatry Service!

Dr Mukesh Kripalani, Specialist Registrar
23 April 2008

Value Your Liaison Psychiatry Service!

We completely support the conclusions of the article by Sakhuja and Bisson in the April 2008 edition of the Psychiatric bulletin. The state ofLiaison psychiatry services in Wales clearly falls well below the recommendations of the Royal College of Physicians and Psychiatrists, the National Service Framework for Mental Health in Wales and what patients should accept in our National Health Service.

With Primary and Secondary care mental health increasingly polarised between those with mild versus those with enduring mental health needs, there is a real risk of those with co-morbid physical and psychiatric disorders failing to get the care they need without Liaison Psychiatry.

The question is what does Liaison psychiatry contribute to this groupof patients? We would like to share some of our experiences on the ground with our Liaison service that has been established and run successfully over the last 12 years:-

•We have managed to reduce psychiatric in-patient admissions following self-harm to 10%, compared to 17% in other areas (data presentedas poster in Liaison Psychiatry Conference March 2008).

•Acute stress reaction/adjustment disorder (ASR/AR) is the second most common cause of admission at 34.7% following self harm in our unit (data presented as poster in Liaison Psychiatry Conference March 2008).

•Moreover of all the patients we see following self-harm, 38% overall fulfil DCR-10 criteria for ASR/AR (data presented as another poster in Liaison Psychiatry Conference March 2008).

•We have already shown that we meet all quality standard indicators for self-harm (http://pb.rcpsych.org/cgi/eletters/31/9/345#2990). Moreover Liaison psychiatry has been credited with a role in reduction in rates of hospital admission following self-harm (1).

•We get regular referrals from both Community Mental Health Teams and Primary Mental health care wherein one who doesn’t meet the enduring mental health criteria whereas the other too complex medically to handle in primary care.

•By providing services for those frequent attendees, somatisers and those suffering with hypochondriacal disorders we manage to reduce inappropriate and costly investigations, excessive use of precious acute beds and reduce frustration in general hospital colleagues.

•We provide training to nurses, doctors and allied health care professionals in the acute hospital such as to provide the best patient journey possible in the system. Our team allows psychiatric trainees valuable experience, which is highly sought in the era of the European working time directive!

•A successful service level agreement with palliative care continuesto underpin the importance of our service and recent invitation to be partof the occupational health team has given a major fillip to expansion plans for our team.

There is truly a different expertise and experience in Liaison Psychiatry teams to fulfil the special co-morbid needs of the acute hospital population and provide the seamless interface between secondary medical services, secondary psychiatric services and primary care servicesof a vulnerable cohort of patients who find themselves doubly disadvantaged. We believe these teams provide excellent value for money but due to stigma may be themselves under-appreciated in their work. Thereis enough feedback from patients, carers and general hospital colleagues to back the existence and support the expertise of a Liaison Psychiatry team and it’s only a matter of time before patients and their carers standup and demand appropriate care being made available to them.

References:

1.Wilkinson S, Taylor G, Templeton L, et al. Admissions to hospital for deliberate self-harm in England 1995-2000: an analysis of Hospital Episode Statistics. Journal of public health medicine. 2002 24 (3): 179-183 http://jpubhealth.oxfordjournals.org/cgi/reprint/24/3/179

Authors:Dr. Mukesh Kripalani, SpR Adult Psychiatry, Northern Deanery.

Dr. Amanda Gash, Consultant Liaison Psychiatrist, Tees, Esk and Wear Valley NHS Trust.

Lyn Williams, Nurse Consultant, Liaison Psychiatry, Tees, Esk and Wear Valley NHS Trust.

Acknowledgements:Staff and Patients of the Liaison Psychiatry team in Middlesbrough.

Declaration of Interest:All 3 work in the Liaison Psychiatry team.
... More

Conflict of interest: None Declared

Write a reply

Developing liaison psychiatry services: a training perspective.

Harinder Bains, Speciality Registrar (ST4)
14 April 2008

This study again highlights the gap in the provision of liaison psychiatry services. Despite there being a clear need for the development of liaison psychiatry in the detection and management of mental disorders (Semple, Brown and Irvine 1996), there is lack of clear definition of the role of these services and liaison psychiatry is seen to be a sub speciality which lacks substantial influence (Lloyd and Mayou 2003).

Lack of rational planning (Ruddy and House 2003), lack of funding, and difficulty in understanding the role and potential of liaison services(Lloyd and Mayou 2003) have been cited as some of the reasons limiting thegrowth of liaison services.

Talking from a trainee’s point of view, more training opportunities in liaison psychiatry would be an effective way of developing services. Training opportunities in liaison psychiatry remain scarce although recommendations have been made to improve undergraduate education and the psychological and psychiatric aspects of general patient care (Sharpe et al 1996).

I had very limited exposure to liaison psychiatry as a SHO apart fromseeing patients with deliberate self harm and overdoses in Accident and Emergency settings. Having now been in a liaison psychiatry placement, I have had the opportunity to see an array of medically unexplained symptoms, somatisation symptoms and functional symptoms, which has significantly enriched my abilities as a Psychiatrist. I therefore feel that such training opportunities should be offered to every psychiatry trainee. This would also help create an improved trained workforce and more Consultants. The lack of Consultants is possibly a major limiting factor in service development and this is reflected in the fact that despite the increase in the number of liaison consultants since 1996, the numbers still fall below that recommended by the Royal College of Psychiatrists (Swift and Guthrie 2003).

References:

Geraldine Swift and Else Guthrie.Liaison psychiatry continues to expand: developing services in the BritishIsles.Psychiatric Bulletin, Sep 2003; 27: 339 - 341.

Geoffrey G. Lloyd and Richard A. Mayou.Liaison psychiatry or psychological medicine?.The British Journal of Psychiatry, Jul 2003; 183: 5 - 7.

Margaret Semple, David Brown, and Elizabeth Irvine.Liaison psychiatry in detection and management of mental illness.Psychiatric Bulletin, Aug 1996; 20: 466 - 469

Rachel Ruddy and Allan House.A standard liaison psychiatry service structure?: A study of the liaison psychiatry services within six strategic health authorities.Psychiatric Bulletin, Dec 2003; 27: 457 – 460

Sharpe, M., Guthrie, E., Pevelar, R., et al (1996). The psychologicalcare of medical patients: a challenge for undergraduate medical education.Journal of The Royal College of Physicians of London, 30, 202-204.

Declaration of interest: Dr Harinder Bains is currently in a ST4 placement in Liaison Psychiatry
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *