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A survey of liaison psychiatry services in general hospitals and accident and emergency departments: do we have the balance right?

  • Tamsin Kewley (a1) and Jim Bolton (a1)
Abstract
Aims and Method

By use of a telephone survey, we aimed to investigate liaison psychiatry services of all 29 general hospitals in Greater London. We specifically enquired about services to accident and emergency (A&E) departments.

Results

We identified wide variations in staffing, working hours and patient groups seen. Fourteen services (48%) worked over 24 h and 4 (14%) had specific A&E teams. Twelve services (41%) had established or planned working links with community crisis services.

Clinical Implications

Generally staff numbers fell below national recommendations and there were frequent gaps in service provision. The recent focus on emergency care has lead to an increase in A&E services, but there is a risk that liaison psychiatry services for other general hospital patients are being neglected.

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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
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Department of Health (1999) National Service Framework for Mental Health: Modern Standards and Service Models. London: Department of Health.
Department of Health (2001) Reforming Emergency Care: First Steps of a New Approach. London: Department of Health.
Howe, A., Hendry, J. & Potokar, J. (2003) A survey of liaison psychiatry services in the south-west of England. Psychiatric Bulletin, 27, 9092.
Mayor of London (2003) Availability of Mental Health Services in London. Highlights of a Report to the Mayor of London. London: Greater London Authority. http://www.london.gov.uk/mayor/health/mentalhealth_availability/mentalhealth_highlights.pdf
Royal College of Physicians & Royal College of Psychiatrists (2003) The Psychological Care of Medical Patients: A Practical Guide (Council Report CR108). London: 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.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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A survey of liaison psychiatry services in general hospitals and accident and emergency departments: do we have the balance right?

  • Tamsin Kewley (a1) and Jim Bolton (a1)
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eLetters

Insidious undermining of the utility of the liaison nursing role

Alexandra L Pitman, SHO in Psychiatry
05 October 2006

Kewley and Bolton’s survey of London liaison psychiatric services raises concerns that government pressures to observe four-hour targets in Accident & Emergency may have compromised liaison input to other general hospital patients1. Almost all teams surveyed fell short of College recommendations regarding service provision2 and the recent threats to liaison services in Oxford and London suggest that resources will not become available to meet these standards. Compounding this issue is the trend towards mergers of Crisis Resolution Teams with Liaison Psychiatric Nursing Teams to cut service costs. Community patients in crisis may tend to be prioritised over patients within the hospital, irrespective of the level of need. This undermines the skills specific to liaison nursing and their unique role in general hospitals.

Our recent audit at Chelsea & Westminster Hospital of the provision of psychosocial assessments to A&E patients presenting with suicidal thoughts or behaviours showed that 90% received full assessment by the liaison team or duty psychiatrist with plans for further action communicated to their GP (or CMHT)3. This level of service was achieved with a liaison nursing team managing 85% of out-of-hours clients without medical input, with implications not only for four-hour targets but also for the European Working Time Directive on junior doctors’ working hours. Any further threats to liaison services run counter to the government’s efforts to tackle suicide targets, to address the psychological needs of patients with cancer, HIV, neurological disorders, cardiovascular disease,and diabetes, and its obligation to uphold employment law.

References:

1 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; 260-3 http://pb.rcpsych.org/cgi/content/full/30/7/260

2 Royal College of Physicians and Royal College of Psychiatrists (2003) The psychological care of medical patients Report CR108. London: Royal College of Physicians and Royal College of Psychiatrists http://www.rcpsych.ac.uk/files/pdfversion/cr108.pdf

3 Audit report available from authors

Alexandra Pitman, SHO in Psychiatry, South Kensington and Chelsea Mental Health Centre, London SW10 9NG Email: alexandra.pitman@imperial.ac.uk

José Catalán, Consultant Psychiatrist, Psychological Medicine Unit, South Kensington and Chelsea Mental Health Centre, London SW10 9NG
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Conflict of interest: None Declared

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