Evaluation of consultation liaison psychiatry in Australian public hospitals (AU-CLS-1)

Abstract

Objective This study aimed to determine whether consultation liaison psychiatric service (CLS) staffing within Australian public hospitals meet national and international minimum staffing standards. Method Semi structured interviews were conducted with CLS Directors across Australia from August to December 2021. Data were collected on demographics, staffing, funding, hospital size and admissions. Results The majority of services did not meet minimum standards for CLS staffing. Non-medical staff outnumbered medical staff with increasing rurality. Psych-oncology CLS had the greatest resources, skill mix and service breadth. Conclusion Although CLS are heterogeneous, most services are inadequately resourced to provide baseline specialist mental health care in Australian hospitals. Establishing national minimum standards for CLS staffing will facilitate uniform service development and quality care provision.

Broadening the state of play – the second national survey of Consultation-Liaison Psychiatry services in New Zealand, 2021

“…Heterogeneity is reflected in variations in coverage of age groups, the ED, and outpatients in particular. Heterogeneity was also found in a recent Australian survey, 4 suggesting heterogeneity in CLP is perhaps an Australasian problem. In contrast, CLP in England is based on a clear, coherent four level service model 5 with 24/7 coverage of the ED as its foundation (Core/Core 24/Enhanced 24/Comprehensive).…”

“…Benchmarking CLP services by staffing levels is fraught with difficulty given that variations in service models, hours of operation, coverage of patient groups, sizes of hospitals and levels of activity make any comparison of services analogous to comparing apples and oranges. With that caveat, comparisons (see Tables 6 and 7) of CLPSNZ-2 with four recent western European national CLP surveys, 3,6–8 a recent Australian survey (AUCLS-1), 4 and the published minimum staffing levels for England 5,9 and Australia 10 reveal just how under-resourced CLP services in NZ are (0.26 psychiatrist FTE and 1.10 clinician FTE per 100 inpatient beds).…”

A survey of the psychiatric care provided for medically ill older adults in general hospitals in New Zealand

“…4–7 National English surveys in 2003 4 and 2015 5 chronicled both the expansion of CLP services to cover all 170 acute hospitals with EDs, and a major shift in service provision for older adults from mainly sectorised POA in-reach services (73% in 2003) to mainly generic adult CLP services (76% in 2015, while 24% had specialist CLPOA services). Australia 6 is similar to England in that a generic adult CLP service is the most common model (72%), but similar to NZ in that POA in-reach, coverage split or shared between CLP and POA in-reach, specialist CLP services for older adults and no service at all, were all also described. In Ireland, 7 consultation by POA in-reach on a sessional basis remains the dominant model, with mainly psychiatrists and registrars, infrequent coverage of the ED, and few proactive or educational initiatives.…”

“…This mix of service models is consistent with the previous NZ survey 3 and in line with international surveys. [4][5][6][7] National English surveys in 2003 4 and 2015 5 chronicled both the expansion of CLP services to cover all 170 acute hospitals with EDs, and a major shift in service provision for older adults from mainly sectorised POA in-reach services (73% in 2003) to mainly generic adult CLP services (76% in 2015, while 24% had specialist CLPOA services). Australia 6 is similar to England in that a generic adult CLP service is the most common model (72%), but similar to NZ in that POA in-reach, coverage split or shared between CLP and POA in-reach, specialist CLP services for older adults and no service at all, were all also described.…”

Towards integrated Consultation-Liaison Psychiatry for older adults in New Zealand

“…In Ireland (Gallagher et al, 2015), consultation by POA in-reach on a sessional basis was the dominant model, with staffing consisting mainly of psychiatrists and registrars, infrequent coverage of the emergency department and few proactive or educational initiatives. The situation in Australia (Flavel et al, 2022), where coverage of older adults by a generic or all-age CLP service was the most common model (72%), but POA in-reach, coverage split or shared between CLP and POA in-reach, specialist CLP services for older adults and no service at all, were also described, closely mirrored New Zealand.…”