Every acute hospital needs a liaison psychiatry service to manage the mental health needs of patients being treated primarily for physical health conditions, according to a new report published recently by the Royal College of Psychiatrists. Implementing liaison services could improve quality of care for patients, reduce rates of readmission, decrease length of stay, and save trusts millions of pounds.
The report, Liaison psychiatry for every acute hospital, 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.
According to the report, at any one time 30-60% patients in any one general hospital will have problems related to their mental health – a figure much higher than is found in the general population. 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 one in three 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 mental health staff – work with general hospital staff to improve the quality of care, reduce stigma and contribute to better clinical outcomes in people with a wide range of physical conditions.
Research shows that having a liaison service in place can have financial benefits for hospitals by reducing patients’ length of stay, reducing rates of readmissions and investigations, and improving the care of people with medically unexplained symptoms, dementia and long-term conditions.
The report makes a series of recommendations on how liaison services should be designed, including:
- Liaison psychiatry services should be funded and planned in conjunction with physical services, so that both the physical and mental health problems of patients 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.”