A programme theory for liaison mental health services in England

Abstract

BackgroundMechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. A small number of logic models have been developed, but they fail to capture the complexity of clinical practice.MethodWe synthesised data from a variety of sources including a large national survey, 73 in-depth interviews with acute and liaison staff working in hospitals with different types of liaison mental health services, and relevant local, national and international literature. We generated logic models for two common performance indicators used to assess organisational outcomes for LMHS: response times in the emergency department and hospital length of stay for people with mental health problems.ResultsWe identified 8 areas of complexity that influence performance, and 6 trade-offs which drove the models in different directions depending upon the balance of the trade-off. The logic models we developed could only be captured by consideration of more than one pass through the system, the complexity in which they operated, and the trade-offs that occurred.ConclusionsOur findings are important for commissioners of liaison services. Reliance on simple target setting may result in services that are unbalanced and not patient-centred. Targets need to be reviewed on a regular basis, together with other data that reflect the wider impact of the service, and any external changes in the system that affect the performance of LMHS, which are beyond their control.

Impact of transforming mental health services for young people in England on patient access, resource use and health: a quasi-experimental study

“…However, attempts to improve one may have consequences elsewhere in the system. Such trade-offs have been illustrated with reference to, for instance, liaison mental health services 29. In particular, this study finds evidence of an increase in access alongside an increase in the waiting time for a second contact, suggesting the increased workload brought about by the transformation was not fully matched by sufficient capacity further along the system.…”

Typology of Psychiatric Emergency Services in the United Kingdom: A narrative literature Review

“…Mental Health Liaison Service (MHLS) aims to provide assessment and treatment for individuals in hospitals with co-morbid physical illness and mental health problems [28][29]. MHLS is not a new concept, and has been described in literature since the 1970s [30].…”

“…MHLS is not a new concept, and has been described in literature since the 1970s [30]. However, the increasing presentation of co-morbid physical and mental illness at A & E and inpatients have further drawn attention to this concept [29][30]. In fact, Plumridge and Reid [31] stated that 28% of acute inpatients have co-morbid mental health problems with physical illness, this number increases to 60% if older patients with delirium and dementia are included.…”

“…In fact, Plumridge and Reid [31] stated that 28% of acute inpatients have co-morbid mental health problems with physical illness, this number increases to 60% if older patients with delirium and dementia are included. Furthermore, the recognition that health care professionals may not be skilled enough to manage the needs of mental health patient has increased the need for MHLS [29].…”

Mental health in South East London general hospitals: using electronic patient records to explore associations between psychiatric diagnoses and length of stay in a patient cohort receiving liaison psychiatry input

“…18 However, policy documents do not recommend how services might gain insight into local need. An ongoing liaison psychiatry collaborative evaluation 19 recommend service audits may be used to identify ‘resource intensive’ patient groups that can then inform ongoing service development.…”