Opening the ‘black box’: liaison psychiatry services and what they actually do

Abstract

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.

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

“…Other clinical problem areas were shared equally between both professions, but nurses were more likely to provide sign-posting and advice than doctors, which may reflect their role in seeing less complex patients than doctors, and their greater presence in ED as opposed to ward work. Our findings support previous work suggesting that doctors are an essential component of a general hospital LP services, with their input being particularly required in ward-based liaison work [38] due to the complex interplay between physical and mental health problems in patients who present to liaison services [16]. A recent systematic review also found that medical input also improves quality of care in ED settings [18] .…”

“…Comparatively, ward work was much more likely to involve dealing with patients with co-morbid physical and mental health problems, including psychological adjustment to physical illness, medication management and interventions for people with medically unexplained symptoms. Becker and colleagues also found that medication management was more common in a ward setting [21], and a previous publication has also described the complexity of ward work and the challenging nature of delivering mental health care in the general hospital setting [16]. The distribution of the different interventions in that previous publication [16] were very similar to that in the current study (e.g.…”

“…The following information was collected: background and setting (e.g. ED, ward) of the person who referred to the LP team; health profession of LP team member who had contact with the patient; reason for referral (problems of adjustment to illness; medically unexplained symptoms; overt psychiatric/psychological symptoms in the presence of physical illness; cognitive impairment; self-harm; acute behavioural disturbance; alcohol or substance misuse; and/ or other problem), first or repeated contact; type of liaison intervention was determined using pre-defined categories [16] (assessment diagnosis and formulation; providing advice/signposting; management of risk; Mental Health Act Assessment or assessment of capacity; medication management; management of disturbed behaviour; other kind of intervention); use of standardised assessment measures; and whether the person was referred on to other services.…”

“…More widely, there is evidence of a range of other positive outcomes of liaison psychiatry services, including better access to mental healthcare for patients in acute settings and patient and referrer satisfaction [12][13][14][15]. However only a small number of evaluations providing data on the nature of clinical work [16], by whom it was provided and any evidence of clinical outcome [17]. The evidence base is small and mainly based upon local service evaluation, and further larger-scale evaluations are required [12,18].…”

“…The Royal College of Psychiatrists recommends that all LP services use the framework to improve the recording of clinical data, with a caveat that there are inherent problems in assessing clinical outcomes in LP services due to contact with most patients being a single, brief, consultation for complex, persistent problems. Three studies have used similar frameworks to FROM-LP to describe the type of interventions delivered by LPs [16,21,24]. However, it remains unclear whether such measures are used routinely by many services, and if so for which clinical or organisational outcomes.…”