Aims and method To develop a simple, pragmatic typology to characterise the nature of liaison interventions delivered by a liaison service in a National Health Service setting. We carried out a retrospective electronic case-note review of referrals to a ward-based liaison psychiatry service.Results Three hundred and forty-four patients were referred to the service over a 12-month period. Ten different types of liaison interventions were identified, with the most common interventions being diagnosis (112 patients, 32.6%), medication management (57 patients, 16.6%), risk assessment and treatment (56 patients, 16.3% each). Mental Health Act work accounted for the greatest number of contacts per patient (median 7).Clinical implications There are inherent limitations in any single-site observational study, as site-specific results cannot be generalised to other liaison services. The intervention categories we developed, however, are easy to use and will provide a way of comparing and benchmarking the range of interventions delivered by different liaison psychiatry services.
Aim/Purpose: Improving access to psychological therapies (IAPT) is a main provider of psychological therapy for adults within the NHS. NHS Digital (2016) reported the dropout rate in IAPT to be as high as 43%. Proctor (2014) found that unhelpful factors in therapy could contribute to the dropout rate. As CBT is the main modality in IAPT, it is important to explore unhelpful factors in CBT as they might be contributing to the dropout rate in IAPT.Design/Methodology: Nine clients (five men and four women) for whom CBT was not helpful were interviewed using a semi-structured protocol. The interviews were analysed using thematic analysis.Results/Findings: Six themes have been identified: 1) Difficulties with CBT itself (e.g.identifying and challenging negative thoughts and finding alternative evidence as well as homework); 2) Negative perception of therapists (e.g. queried if therapists were committed and had empathy); 3) Clients' unhelpful internal patterns (e.g. unrealistic expectations or feeling self-critical); 4) Physical health, mental health and psychosocial barriers (e.g. feeling too depressed or anxious to undertake CBT); 5) Unhelpful IAPT processes (e.g. difficulties with outcome measures and assessments); and 6) Consequences of unhelpful treatment (e.g. not addressing core underlying issues and clients feeling worse).
Conclusions/Implications (including practice implications):The findings indicate that all practitioners should consider unhelpful factors in therapy, as they have potentially detrimental effects on clients' outcomes. Additionally, this research found that therapeutic interventions need to be tailored to clients' goals, internal patterns and preferences. Importantly, it was found that unhelpful factors extend to health and psychosocial issues which should be addressed prior to therapy.
K E Y W O R D SCBT, IAPT, unhelpful factors, clients in deprived area
Aims and method This article presents a 12-month case series to determine the fraction of ward referrals of adults of working age who needed a liaison psychiatrist in a busy tertiary referral teaching hospital.Results The service received 344 referrals resulting in 1259 face-to-face contacts. Depression accounted for the most face-to-face contacts. We deemed the involvement of a liaison psychiatrist necessary in 241 (70.1%) referrals, with medication management as the most common reason.Clinical implications A substantial amount of liaison ward work involves the treatment and management of severe and complex mental health problems. Our analysis suggests that in the majority of cases the input of a liaison psychiatrist is required.
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