The nature and activity of liaison mental services in acute hospital settings: a multi-site cross sectional study

Abstract

Background: To describe the clinical activity patterns and nature of interventions of hospital-based liaison psychiatry services in England. Methods: Multi-site, cross-sectional survey. 18 acute hospitals across England with a liaison psychiatry service. All liaison staff members, at each hospital site, recorded data on each patient they had face to face contact with, over a 7 day period. Data included location of referral, source of referral, main clinical problem, type of liaison intervention employed, staff professional group and grade, referral onto other services, and standard assessment measures. Results: A total of 1475 face to face contacts from 18 hospitals were included in the analysis, of which approximately half were follow-up reviews. There was considerable variation across sites, related to the volume of Emergency Department (ED) attendances, number of hospital admissions, and work hours of the team but not to the size of the hospital (number of beds). The most common clinical problems were co-morbid physical and psychiatric symptoms, self-harm and cognitive impairment. The main types of intervention delivered were diagnosis/formulation, risk management and advice. There were differences in the type of clinical problems seen by the services between EDs and wards, and also differences between the work conducted by doctors and nurses. Almost half of the contacts were for continuing care, rather than assessment. Eight per cent of all referrals were offered follow up with the LP team, and approximately 37% were referred to community or other services. Conclusions: The activity of LP services is related to the flow of patients through an acute hospital. In addition to initial assessments, services provide a wide range of differing interventions, with nurses and doctors carrying out distinctly different roles within the team. The results show the volume and diversity of LP work. While much clinical contact is acute and confined to the inpatient episode, the LP service is not defined solely by an assessment and discharge function; cases are often complex and nearly half were referred for follow up including liaison team follow up.

Experiences of care for self-harm in the emergency department: comparison of the perspectives of patients, carers and practitioners

“…In this study, practitioners spoke of the extensive documentation required for each assessment they conducted, often spending twice as long documenting an assessment than time spent with the person, in line with findings from previous studies. 5,7 Mental health record systems have been described as being unfit for purpose for high-volume, low-contact services such as the emergency department, compared with mental health services who have smaller case-loads and ongoing patient contact. 7 This in part explained the formulaic question-and-answer style assessments that were perceived as superficial by patients.…”

“…UK hospitals have sought to meet such complexity through liaison psychiatry services, which are now well established in acute hospitals. 5 Medical needs are addressed by generalist emergency department practitioners and practitioners from liaison psychiatry teams offer a psychosocial assessment, following National Institute for Health and Care Excellence (NICE) guidelines. 6…”

Consultation-Liaison Psychiatry Services in Ireland: A National Cross-Sectional Study

“…Where hospitals have data and information systems in place it allows for a more granular examination of the work of the CLP service ( 27 , 28 ). Universal information systems would allow comparisons to be made to similar work conducted internationally, and to establish whether the work of Irish CLP differs from other countries, and where it needs to be improved ( 25 , 29 , 30 ). The data available suggests very high levels of clinical activity, compared to other areas of mental health services.…”

Psychiatric liaison service referral patterns during the UK COVID-19 pandemic: An observational study

“…All liaison psychiatry services in the sector are designated “Core 24”, providing services 24 h per day for a hospital with an ED, but do not do outpatient work. 4 , 10 ( Table 1 ).…”