Liaison psychiatry professionals' views of general hospital care for patients with mental illness

Noblett, Joanne; Caffrey, Alison; Deb, Tanya; Khan, Abdul Qadir; Lagunes-Córdoba, Emmeline; Gale‐Grant, Oliver; Henderson, Claire

doi:10.1016/j.jpsychores.2017.02.004

Cited by 26 publications

(31 citation statements)

References 10 publications

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“…Patients with bipolar disorder may not be offered diagnostic procedures or treatment for somatic diseases simply because of the psychiatric diagnosis per se or because they are unable to follow current treatment regiments due to the disorder. In general, there is data supporting a less positive attitude towards patients with SMI resulting in poor communication, disregard for patients’ dignity and delays in investigation or treatment in the physical treatment setting (Happell et al 2012; Neupane et al 2016; Noblett et al 2017), as well as in the community (Mirnezami et al 2016). Several experts have proposed the initiation of coordinated or combined treatment options with collaboration between specialized psychiatric and somatic care for patients with SMI to increase the likelihood of optimal treatment as well as reducing attrition rates of patients treated (Fleischhacker et al 2008; Nielsen and Licht 2018).…”

Section: Discussionmentioning

confidence: 99%

Why are somatic diseases in bipolar disorder insufficiently treated?

Nielsen

Kugathasan

Straszek

et al. 2019

Int J Bipolar Disord

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Background Somatic diseases, including cardiovascular, respiratory, and cancer diseases, are the main contributors to a shortened life expectancy of 10–20 years in patients with bipolar disorder as compared to the general population. In the general population an increase in survival has been observed over the last decades, primarily due to the advances in primary prophylaxis, medical treatment and progress in early detection and monitoring of somatic diseases. In this narrative review, we discuss the existing literature on treatment and outcomes of cardiovascular, respiratory, and cancer diseases in patients with bipolar disorder, and put this in the context of findings in studies on patients diagnosed with other severe mental disorders. Main body The existing literature suggests that patients with bipolar disorder receive fewer or delayed medical interventions, when admitted with severe somatic diseases, compared to those not diagnosed with bipolar disorder. Cardiovascular disease is the most investigated disease regarding outcomes in patients with severe mental illness, and novel findings indicate that the increased mortality following cardiac events in these patients can be reduced if they are intensively treated with secondary prophylactic cardiac intervention. Elderly patients diagnosed with mental disorders and cancer experience a delay in receiving specific cancer treatment. No studies have investigated treatment outcomes in patients with severe mental disease and respiratory diseases. Conclusion It is surprising and of major concern that patients with bipolar disorder have not benefitted from the significant improvement that has taken place over time over time of somatic treatments in general, especially in countries with equal and free access to healthcare services. Therefore, no matter whether this situation is a result of a negative attitude from health care providers to patients with mental illness, the result of the patient’s lack of awareness of their physical illness or the results of other factors, further attention including research on developing strategies for improving the management of somatic diseases in patients with bipolar disorder is needed.

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Section: Discussionmentioning

confidence: 99%

Why are somatic diseases in bipolar disorder insufficiently treated?

Nielsen

Kugathasan

Straszek

et al. 2019

Int J Bipolar Disord

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“…This upskilling will potentially include unlearning the rigidity of strict clinical specialism [ 49 ]. Additionally, health professionals will need to rely on collaboration skills for practices such as effective engagement between general hospital staff and psychiatric liaison teams [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Hospital length of stay variation and comorbidity of mental illness: a retrospective study of five common chronic medical conditions

Siddiqui

Dwyer

Stankovich

et al. 2018

BMC Health Serv Res

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BackgroundWith the increasing burden of mental illness globally, it is becoming common for hospitalised patients with chronic medical conditions to have a comorbidity of mental illness. This combination could prolong length of stay (LOS) of this patient cohort. We conducted an investigation in Tasmania, Australian hospitals to characterise this cohort and assess if co-morbidity of mental illness is a distinguishing factor that generates LOS variation across different chronic medical conditions.MethodsThe retrospective study analysed 16,898 admissions of patients with a primary diagnosis of one of five chronic medical conditions: lung or colorectal cancer, chronic obstructive pulmonary disease (COPD), type II diabetes, ischaemic heart disease (IHD) and stroke. Data were from July 2010 to June 2015, across four hospitals that collectively cover 95% of public hospital admissions in Tasmania, Australia. Descriptive statistics were used to compare characteristics of patients between the scenarios of with and without co-morbidity of mental illness. We used negative binomial regression models to assess whether co-morbidity of mental illness, along with its sub-types, after adjustment for potential confounding variables, associated with LOS variation in patients of each medical condition. Based on the adjusted LOS variation, we estimated differences in bed days’ use between patients with and without comorbidity of mental illness.ResultsPatients with co-morbidity of mental illness were significantly younger in comparison to patients without mental illness. With each medical condition, patients with comorbidity of mental illness had incurred higher bed days’ use than for those without mental illness. In cancer and stroke cohorts, co-morbidity of mental illness unfavourably affected the LOS variation by as high as 97% (CI: 49.9%–159%) and 109% (78%–146%), respectively. Though mental and behavioural disorders due to psychoactive substances was a dominant sub-type of mental illness across the medical conditions, it contributed significant unfavourable LOS variation only in the stroke patients i.e. 36.3% (CI: 16.2%–59.9%).ConclusionsMental illness consistently produced unfavourable LOS variation. Upskilling of healthcare teams and greater reporting and analysis of LOS variation for this patient cohort, and the sub-cohorts within it, are necessary to provide improved medical care and achieve system efficiencies.

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“…Therefore, their responsibilities are constrained, as their patient contact is characterised by unplanned encounters, rather than by pre-planned care. Noblett et al (2017) suggest a way round this problem is by 'diluting' the team, and spreading the individuals around the ward areas, giving them a more visible presence.…”

Section: Implications For Practicementioning

confidence: 99%

Evaluation of a mental health liaison team. Part 2: the themes and their effect on practice

et al. 2017

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Hospitals and emergency departments (EDs) are caring for increasing numbers of patients who present with underlying mental health issues. Managing these patients can be challenging for clinical staff who often lack the specialist knowledge and skills required to provide appropriate care. This article, part two of two on the evaluation of a newly formed mental health liaison team (MHLT) working in a general hospital, focuses on the perceptions and experiences of the MHLT participants, and explores three sub-themes derived from the interview data. The article considers the effect of these themes on practice, and the relationship between MHLT members and staff in EDs and the wider hospital.

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Liaison psychiatry professionals' views of general hospital care for patients with mental illness

Cited by 26 publications

References 10 publications

Why are somatic diseases in bipolar disorder insufficiently treated?

Why are somatic diseases in bipolar disorder insufficiently treated?

Hospital length of stay variation and comorbidity of mental illness: a retrospective study of five common chronic medical conditions

Evaluation of a mental health liaison team. Part 2: the themes and their effect on practice

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