Article Text

Download PDFPDF

Organisation and delivery of liaison psychiatry services in general hospitals in England: results of a national survey
  1. Andrew Walker1,
  2. Jessica Rose Barrett2,
  3. William Lee3,
  4. Robert M West4,
  5. Elspeth Guthrie4,
  6. Peter Trigwell5,
  7. Alan Quirk6,
  8. Mike J Crawford6,7,
  9. Allan House4
  1. 1 Clinical Research Network National Coordinating Centre, National Institute of Health Research Clinical Research Network, Leeds, UK
  2. 2 National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
  3. 3 Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
  4. 4 Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  5. 5 National Inpatient Centre for Psychological Medicine, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
  6. 6 College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
  7. 7 Centre for Psychiatry, Department of Medicine, Imperial College London, London, UK
  1. Correspondence to Dr Elspeth Guthrie; e.a.guthrie{at}leeds.ac.uk

Abstract

Objectives To describe the current provision of hospital-based liaison psychiatry services in England, and to determine different models of liaison service that are currently operating in England.

Design Cross-sectional observational study comprising an electronic survey followed by targeted telephone interviews.

Setting All 179 acute hospitals with an emergency department in England.

Participants 168 hospitals that had a liaison psychiatry service completed an electronic survey. Telephone interviews were conducted for 57 hospitals that reported specialist liaison services additional to provision for acute care.

Measures Data included the location, service structures and staffing, working practices, relations with other mental health service providers, policies such as response times and funding. Model 2-based clustering was used to characterise the services. Telephone interviews identified the range of additional liaison psychiatry services provided.

Results Most hospitals (141, 79%) reported a 7-day service responding to acute referrals from the emergency department and wards. However, under half of hospitals had 24 hours access to the service (78, 44%). One-third of hospitals (57, 32%) provided non-acute liaison work including outpatient clinics and links to specialist hospital services. 156 hospitals (87%) had a multidisciplinary service including a psychiatrist and mental health nurses. We derived a four-cluster model of liaison psychiatry using variables resulting from the electronic survey; the salient features of clusters were staffing numbers, especially nursing; provision of rapid response 24 hours 7-day acute services; offering outpatient and other non-acute work, and containing age-specific teams for older adults.

Conclusions This is the most comprehensive study to date of liaison psychiatry in England and demonstrates the wide availability of such services nationally. Although all services provide an acute assessment function, there is no uniformity about hours of coverage or expectation of response times. Most services were better characterised by the model we developed than by current classification systems for liaison psychiatry.

  • mental health
  • consultation-liaison
  • liaison psychiatry
  • hospital psychiatry
  • health services research

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors AH, MJC, EG and PT conceived of the research. JRB and WL carried out the survey. AAW coordinated the telephone interviews. RMW carried out the statistical analysis. AQ and all other authors contributed to the manuscript and approved the final version.

  • Funding The present study arises from two funding initiatives: a national survey of staffing and structure in liaison psychiatry services in acute hospitals completed on behalf of the Royal College of Psychiatrists and the National Collaborating Centre for Mental Health commissioned by NHS England (Liaison Psychiatry Survey of England 2015, LPSE 2015) and a research study funded by the UK’s National Institute for Health Research HS&DR programme to evaluate the effectiveness and cost- effectiveness of liaison psychiatry services (LP-MAESTRO project number 13/58/08).

  • Disclaimer The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR, NIHR, NHS or the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval NHS Ethical permission (REC reference: 15/NS/0025) and Trust level approval was obtained for the telephone interviews.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Survey data are available from the author WL.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.